Liver disease - alcoholic
Description
- Spectrum, and the stages overlap rather than progressing in lockstep
| Stage | Features | Reversible? |
|---|---|---|
| Steatosis | In ~90% of heavy drinkers. Asymptomatic, hepatomegaly | Yes - within weeks of abstinence |
| Alcohol-related (steato)hepatitis | Jaundice, tender hepatomegaly, fever, leucocytosis, AST:ALT >2 | Partly |
| Fibrosis -> cirrhosis | In 10-20% of heavy drinkers | Fibrosis can regress with abstinence |
| Decompensated cirrhosis / HCC | No |
- *Only a minority of heavy drinkers get cirrhosis - genetics (PNPLA3*), sex, obesity and coexisting liver disease decide who
- New nomenclature: MetALD where metabolic risk factors coexist with alcohol 20-50 g/day (F) or 30-60 g/day (M); ALD above those thresholds
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