A patient arrives from the emergency department.
The patient could not walk by himself, and the family members pushed him over with a wheelchair.
The patient’s complexion is dark, and it looks like a typical liver disease face. This kind of face is caused by the patient’s liver damage, endocrine dysfunction, affecting pigment metabolism and causing pigment deposition in the skin. .
Take a closer look at the patient. The abdomen is swollen like a drum, and the lower limbs are swollen like bread. It is a pit that cannot be recovered for a long time.
The patient’s diagnosis was clear, decompensated cirrhosis, ascites, and lower extremity edema were all associated with reduced albumin levels.
The patient’s medical history was inquired, and the patient did not have chronic liver diseases such as hepatitis B and C.
Only, chronic heavy drinking.
I asked my family how many times a week and how much?
The answer I got was basically every day, every day, often a dozen bottles of beer at a time.
The diagnosis of this person can be clear, the liver function decompensation stage of alcoholic cirrhosis.
Then some people will ask, how can drinking alcohol cause such serious liver disease?
My answer is not only yes, but decompensated cirrhosis due to alcohol consumption is common.
How does alcohol damage the liver?
Alcohol will be metabolized into acetaldehyde in the body, which can combine with protein molecules in liver cells, causing liver metabolic disorders;
Causes the decrease of glutathione in hepatocytes, leading to necrosis of hepatocytes;
Producing too many free radicals will cause damage to cell membrane lipid peroxidation, affecting mitochondrial function, and lipid deposition in hepatocytes;
Activation of hepatic stellate cells and proliferation of fibrotic tissue.
Alcohol also increases various pro-inflammatory factors and promotes fibrosis.
What are the clinical manifestations of alcoholic liver disease?
Typical clinical manifestations are jaundice, anorexia, fever, and hepatomegaly with tenderness.
Laboratory tests show moderately elevated transaminases (usually <300 IU/L) and an AST/ALT ratio ≥2. Patients may also present with right upper quadrant/median epigastric pain, hepatic encephalopathy, and signs of malnutrition.
Patient signs and symptoms
Common signs and symptoms of alcoholic hepatitis include:
● Jaundice within 3 months prior to presentation.
Fever due to alcoholic hepatitis should only be considered if other causes of fever, including spontaneous bacterial peritonitis, pneumonia, and urinary tract infection, have been ruled out.
• Pain in the right upper quadrant/median epigastrium, which may be severe enough to resemble an acute abdomen.
● Abdominal distention due to ascites.
•Proximal muscle weakness due to muscle atrophy.
Patients with severe alcoholic hepatitis and/or underlying cirrhosis may have signs of hepatic encephalopathy.
Dangers of drinking alcohol in patients with liver disease?
1. Hepatitis B (cirrhosis)
Drinking alcohol increases the surface antigen level of HBV in the human body and delays the clearance of HBV. In patients with HBV-related cirrhosis, alcohol consumption is associated with an increased risk of liver fibrosis progression and hepatocellular carcinoma. Correspondingly, in patients with alcoholic liver disease, the presence of HBV infection is associated with the occurrence of hepatocellular carcinoma and liver-related death.
2. Hepatitis C (cirrhosis)
Because the interaction between alcohol consumption and HCV affects immune responses, cytotoxicity, and oxidative stress, alcohol consumption is associated with longer-lasting HCV infection and more extensive liver damage. Alcohol consumption affects HCV viral replication in certain patient subgroups, alcohol consumption also promotes fibrosis progression, and alcohol consumption is also associated with longer length of stay and higher in-hospital mortality.
3. Non-alcoholic fatty liver disease
obese heavy drinkers were significantly more likely to have abnormal liver function test results and liver steatosis than non-obese heavy drinkers.
4. Acute-on-chronic liver failure
Alcohol consumption is one of the most common causes of acute decompensation in patients with chronic liver disease, known as acute-on-chronic liver failure, and is associated with organ failure and short-term death.