alcoholic%20liver%20disease
ALCOHOLIC LIVER DISEASE
Alcoholic liver disease diagnosis is suggested by an established history of habitual alcohol intake of sufficient length and intensity.
Toxic daily threshold of alcohol consumption is 40-80 g for males and 20-40 g for females for 10-12 years.
Signs of alcohol abuse and hepatic injury include malnutrition and muscle wasting, cutaneous telangiectasia, palmar erythema, finger clubbing, Dupuytren's contracture, peripheral neuropathy, parotid gland enlargement and signs of gynecomastia and hypogonadism may also be present.

Lifestyle Modification

Abstinence from Alcohol

  • Cornerstone of long-term management of alcoholic liver disease (ALD)
  • Patient should be strongly encouraged to abstain or greatly reduce alcohol intake, particularly obese or chronic hepatitis C virus patients
  • Educate the patient regarding the nature of the disease and the benefit of discontinuing alcohol intake
    • Abstinence or marked reduction in alcohol intake has been shown to improve histology and/or survival in all stages of ALD
      • Abstinence can cause total resolution of alcoholic steatosis
  • Assistance should be given to the patient to help them change their behavior
    • Alcohol relapse may be effectively reduced by motivational interventions, eg cognitive behavioral therapy
  • Patient may require consultation with a psychiatrist or addiction specialist
  • Naltrexone or Acamprosate may help decrease risk of relapse in patients with alcohol abuse or dependence who have achieved abstinence and have no advanced ALD
  • Baclofen is used in patients with moderate alcohol withdrawal symptoms and to prevent alcohol relapse in patients with advanced ALD
  • Benzodiazepines are used in patients with severe alcohol withdrawal syndrome and ALD

Other Lifestyle Modifications

Smoking Cessation

  • Smoking may increase rate of progression of fibrosis in ALD
  • Patients should be encouraged to stop smoking

Obese Patients

  • Body mass index (BMI) has been shown to be an independent risk factor for ALD development
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