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Alcohol-induced Liver Disease with Case

by Kelley Chuang, MD

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    00:00 Let's begin our next case.

    00:03 A 67-year-old woman is seen in clinic for a routine visit.

    00:07 She feels well, her only past medical history is hypertension.

    00:11 She drinks 6 cans of beer per night.

    00:15 She recently traveled to Mexico but has not had any diarrhea.

    00:19 Her vitals are normal.

    00:20 She has mild hepatomegaly on physical exam.

    00:24 Lab studies are shown here: So her ALT is 85 (U/L), AST is 180 (U/L) and her bilirubin is 0.8 (mg/dL).

    00:32 What is the most likely diagnosis? So let's point out that she has an alcohol use disorder.

    00:40 She has recent travel to Mexico which does raise some suspicion for hepatitis A or E but notably, she has no symptoms of either of these diseases.

    00:51 And she has this AST to ALT ratio of greater than 2 to 1.

    00:57 We'll discuss what that means in a bit.

    01:01 So, let's talk now about alcohol-induced liver disease.

    01:05 In general, this is just inflammation of the liver caused by alcohol.

    01:10 Patients often have a serum AST and ALT elevation of 2 to 6 times the upper limit of normal.

    01:19 The typical ratio is an AST to ALT ratio of 2 to 1 or greater.

    01:26 Patients may be either asymptomatic with just fatty liver or they may be symptomatic and develop alcoholic hepatitis.

    01:34 So here on the right you can see the natural progression of this disease.

    01:38 You begin with a normal liver.

    01:40 With recurrent alcohol use, you develop fatty liver or steatosis With ongoing use, you can develop inflammation, so steatohepatitis.

    01:49 This can then progress to fibrosis, cirrhosis and lastly, the dreaded hepatocellular carcinoma.

    01:58 So, patients with this disease may present with jaundice, a loss of appetite or anorexia and they may also have tender hepatomegaly.

    02:08 The treatment depends on the severity of their disease.

    02:12 So if it is mild, you just do supportive care and counsel them to remain abstinent from alcohol.

    02:19 If their disease is moderate to severe with inflammation, you could consider prednisone.

    02:27 So, let's return to our case.

    02:30 We have a 67-year-old woman with an alcohol use disorder, a recent travel to Mexico but no symptoms of hepatitis A or E and she has an AST to ALT ratio of greater than 2 to 1 and both of these tests are somewhat abnormal within the 2 to 6 times the upper limit of normal.

    02:49 So this ratio with our clinical picture should prompt you to think of alcoholic liver disease.

    02:55 She is asymptomatic so she likely just has alcoholic steatohepatitis and she should be counseled for her alcohol use disorder.


    About the Lecture

    The lecture Alcohol-induced Liver Disease with Case by Kelley Chuang, MD is from the course Disorders of the Hepatobiliary Tract (Quiz Coming Soon).


    Included Quiz Questions

    1. Prednisone
    2. Supportive care
    3. Penicillamine
    4. Lactulose
    5. Azathioprine
    1. > 2:1
    2. < 2:1
    3. 1:1
    4. >1:2
    5. 2:3

    Author of lecture Alcohol-induced Liver Disease with Case

     Kelley Chuang, MD

    Kelley Chuang, MD


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