Alcohol induced liver injury results from chronic alcoholic ingestion which may be classified as:
- Alcoholic fatty liver (AF)
- Alcoholic hepatitis (AH)
- Alcoholic cirrhosis of liver (AC)
Pathogenesis
The mechanism whereby alcohol produces different liver lesion is poorly understood. Fatty change may be due to increased production and decreased use of fatty acids in the liver cells following the conversion of alcohol to acetaldehyde by alcohol dehydrogenase.
For the development of alcoholic hepatitis, fibrosis and cirrhosis, production of toxic metabolites called adducts during the conversion of acetaldehyde to acetate may be responsible. In addition, immune reaction to liver cells altered by alcohol may also be involved.
Determinants of Liver Injury are:
Amount and duration of alcohol ingestion
The risk of developing alcoholic liver disease occurs with daily intakes above 30 gm (3 units) in men and above 20 gm (2 units) in women.
More than 5 years of drinking (usually more than 10 years) is required to produce alcoholic cirrhosis. A steady daily intake is more hazardous than intermittent drinking.
Malnutrition
This augments the detrimental effects of chronic alcohol ingestion
Sex
Women are affected at a much lower dose of alcohol men suggesting that hormonal factors may be responsible.
