1. Alcoholic Liver
Disease
Lecture 24
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Excessive alcohol (ethanol)
consumption is the leading cause of
liver disease in most
Western countries.
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3. Forms of alcoholic liver disease
(1)Hepatic steatosis (fatty liver
disease)
(2) Alcoholic hepatitis
(3) Cirrhosis.
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4. Fatty Liver /Steatosis
Definition:
• Fatty liver is the collection of excessive
amounts of triglycerides and other
fats inside liver cells.
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5. Description
• The liver is the organ responsible for changing
fats eaten in the diet to types of fat that can
be stored and used by the body.
• Triglycerides are one of the forms of fat
stored by the body and used for energy and
new cell formation.
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6. The break down of fats in the liver can be disrupted
by
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7. Morphology of
1.Hepatic Steatosis (Fatty Liver).
After even moderate intake of alcohol,
microvesicular lipid droplets
accumulate in hepatocytes.
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1.Hepatic Steatosis (Fatty Liver).
After even moderate intake of alcohol,
microvesicular lipid droplets
accumulate in hepatocytes.

8. With chronic intake of alcohol, lipid
accumulates creating
that compress and displace the hepatocyte
nucleus to the periphery of the cell.
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10. The normal adult liver weighs 1400 -1600 gm
Macroscopically, the fatty liver of chronic
alcoholism is a large (as heavy as 4 to 6
kg), soft organ that is yellow and greasy.
The fatty change is completely reversible if there is
abstention from further intake of alcohol.
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11. Morphology 2. Alcoholic Hepatitis (Alcoholic Steatohepatitis).
Alcoholic hepatitis is characterized by:
1. Hepatocyte swelling and necrosis
2. Mallory bodies:
Mallory bodies are visible as eosinophilic cytoplasmic clumps in hepatocytes.
3. Neutrophilic reaction
4. Fibrosis
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12. ETHANOL 12
American Pathologist

13. Mallory Bodies
Large, poorly defined accumulations of
eosinophilic material in the cytoplasm of
damaged hepatic cells in certain forms of
cirrhosis especially those due to alcoholism.
• Synonym(s): alcoholic hyalin, alcoholic hyaline
bodies
Mallory body, Mallory-Denk body, and
Mallory's hyaline
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14. ETHANOL 14Mallory body with the characteristic twisted-rope appearance (centre of image - within
a ballooning hepatocyte). H&E stain

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20. Alcoholic cirrhosis. A, The characteristic diffuse nodularity of the surface reflects the
processes of nodular regeneration and scarring. The greenish tint of some nodules is
due to bile stasis. A hepatocellular carcinoma is present as a budding mass at the
lower edge of the right lobe (lower left).
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21. B, The microscopic view shows nodules of varying sizes entrapped in blue-staining
fibrous tissue. The liver capsule is at the top (Masson trichrome).
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22. Alcoholic liver disease. The interrelationships among hepatic steatosis,
hepatitis, and cirrhosis are shown, depicting key morphologic
features.
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23. Pathogenesis.
• Short-term ingestion of as much as 80 gm of
alcohol over one to several days generally
produces mild, reversible hepatic
steatosis.
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24. • Daily intake of 80 gm or more of ethanol
generates significant risk for severe hepatic
injury, and daily ingestion of 160 gm or more
for 10 to 20 years is associated more
consistently with severe injury.
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25. • Only 10% to 15% of alcoholics, however,
develop cirrhosis.
• Thus, other factors must also influence the
development and severity of alcoholic liver
disease.
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26. Factors other than alcohol
1. Gender. Women
2. Ethnic differences
3. Genetic factors
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27. Hepatocellular steatosis results from
(1) shunting of normal substrates away from
catabolism and toward lipid biosynthesis
(2) impaired assembly and secretion of
lipoproteins;
(3) increased peripheral catabolism of fat.
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28. Clinical Features
• 1.Hepatic steatosis (fatty
liver):
Hepatomegaly,
• with mild elevation of serum bilirubin and
alkaline phosphatase levels.
• Severe hepatic dysfunction is unusual.
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29. Treatment
• Alcohol withdrawal and
• the provision of an adequate dietare
sufficient treatment.
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30. 2. Alcoholic hepatitis
tends to appear acutely, usually following a
bout of heavy drinking.
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31. Clinical features of Alcoholic Hepatitis
1. Malaise,
2. Anorexia,
3. Weight loss,
4. Upper abdominal discomfort,
5. Tender hepatomegaly,
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32. Laboratory findings:
hyperbilirubinemia,
elevated alkaline phosphatase,
neutrophilic leukocytosis.
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33. • An acute cholestatic syndrome may appear,
resembling large bile duct obstruction.
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34. • The outlook is unpredictable; each bout of
hepatitis incurs about a 10% to 20% risk of
death.
• With repeated bouts, cirrhosis appears in
about one third of patients within a few
years.
• Alcoholic hepatitis also may be
superimposed on established cirrhosis.
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35. • With proper nutrition and total cessation of
alcohol consumption, the alcoholic hepatitis
may clear slowly.
• However, in some patients, the
hepatitis persists, despite
abstinence, and progresses to cirrhosis.
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36. Laboratory findings:
• Elevated serum aminotransferase,
• Hyperbilirubinemia,
• Elevation of serum alkaline phosphatase,
• Hypoproteinemia,
• Anemia.
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SGOT, SGPT
Cholestasis
Diagnosis

37. • In some instances, liver biopsy may be
indicated, since in about 10% to 20% of cases
of presumed alcoholic cirrhosis, another
disease process is found.
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38. Silent Cirrhosis
• Finally, cirrhosis may be clinically silent,
discovered only at autopsy or
• when stress such as infection or trauma tips
the balance toward hepatic insufficiency.
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39. Prognosis
• Five-year survival approaches 90% in
abstainers who are free of jaundice, ascites,
or hematemesis;
• it drops to 50% to 60% in those who
continue to imbibe.
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40. In the end-stage alcoholic the proximate causes of death are
(1) hepatic coma,
(2) massive gastrointestinal hemorrhage,
(3) intercurrent infection
(4) hepatorenal syndrome
(5) hepatocellular carcinoma
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41. Summary
• Alcoholic liver disease is a chronic disorder
featuring steatosis, hepatitis, progressive
fibrosis, cirrhosis, and marked derangement
of vascular perfusion.
• It can be regarded as a maladaptive state in
which cells in the liver respond in an
increasingly pathologic manner to a stimulus
(alcohol) that originally was only marginally
harmful.
• For some unknown reason, cirrhosis
develops in only a small fraction of chronic
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42. Drug- and Toxin-
Induced Liver
Disease
The drugs and toxins
which cause hepatic
injury along with their
specific effects.
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