Alcoholic Liver Disease Paper Example

Introduction

Alcoholic liver disease (ALD) is a type of disease that occurs when heavy alcohol drinking triggers the replacement of healthy liver tissue with tissue that is scarred over a period. It is estimated that around 20% to 10% of the people who do heavy alcohol drinking end up developing the alcoholic liver disease which is also known as alcoholic liver cirrhosis. Some of the risks associated with the alcoholic liver disease include genetic factors, poor dieting or malnutrition, obesity, HIV or rhepatitis C and demographic factors (Tsochatzis et al., 2014). The mentioned risk factors together with binge alcohol drinking interplay and end up resulting in the disease itself. In the absence of proper self-care and management practices such as abstinence and proper dieting, ALD can be fatal. This paper aims to discuss what ALD is and the related risks, treatment, management, and self-care.

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The liver plays a central role in the removal of alcohol from the body as it is a significant toxin. Considering that the liver prioritizes the removal of alcohol from the bloodstream, excessive drinking eventually leads to overworking the liver. ALD is classified into three categories: alcohol cirrhosis, alcoholic hepatitis, and Steatosis. Approximately 35% of the binge drinkers develop alcoholic hepatitis which is defined as liver inflammation that brings about the liver cell death. The symptoms associated with alcoholic hepatitis include abdominal pain, jaundice, vomiting, nausea, and fever. Steatosis is known as the most common ailment of the liver that is associated with heavy alcohol drinking (Vilstrup et al., 2014). Steatosis is characterized by the excessive buildup of fats in the liver cells hence the liver ends up limiting the efficiency of the liver itself. The main symptom associated with Steatosis is the enlargement of the liver and abdominal discomfort. The third type of ALD which is considered as the most detrimental is alcoholic cirrhosis. Liver cirrhosis is characterized by the death of the liver cells and spread or rather replacement with scar tissue (Louvet & Mathurine, 2015). The symptoms that accompany liver cirrhosis include pain, fever, vomiting and nausea, jaundice, mental challenges, high blood pressure and ascites (stomach fluid accumulation).

Risk Factors Associated with Alcoholic Liver Disease

Heavy indulgent in alcohol drinking is the major risk factor associated with developing ALD. The liver plays a significant role in the metabolism of ethanol. The fast removal of ethanol from the system is a way of the liver protecting itself from hyper-toxicity. The metabolism of alcohol leads to the production of metabolites such as acetaldehyde that is toxic to the liver and in extreme cases the change in the normal functioning of biochemical processes. Gender is also a risk factor as it is known that women are more likely to develop ALD as compared to men. ALD can also occur due to genetic factors, and it can be considered congenital (Louvet & Mathurine, 2015). Some people are born without the enzymes that aid in the removal of ethanol from the body system. Obesity is also a risk factor in that it is mostly associated with deposition of excess fat that can find its way into the liver cells. Poor dieting also encourages the development of ALD in heavy alcohol drinkers.

Alcoholics tend to neglect good eating habits that end up limiting the liver cells from receiving nutrients required for optimal functioning. The ethnicity of an individual also serves as a risk for developing ALD. Males who are Hispanic and men who are African American are at more risk of developing ALD as compared to other men of other ethnic backgrounds (Tsochatzis et al., 2014). Finally, viruses such as hepatitis C interfere with the normal functioning of the liver cells by targeting the liver cells. With HIV, by targeting the CD4 cells, the general immunity and normal metabolic processes of the body cells are altered.

Diagnosis of Alcoholic Liver Disease

Alcoholic liver disease diagnosis is generally made based on the patients' history, clinical and also laboratory findings but for uncertain situations, imaging may be supported as well as biopsy liver results. However, histological features of alcoholic liver disease describe the diagnosis. Screening is recommended for patients with alcoholic liver disease as part of their preventive and routine medical care (Torruellas, French, & Medici, 2014). Patients who show features of high serum transaminase level are therefore supposed to do alcohol liver disorder screening. AUDIT (alcohol use disorders identification test) is one of the tools used in detecting alcohol disorders.

Physical Examination

Thorough physical check-up should be done to determine whether the patient has a chronic alcoholic liver disease, the physical checkup outcomes in patients will vary based on diseases' severity and vary from normal test to physical signs (Torruellas, French, &Medici, 2014). The physical results in patients with the acute alcoholic liver disease may be either normal or also non-diagnostic.

Laboratory testing is part of first testing, patients with ALD are supposed to have a full blood count, alkaline phosphates and hepatic panel. Common hematological outcomes in patients who suffer from ALD are macrocytic anemia, high rate of erythrocyte sediment and thrombocytopenia. Imaging such as MRI and CT (magnetic resonance imaging, computed tomography scan) respectively are the currently available imaging modalities used for the liver ultrasound (Torruellas, French, & Medici, 2014). The imaging determines the existence of the liver disease.

Treatment of Alcoholic Liver Disease

Alcoholic liver disease cannot be reversed, but the doctor can advise the patient on treatment that reduces the symptoms and slows the progress of the disease. The initial step in treating the disease is to stop drinking. Since the patient is reliant on alcohol, he or she must be in the hospital under the doctor's care because the patient may experience health complications while undergoing recovery (Louvet & Mathurine, 2015). The process of recovering is gradual. Some strategies aim at attaining retaining the abstinence, and it requires close involvement of psychiatrists, psychologists, and physicians. Cognitive behavioral therapy in the psychological treatment and motivational enhancement treatment tend to decrease alcohol intake in victims.

Drug Therapies

The foundation for steroid is reducing immune response as well as pro-inflammatory cytokine response. Therefore, the use of corticosteroids helps in moderate and severe alcoholic liver disease thus increasing the survival period up to one year (Louvet & Mathurine, 2015).

Pentoxifylline (PTX) is a nonselective inhibitor that decreases the concentrations of intracellular of adenosine and also reduces the pro-inflammatory chemokines/cytokines production. The chemokines/cytokines include TNF (tumor necrosis factor). PTX is regularly used in AH and alcoholic liver disease patients' because it contains anti-inflammatory properties, protective effect s that are against hepatorenal syndrome and the outstanding safety profile (Louvet & Mathurine, 2015).

Anti-TNF therapy is highly recommended because it is a very effective treatment for alcoholic liver disease, inflammatory bowel sickness, and rheumatoid arthritis. Anti-TNF monoclonal antibody assists in blocking the biological effects (Louvet & Mathurine, 2015). In most cases, the antibodies are prepared in the laboratory or purchased commercially.

Colchicine is an ant fibrotic and anti-inflammatory drug with the long-term treatment for ALD patients (Louvet & Mathurine, 2015).

Liver transplant refers to a surgical process that replaces the liver that has a disease with the healthy liver from another person; it is the only cure for permanent liver failure. Liver transplant increases the patients' survival chances. Liver transplant is considered if only the patient commits never to drink alcohol again, the patient is good health wise to survive the operation and if the patient's liver fails progressively in spite of not consuming alcohol (Louvet & Mathurine, 2015). For liver transplant to be successful the donor must be between 18-60 years of age, body mass index of not more than 35,blood type that is compatible with the recipient, good mental and physical health, no heart or kidney disease, no HIV/AIDS, no cancer, no hepatitis or chronic infections and no drug abuse.

It has been documented that patients who suffer from alcoholic liver disease suffer from lack of vitamin E; therefore Vitamin E is used broadly with hepatoprotective effects to experimental models of liver injury (Louvet & Mathurine, 2015). Vitamin E has numerous potential helpful effects that include membrane stabilization, production of TNF, collagen production and NF-kB activation. Vitamin E supplement thus increases overall mortality. People who drink heavily usually suffer from lack of vitamin B-complex, and this may cause malnutrition or anemia.

Management of Alcoholic Liver Disease

The first step in the management of ALD begins with cessation of alcohol consumption. The moment an alcoholic stops consuming alcohol, the buildup of fatty tissue in the liver cells reduces. Therefore, the portal pressure will be normalized with time and the risks of developing visceral bleeding and portal hypertension will be minimized. Alcoholics with alcoholic cirrhosis who abstain from alcohol for at least one and a half year are more likely to experience improved health outcomes. Another benefit of alcohol abstinence is a factor that can be considered during liver transplantation. Mathurin & Bataller, 2015). It is mandatory that before the listing is carried out in transplant centers, a patient in need of a liver transplant must abstain from alcohol drinking for a minimum of six months.

Abstaining from alcohol by patients with ALD is not an easy task. The reduction and no consumption of alcohol is associated with alcohol withdrawal symptoms that can give birth to dire complications. The complications include hyperreflexia, high blood pressure, tachycardia and seizures, and increased irritability. Therefore, it is vital that the ALD patients are given medications that will aid in tackling the withdrawal symptoms. Examples of drugs that are offered include clomethiazole and Benzodiazepines (Mathurin & Bataller, 2015). Considering that Benzodiazepines have adverse side effects, other drugs such as baclofen, gabapentin, topiramate, and clonidine are administered.

The second way of managing ALD is through proper dieting and evaluation of the patient's nutritional requirements. Nutrition is considered to be the best supportive therapy when managing ALD. Excessive alcohol consumption impairs normal intestinal nutrient absorption such as the absorption of Zinc. To have improved health outcomes in patients with ALD, the nitrogen balance must be restored. This can be done by ensuring a daily intake of proteins, trace elements and minerals (Mathurin & Bataller, 2015). Calorie intake of around 35-40 per kg and consumption of approximately 1.2 to 1.5 per grams of proteins is crucial.

Additionally, the intake of zinc, vitamin A, folate, vitamin D and thiamine is essential. It is also critical for a patient with ALD to avoid fatty foods and to reduce their sa...