Alcohol-related%20liver%20disease Signs and Symptoms

Signs and Symptoms

Patient may present with signs and symptoms related to portal hypertension:

Abdominal wall collaterals
Ascites
Hepatic encephalopathy
Splenomegaly
Venous hum

Signs of Alcohol Abuse and Hepatic Injury

Malnutrition and muscle wasting
Jaundice
Cutaneous telangiectasia
Palmar erythema
Finger clubbing
Dupuytren’s contracture
Rhinophyma
Spider angioma
Peripheral neuropathy
Parotid gland enlargement
Signs of gynecomastia and hypogonadism may also be present

Others

Patient may be asymptomatic
Hepatomegaly, which is the most common sign in patients with alcohol-related liver disease (ALD)
Hepatic bruit
Alcohol withdrawal (eg tremors, tachycardia, agitation, delirium tremens)
Anorexia, weight loss
Systemic inflammatory response syndrome (SIRS) (≥2 of the following: Heart rate >100 beats/minute, respiratory rate >12 breaths/minute, temperature >38°C or <36°C, WBC count >12,000 or <4000 mm)

Epidemiology

Leading cause of acute and chronic liver failure, cirrhosis and liver cancer
One of the leading causes of liver transplantation
Approximately 20% of alcoholics have alcoholic hepatitis
Causes approximately 6% of all deaths worldwide
- Alcoholic cirrhosis accounts for approximately 10% of alcohol-related deaths worldwide

Pathophysiology

ALD results from complex interaction of behavioral, environmental and genetic factors
- Heavy alcohol consumption leads to hepatic fat accumulation by affecting the redox mechanisms in the liver through interference with transcription factors that regulate fatty acid synthesis and oxidation leading to increased fatty acid synthesis and reduced fatty acid oxidation
- Gut permeability changes resulting to increased portal vein endotoxin, innate immune response activation, liver inflammation, injury, apoptosis and necrosis, and fibrosis thereby activating the cytokine and oxidative stress cascades leading to liver injury

Risk Factors

Cofactors in the Development of ALD

The amount (>30 g/day) and type of alcohol ingested and drinking pattern (eg daily drinking, binge drinking)
- Red wine was less likely to be associated with cirrhosis than other alcoholic drinks
Genetic factors
- Genetic variants PNPLA3, TM6SF2, MBOAT7, HSD17B13
- Rate of alcohol metabolism plays a role
Gender
- Women are more susceptible compared to men
Diet and nutrition
- Undernutrition
- Overnutrition and obesity are established independent risk factors for hepatic steatosis and steatohepatitis
Cigarette smoking
Co-morbid conditions (eg metabolic dysfunction-associated steatohepatitis [MASH], metabolic dysfunction-associated steatotic liver disease [MASLD], viral hepatitis and hemochromatosis)
- Concomitant hepatitis B virus (HBV) infection accelerates the progression of ALD and may hasten mortality
- Hepatitis C virus (HCV) infection increases probability of development of cirrhosis by 8- to 10-fold and accelerates progression of ALD

Nephrologists’ insights: Why give TAF to chronic HBV patients in renal clinics?

Dr. Desmond Yap, Dr. Benjamin So, 31 Jan 2023

Chronic hepatitis B (CHB) and its treatments are both risk factors for chronic kidney disease (CKD), especially in the face of cardiometabolic comorbidities and in patients of advanced age. In an interview with MIMS Doctor, Dr Desmond Yap of the Division of Nephrology, University of Hong Kong and Dr Benjamin So of the Division of Nephrology, Queen Mary Hospital, discussed how hepatitis B virus (HBV) infection and certain nucleos(t)ide analogues (NAs) may potentially affect kidney function, and how to better manage CHB patients in renal clinics, including those with CKD and kidney transplant recipients (KTRs).

HCV pangenotypic DAA therapy in a patient with concomitant antipsychotic treatment

Dr. Ting-Ting Chan, 27 Oct 2023

A 43-year-old male former intravenous drug user presented with incidental findings of elevated alanine transaminase (ALT) levels in December 2021. The patient had depression and drug-induced psychosis associated with previous heroin, ketamine and methamphetamine use. He was on quetiapine 300 mg daily for his psychotic symptoms, pantoprazole 40 mg daily as needed for occasional acid reflux, and simvastatin 10 mg daily for hyperlipidaemia. He did not have hepatitis B virus (HBV) or human immunodeficiency virus (HIV) coinfection.

Reducing risks and improving long-term outcomes in patients with CHB

Prof. Vincent Wong, Prof. Ray Kim, Dr. Tan Poh Seng, 10 Sep 2019

Chronic hepatitis B (CHB) remains a major public health concern because of its worldwide distribution and potential adverse sequelae, including cirrhosis and hepatocellular carcinoma (HCC). At a recent symposium held during the GIHep Singapore 2019, Professor Vincent Wong from the Chinese University of Hong Kong and Professor Ray Kim from the Stanford University School of Medicine, Stanford, California, US, discussed antiviral treatments for CHB, with a focus on the novel agent tenofovir alafenamide (Vemlidy®). Dr Tan Poh Seng from the National University Hospital, Singapore, chaired the symposium.