Percutaneous liver biopsy with or without ultrasonic guidance

•standard diagnostic approach for establishing the presence of chronic hepatitis

•Laparoscopic liver biopsy, which is used in large referral centers, has the advantage of minimizing the sample error by facilitating gross inspection of the liver and thus ensuring an adequate biopsy sample size.

Alcoholic hepatitis: liver biopsy

•Major features found include

–marked variation in cell size

–evidence of cell necrosis and variable inflammation with a mixture of polymorphonuclear and mononuclear cell

–there is evidence of variable sinusoidal compression

–pericellular fibrosis is an important feature

–In many pts eosinophilic inclusions (Mallory bodies) are found

–Often the most intense alcoholic-induced injury is in Zone III (centrilobular)

Treatment of severe alcoholic hepatitis

•Administration of prednisolone in moderately large doses may be helpful in patients with encephalopathy

•However, the use of glucocorticoids in acute alcoholic hepatitis remains controversial and should probably be reserved

•Maintenance therapy with colchicine (0.6 mg PO bid) has been shown to slow disease progression and increase longevity of the patient with alcoholic liver disease in one long-term study.

Причины смерти при алкогольном гепатите

Alcoholic cirrhosis

•The typical alcoholic patient with cirrhosis has had a daily consumption of a pint or more of whiskey, several quarts of wine, or an equivalent amount of beer for at least 10 years.

•The amount and duration of ethanol ingestion, rather than the type of alcoholic beverage or the pattern of ingestion, appear to be the important determinants

Alcoholic cirrhosis

•historically referred to as Laennec's cirrhosis

•is the most common type of cirrhosis in North and South America and in western Europe

•It is characterized by diffuse fine scarring, fairly uniform loss of liver cells, and small regenerative nodules

•may be clinically silent and 10 to 40% cases are discovered incidentally at laparotomy or autopsy

•In many cases symptoms are insidious in onset, occurring usually after 10 or more years of excessive alcohol use and progressing slowly over subsequent weeks and months

Alcoholic cirrhosis: clinical manifestations

•Easy bruising

•Increasing weakness and fatigue

•Hepatocellular dysfunction and portal hypertension

•Anorexia and malnutrition lead to weight loss and a reduction in skeletal muscle mass

•Progressive jaundice

•Bleeding from gastroesophageal varices, ascites

•Encephalopathy

•Progressive renal dysfunction often complicates the terminal phase of the illness.