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Harrison's Principles of Internal Medicine, 18e
| Part 14. Disorders of the Gastrointestinal System > Section 2. Liver and Biliary Tract Disease > |
Chapter 307. Alcoholic Liver Disease
Sections: Alcoholic Liver Disease: Introduction, Further Readings.
Topics Discussed: alcoholic liver diseases; liver disease, drug-induced; substance-related disorders: alcohol, nicotine, and caffeine; toxic responses of the liver.
Excerpt:"Chronic and excessive alcohol ingestion is one of the major causes of liver disease. Per capita, alcohol consumption and cirrhosis have risen in the last decade in United Kingdom and Russia but has decreased in many developed countries including the United States. The pathology of alcoholic liver disease consists of three major lesions, with the injury rarely existing in a pure form: (1) fatty liver, (2) alcoholic hepatitis, and (3) cirrhosis. Fatty liver is present in >90% of binge and chronic drinkers. A much smaller percentage of heavy drinkers will progress to alcoholic hepatitis, thought to be a precursor to cirrhosis. The prognosis of severe alcoholic liver disease is dismal; the mortality of patients with alcoholic hepatitis concurrent with cirrhosis is nearly 60% at 4 years. Although alcohol is considered a direct hepatotoxin, only between 10 and 20% of alcoholics will develop alcoholic hepatitis. The explanation for this apparent paradox is unclear but involves the complex interaction of facilitating factors, such as intake frequency, diet, and gender.Quantity and duration of alcohol intake are the most important risk factors involved in the development of alcoholic liver disease (Table 307-1). The roles of beverage type(s), i.e. wine, beer, or spirits,..."
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