Alcoholic liver disease

1. Big picture

Alcoholic liver disease, now often called alcohol-associated liver disease (ALD), is a spectrum of alcohol-related liver injury:

Alcohol-related steatosis
        ↓
Alcohol-associated steatohepatitis / alcoholic hepatitis
        ↓
Fibrosis
        ↓
Cirrhosis
        ↓
Decompensation and hepatocellular carcinoma

The exam usually focuses on three patterns:

1. Fatty liver: asymptomatic hepatomegaly, reversible with abstinence.
2. Alcoholic hepatitis: recent heavy alcohol intake + jaundice + fever + tender hepatomegaly + leukocytosis + high bilirubin/INR.
3. Alcoholic cirrhosis: portal hypertension, ascites, varices, encephalopathy, coagulopathy, hepatocellular carcinoma risk.

AASLD describes ALD as a spectrum from hepatic steatosis to alcoholic hepatitis, alcohol-associated cirrhosis, and acute-on-chronic liver failure; progression depends on continued heavy alcohol use and risk factors such as female sex, genetics, diet, and comorbid liver disease. ([aasld.org][1])

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