ALCOHOLIC LIVER-DISEASE

The diagnosis of alcoholic river disease depends on demonstration of a lcohol abuse, the presence of hepatic disease, and evidence that the d isease is due to alcohol. Documentation of hepatotoxic alcohol intake depends on a combination of history from the patient and his or her fa mily, blood and urine alcohol levels, serum markers (gamma-glutamyl tr ansferase, mean corpuscular erythrocyte volume, carbohydrate-deficient transferrin [CDT]), and sometimes liver biopsy. CDT appears to have h igher specificity than the other markers. Liver damage correlates with amount and duration of alcohol consumption. Women are more sensitive to alcohol intake as regards the development of liver disease. Differe nt factors may influence the development of alcoholic liver disease, i ncluding high lipid intake (mostly unsaturated fatty acids), coinfecti on with hepatitis C, lower first pass effect in women, and genetic fac tors, eg, polymorphism of alcohol dehydrogenase. The spectrum of alcoh olic liver disease includes fatty liver, alcoholic hepatitis, and cirr hosis. Oxidative stress, aldehyde adducts, and endotoxin are some of t he proposed mechanisms for alcohol-induced liver damage. The interacti on of alcohol with other drugs, like acetaminophen and isoniazid, is i ncreasingly appreciated. Chronic alcohol consumption may fewer the tox ic dose of acetaminophen for the liver, and it is recommended that chr onic alcoholics limit their daily intake to no more than 2 g/d. Abstin ence from alcohol, proper nutrition, and corticosteroids (for selected patients) are some of the well-known therapeutic approaches for alcoh olic liver disease. There has been much discussion about the role of l iver transplantation; concerns include survival relative to other reci pients, recidivism to alcohol, quality of life after transplantation, and effect of such organ assignment on donor availability. At present, survival after transplantation in these patients is similar to other liver recipients, and it is felt that their need for hepatic transplan tation should be evaluated on the same basis as for other types of riv er disease.