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Alcoholic Liver Disease

Alcoholic liver disease This is the commonest liver disease in India. It is caused by excessive consumption of alcohol generally beyond safe dose. It is a preventable disease. The three primary types of alcohol-induced liver injuries are fatty liver, alcoholic hepatitis and liver cirrhosis. Epidemiology:- Ninety to ninety-five percent of people with chronic alcohol consumption develop fatty liver. In almost all instances, this lesion is thought to be reversible on cessation of alcohol intake.

A minority of individuals goes on to perivenular sclerosis (collagen deposition in and around central veins). Ten to thirty-five percent of chronic alcoholics, however, have acute liver injury that may become recurrent or chronic. Some of these patients recover, but others go on to sinusoidal, perivenular, and pericentral fibrosis and cirrhosis. Even during the inflammatory stage without the presence of cirrhosis, patients may have portal hypertension, ascites, and esophageal varices. The association of alcohol abuse and liver damage has been known since the time of the ancient Greeks. The availability of alcoholic beverages, licensing laws, and economic, cultural, and environmental conditions all influence both per capita alcohol consumption and mortality from alcohol- related liver disease. Alcoholism is, in part, inherited, and aberrant alcohol-drinking behavior is genetically influenced.

The risk factors that may affect the susceptibility to development of alcoholic liver disease include genetic factors, malnutrition, female gender, and viral agents (hepatitis virus B, C, and D). Relation of cirrhosis to alcohol consumption. The alcohol content of various beverages is shown in Table -1. The development of alcoholic cirrhosis correlates with the quantity and duration of alcohol consumption. For men, the relative risk of cirrhosis has been estimated to be six times greater when consumption is 40 to 60 g of alcohol per day than when it is up to 20 g per day, and 14 times greater at 60 to 80 g per day.

The average cirrhogenic dose has been calculated to be 40 to 80 g of ethanol per day consumed for approximately 10 to 12 years. In a case-controlled study in men, the relative risk for cirrhosis was 1.83 for men consuming 40 to 60 g of absolute alcohol per day compared to men consuming less than 40 g per day. The relative risk rose to 100 for men consuming more than 80 g per day. The average cirrhogenic and threshold doses are lower in women than in men. There is no valid epidemiologic or clinical evidence to suggest that drinking habits (continuous vs. periodic) and the type of alcoholic beverage influence mortality from cirrhosis.

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