Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

92 Alcoholic Liver Disease (ALD)

■Abstinence from alcohol:

➣Counseling, alcohol rehabilitation, &/or naltrexone

➣Indication: reduce risk of relapse, improve long-term prognosis

■Naltrexone:

➣Side effects: opiate withdrawal, nausea, vomiting, abdominal

cramps, anxiety, headache, insomnia, nervousness, arthralgia

➣Contraindications: w/ caution in pts w/ hepatic or renal impair-

ment, liver failure, opiate use

follow-up

During Treatment

■Monitor for alcohol withdrawal, infection, GI bleed, renal insuffi-

ciency, glucose intolerance, side effects of therapy, progression of

liver disease

■LFT, CBC, PT, electrolytes regularly

Routine

■Alpha-fetoprotein & abdominal US q 6–12 mo in alcoholic cirrhosis

(survival benefit of screening still uncertain)

complications and prognosis

Complications

■Steatosis: 90–100% of all heavy drinkers, reversible w/ abstinence

■Steatohepatitis: 10–35% of heavy drinkers:

■10–20%/y progress to cirrhosis, 24–68% w/ continued alcohol abuse

■Not completely reversible, can progress despite abstinence

■Cirrhosis: 8–20% of heavy drinkers, more than 8X increased risk w/

chronic HCV infection,=10–20%/y of alcoholic hepatitis progress

to cirrhosis

■HCC: increased risk w/ HCV coinfection

Prognosis

■Average survival of ALD: 80% 1 y, 50% 5 y

■Continued alcohol consumption (single most important risk factor

for progression of liver disease)

■Severe alcoholic hepatitis: >50% mortality during hospitalization

(corticosteroids reduce mortality risk∼25%)

■4–5 y survival rate:

■Fatty liver alone: 70–80%

■Alcoholic hepatitis or cirrhosis w/o hepatitis: 50–75%

■Cirrhosis w/ hepatitis: 30–50%

■Cirrhosis: 40–48% if continued alcohol use, 60–77% if stopped