tic procedures might include abdominal ULTRA-
SOUND, COMPUTED TOMOGRAPHY(CT) SCAN, or PERCU-
TANEOUS LIVER BIOPSY.
Treatment Options and Outlook
Treatment is alcohol cessation and support for
symptoms. The doctor may recommend an alcohol
and SUBSTANCE ABUSE TREATMENT PROGRAM, counsel-
ing, 12-step program such as Alcoholics Anony-
mous, and other efforts to help maintain SOBRIETY.
When liver disease of alcoholism reaches end-
stage LIVER FAILURE, LIVER TRANSPLANTATIONmay be
an option for a person who has maintained sobri-
ety for at least six months and has a reasonable
expectation of doing so following the liver trans-
plantation. Though liver disease of alcoholism
continues if alcohol consumption resumes, with
alcohol abstinence the manifestations of liver dis-
ease are generally reversible (except cirrhosis).
Risk Factors and Preventive Measures
Chronic alcohol use is the only cause of liver dis-
ease of alcoholism. Though most often the use is
excessive, alcohol-related damage can occur to the
liver with moderate alcohol consumption that
extends over a long period of time. Alcoholic
steatohepatitis can develop in a person who con-
sumes as few as four alcoholic drinks a week. The
only, and absolute, preventive measure is absti-
nence from alcohol.
See also ENCEPHALOPATHY; HEPATOTOXINS.
liver failure The inability of the LIVERto func-
tion. Liver failure may be acute (comes on sud-
denly) or chronic (develops over time). Because
the liver has the unique ability to regenerate, the
damage it takes to cause liver failure is substantial.
Liver failure generally occurs when more than 75
percent of the liver’s hepatocytes, the cells that
carry out most of the liver’s functions, die, a cir-
cumstance called hepatocellular necrosis. LIVER
TRANSPLANTATIONis the only curative treatment for
permanent liver failure.
The most common causes of hepatocellular
necrosis leading to liver failure are
- ALCOHOL
- acetaminophen and especially acetaminophen
OVERDOSE- Amanitamushroom ingestion
- the illicit DRUGecstasy (MDMA)
- isoniazid and rifampin in combination to treat
TUBERCULOSIS- industrial chemicals such as arsenic, phospho-
rus, carbon tetrachloride, and vinyl chloride - disease processes
- industrial chemicals such as arsenic, phospho-
Hepatocellular necrosis is a SIDE EFFECTpossible
with numerous prescription medications, notably
certain ANTIBIOTIC MEDICATIONS, “statin” lipid-lower-
ing medications, and tricyclic ANTIDEPRESSANT MED-
ICATIONS. In some circumstances prompt medical
intervention, such as with known overdose of
drugs, can slow or halt hepatocellular necrosis and
prevent liver failure, though liver damage may
still occur. Such interventions might include
aggressive medical efforts to remove or neutralize
the responsible drug, administration of acetylcys-
teine for acetaminophen overdose, and liver
hemodialysis (though this is of limited availabil-
ity). In many circumstances, however, the
destructive action of the toxin or the inflamma-
tory process overwhelms the liver and attempted
medical interventions have little effect.CONDITIONS THAT CAN CAUSE LIVER FAILURE
BILIARY ATRESIA chronic HEPATITIS
CIRRHOSIS HEAT STROKE
HEMATOCHROMATOSIS HEMORRHAGIC FEVER
LIVER CANCER LIVER DISEASE OF ALCOHOLISM
PORTAL HYPERTENSION PRIMARY BILIARY CIRRHOSIS
PRIMARY SCLEROSING CHOLANGITIS REYE’S SYNDROME
secondary AMYLOIDOSIS WILSON’S DISEASEAcute liver failure Acute liver failure, also
called fulminant HEPATITIS, develops in days to
weeks. It nearly always follows a significant
assault to the liver, such as drug overdose or
severe trauma (such as gunshot wound) that
destroys liver tissue. Hepatitis A INFECTIONalso can
cause acute liver failure. Recovery without liver
transplantation is uncommon and is most likely to
occur with hepatitis A infection (about 50 percent
recovery rate) and promptly treated acetamino-
phen toxicity.
Chronic liver failure Chronic liver failure, also
called nonfulminant hepatitis, develops over72 The Gastrointestinal System