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Alcoholic Liver Disease in
Pregnancy
Dr Nasir Khokhar MD FACP FACG
Prof of Medicine and Gastroenterology
Shifa Internation...
Alcohol effect on fetus brain
Effects on Fetus
Alcohol effects
Women with ALD were generally of higher age and body mass
index, more likely to smoke cigarettes during pregnancy and to
h...
Alcohol and liver
Clinical Presentations
Fatty liver Normal liver
Alcohol and HCV
Liver problems in pregnancy
Liver disease in pregnancy
Clinical Manifestations
Pathogenesis
Role of mitochondria
Mitochondrial Dysfunction
Role of mitochondria
Alcohol induced liver disease
Alcohol induced liver disease
Effects of acetaldehyde
Immunologic aspects
Treatment
Treatment of Fatty liver
Illness severity and risk of poor
outcome in alcoholic hepatitis
• Maddrey discriminant function (MDF): based
on PT and bi...
Treatment of Acute Alcoholic Hepatitis
With Prednisolone ± N-Acetyl Cysteine
Nguyen-Khac E, et al. AASLD 2009. Abstract 91...
Management of alcoholic hepatitis
Management of cirrhosis and its
complications
• Portal Hypertension: Variceal
bleeding, Ascites, Hepato renal
syndrome, Sp...
In pregnancy, Not this drink
But this drink
Thanks
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
Alcoholic liver disease in Pregnancy
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Alcoholic liver disease in Pregnancy

  1. 1. Alcoholic Liver Disease in Pregnancy Dr Nasir Khokhar MD FACP FACG Prof of Medicine and Gastroenterology Shifa International Islamabad
  2. 2. Alcohol effect on fetus brain
  3. 3. Effects on Fetus
  4. 4. Alcohol effects
  5. 5. Women with ALD were generally of higher age and body mass index, more likely to smoke cigarettes during pregnancy and to have a low socio-economic status. They had an increased risk of very preterm birth. Infants of were at increased risk for low Apgar scores (<7) at 5 min. Similar associations with slightly lower-risk estimates were found among women diagnosed with ALD after birth. Mothers with Alcoholic Liver Disease and the Risk for Preterm and Small-for- gestational-age Birth. Alcohol and Alcoholism 2013;48:166–171. Pregnancy, Alcohol and fetus
  6. 6. Alcohol and liver
  7. 7. Clinical Presentations
  8. 8. Fatty liver Normal liver
  9. 9. Alcohol and HCV
  10. 10. Liver problems in pregnancy
  11. 11. Liver disease in pregnancy
  12. 12. Clinical Manifestations
  13. 13. Pathogenesis
  14. 14. Role of mitochondria
  15. 15. Mitochondrial Dysfunction
  16. 16. Role of mitochondria
  17. 17. Alcohol induced liver disease
  18. 18. Alcohol induced liver disease
  19. 19. Effects of acetaldehyde
  20. 20. Immunologic aspects
  21. 21. Treatment
  22. 22. Treatment of Fatty liver
  23. 23. Illness severity and risk of poor outcome in alcoholic hepatitis • Maddrey discriminant function (MDF): based on PT and bilirubin: greater than 32 indicate severe disease; 30-day mortality approximately 50% • Combined Clinical and Laboratory Index • Model for end-stage liver disease (MELD) score • Glasgow alcoholic hepatitis score (GAHS) • Asymmetric dimethylarginine (ADMA) score
  24. 24. Treatment of Acute Alcoholic Hepatitis With Prednisolone ± N-Acetyl Cysteine Nguyen-Khac E, et al. AASLD 2009. Abstract 91. Prednisolone 40 mg/day for 28 days + NAC IV on Days 1-5* (n = 85) Prednisolone 40 mg/day for 28 days + 5% Glucose (Carrier) IV on Days 1-5 (n = 89) Pts with acute alcoholic hepatitis (N = 174) Follow-up: Mos 1, 2, 3, 6 Stratified by center *Day 1 NAC: 150 mg/kg in 250 mL 5% glucose over 15 mins; 50 mg/kg in 500 mL 5% glucose over 4 hrs; 100 mg/kg in 1000 mL 5% glucose over 16 hrs. Days 2-5 NAC: 100 mg/kg in 1000 mL 5% glucose. Mortality, % Prednisolone + NAC (n = 85) Prednisolone + Carrier (n = 89) P Value Mo 6 (primary endpoint) 27.1 38.2 .117 Mo 1 8.2 23.6 .005 Mo 2 15.3 32.6 .007 Mo 3 22.4 33.7 .095 N Engl J Med 2011;365:1781-9.
  25. 25. Management of alcoholic hepatitis
  26. 26. Management of cirrhosis and its complications • Portal Hypertension: Variceal bleeding, Ascites, Hepato renal syndrome, Spontaneous Bacterial Peritonitis • Hepato cellular failure: Hepatic encephalopathy • Hepato cellular carcinoma
  27. 27. In pregnancy, Not this drink
  28. 28. But this drink
  29. 29. Thanks
  • winnaing7923

    Mar. 24, 2015

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