Alcohol chronic liver disease

Persons aged 2 to 64 years who are at increased risk for pneumococcal disease or its complications if they become infected should be vaccinated. Persons at increased risk for severe disease include those with chronic illness such as chronic cardiovascular disease (e.g., congestive heart failure [CHF] or cardiomyopathies), chronic pulmonary disease (e.g., chronic obstructive pulmonary disease [COPD] or emphysema, and asthma that occurs with chronic bronchitis, emphysema, or long-term use of systemic corticosteroids), diabetes melli-tus, alcoholism, chronic liver disease (cirrhosis) (36-39), or cerebrospinal fluid leaks. 

Persons aged 2-64 years with alcoholism, chronic liver disease, or cerebrospinal fluid leaks... 

Cirrhosis is the result of long-term insult to the liver, so damage is typically not evident clinically until the fourth decade of life. Chronic liver disease and cirrhosis combined were the 12th leading cause of death in the United States in 2002. In patients between the ages of 25 and 64, damage from excessive alcohol use accounted for over one-half of the deaths.2 Alcoholic liver disease and viral hepatitis are the most common causes of cirrhosis in the United States and worldwide. 

Education, simple rules of personal hygiene and safe food preparation can prevent many diarrheal diseases. Hand washing with soap is an effective step in preventing spread of illness. Human feces must always be considered potentially hazardous. Immunocompromised persons, alcoholics, persons with chronic liver disease and pregnant women may require additional attention, and health care providers can play an important role in providing information about food safety. These populations should avoid undercooked meat, raw shellfish, raw dairy products, French-style cheeses and unheated deli meats [114]. 

HIV infection1 12 13 CD4+T lymphocyte count Diabetes, heart disease, chronic pulmonary disease, chronic alcoholism Asplenia12 (Including elective splenectomy and terminal complement component deficiencies) Chronic liver disease Kidney failure, end-stage renal disease, receipt of hemodialysis... 

Medical indications Chronic pulmonary disease (excluding asthma) chronic cardiovascular diseases, diabetes mellitus chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis) chronic alcoholism, chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]) immunosuppressive conditions and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. 

No populations with unusual susceptibility to health effects of 1,2-diphenylhydrazine have been identified. It is possible that people with chronic liver disease or possibly compromised hepatic function (e.g., very young or very old people, alcoholics) might be unusually susceptible to... 

Patients with psoriasis or RA who have any of the following alcoholism, alcoholic liver disease, or other chronic liver disease overt or laboratory evidence of immunodeficiency syndromes preexisting blood dyscrasias (eg, bone marrow hypoplasia, leukopenia, thrombocytopenia, significant anemia). 

Hepatotoxicity. Duloxetine is rarely associated with increases in serum transaminase levels, typically in the first 2 months of treatment. In controlled trials in major depressive disorder, elevations of alanine aminotransferase (ALT) to greater than three times the upper limit of normal occurred in 0.9% (8 of 930) of the duloxetine-treated patients and in 0.3% (2 of 652) of the placebo-treated patients. Current product labeling contains a caution regarding the use of duloxetine in patients with significant alcohol use or chronic liver disease. Postmarketing reports have indicated that increases in transaminases have occurred in some patients with chronic liver disease (Cymbalta 2005). 

CIRRHOSIS A chronic liver disease that is caused by alcohol abuse, toxins, nutritional deficiency, or infection. A main symptom of cirrhosis is portal hypertension. 

Alcoholics with chronic liver disease may have disorders of fluid and electrolyte balance, including ascites, edema, and effusions. These factors may be related to decreased protein synthesis and portal hypertension. Alterations of whole body potassium induced by vomiting and diarrhea, as well as severe secondary aldosteronism, may contribute to muscle weakness and can be worsened by diuretic therapy. Some alcoholic patients develop hypoglycemia, probably as a result of impaired hepatic gluconeogenesis. Some alcoholics also develop ketosis, caused by excessive lipolytic factors, especially increased cortisol and growth hormone. 

Folic acid deficiency, unlike vitamin B12 deficiency, is often caused by inadequate dietary intake of folates. Alcoholics and patients with liver disease develop folic acid deficiency because of poor diet and diminished hepatic storage of folates. There is also evidence that alcohol and liver disease interfere with absorption and metabolism of folates. Pregnant women and patients with hemolytic anemia have increased folate requirements and may become folic acid-deficient, especially if their diets are marginal. Evidence implicates maternal folic acid deficiency in the occurrence of fetal neural tube defects, eg, spina bifida. (See Folic Acid Supplementation A Public Health Dilemma.) Patients with malabsorption syndromes also frequently develop folic acid deficiency. Folic acid deficiency is occasionally associated with cancer, leukemia, myeloproliferative disorders, certain chronic skin disorders, and other chronic debilitating diseases. Patients who require renal dialysis also develop folic acid deficiency, because folates are removed from the plasma each time the patient is dialyzed. 

Adverse effects Adverse effects are a minor problem with rifampin, but can include nausea and vomiting, rash, and fever. The drug should be used judiciously in patients with hepatic failure because of the jaundice that occurs in patients with chronic liver disease, alcoholics, or in the elderly. 

Alcohol intake is the most important cause of liver cirrhosis in the Western world [2]. Data from the World Health Organization show that the incidence of chronic liver disease and cirrhosis associated with alcohol in the UK is 10.42 per 100 000 people [3]. Interestingly, only around... 

Alcohol consumption is the leading cause of chronic liver disease in adults. Biliary atresia is a leading cause of chronic liver disease in children. 

Osteoporosis is also common in those on long-term corticosteroid therapy (for example patients with autoimmune hepatitis or coexisting inflammatory bowel disease). Patients with chronic liver disease may also have other risk factors for osteoporosis related to their disease state. These include vitamin D deficiency, excessive alcohol consumption, poor diet, physical inactivity and low body mass index. Oestrogen deficiency in the postmenopausal stage further increases the risk. 

Cirrhosis occurs most frequently in the setting of alcoholic liver disease and represents the final common pathway of a number of chronic liver diseases. The development of cirrhosis is characterized by the appearance of fibroblasts and collagen deposition. This is accompanied by a reduction in liver size and the formation of nodules of regenerated hepatocytes. As a result, total liver content of cytochrome P450 is reduced in these patients. Initially, fibroblasts deposit collagen fibrils in the sinusoidal space, including the... 

Attali, R, Ink, O., Pelletier, G., Vernier, C, Jean, F., Moniton, L., Etienne, J.-E Dupuytren s contracture, alcohol consumption, and chronic liver disease. Arch. Intern. Med. 1987 147 1065-1067... 

Bell, H., Raknerud, N., Orjaseter, H., Haug, E. Serum procollagen III peptide in alcoholic and other chronic liver diseases. Scand. J. Gastroenterol. 1989 24 1217-1222... 

Chronic liver insufficiency is due to the progression of an already existing chronic liver disease. This generally tends to be advanced cirrhosis of varied aetiology. Basically, however, any liver disease can be a potential cause of chronic liver insufficiency. Alcohol and infections as well as certain medicaments are also deemed to be common causes. A great number of substances and events can trigger liver insufficiency. 

In 1980 the term non-alcoholic steatohepatitis (NASH) was introduced by J. Ludwig et al. to denote chronic liver disease with increased enzymatic activity and the histological picture of alcohol-induced hepatitis. (60) The histological feature itself was described by H. Thaler as early as 1962 in his paper Fatty liver and its relationship to cirrhosis . (76) Over the following years, transition from a diabetic fatty liver into cirrhosis was reported (S. Iron et al., 1979) as well as from an obesity-induced fatty liver into cirrhosis (M. Adler et al., 1979). 

Haemosiderosis can be found in several chronic liver diseases, such as chronic hepatitis (especially HVC leading to a reduced response rate to a-interferon), late-stage cirrhosis, spontaneous or surgical portal-systemic shunts, and non-alcoholic steatohepatitis. 

Vitamin E plays an important role in cell metabolism as an antioxidant for the elimination of reactive oxygen intermediates. Subsequent to intestinal resorption, vitamin E is transported in chylomicrons into the liver, from where it reaches other organs together with VLDL. Vitamin E deficiency is observed in chronic liver diseases caused by alcohol, Wilson s disease, haemochromatosis and abetalipoproteinaemia. In vitamin E deficiency, neurologic disturbances (areflexia, dysbasia, ocular palsy, reduced perception of vibration) occur haemolysis can likewise be induced or become more pronounced due to epoxide formation of unsaturated fatty acids within the erythrocyte membranes. 

In cirrhosis, reduced bone density of the vertebral bodies could be observed in 16% and of the antebrachial bones in 23% of patients (compared to 7% and 5% respectively, in the control group). Fractures of the vertebral bodies were detected in 16% and of the antebrachial bones in 21% of cases (compared to 8% and 8% respectively, in the control group). Hepatic osteopathy usually occurs independently of the cause and type of the chronic liver disease. However, alcoholism, haemochromatosis and Wilson s disease result in osteoblastic hypofunction, so that osteopathy is more likely to occur in these patients, even prior to the development of cirrhosis. The occurrence of osteopathy is closely correlated with the severity of the liver disease and with hypogonadism. In liver cirrhosis, the prevalence of osteopenia is about 30%. (49,73)... 

Chronic liver diseases, especially cirrhosis and alcohol-induced conditions, are accompanied by malnutrition in 50-80% of cases. The prognosis of the liver disease largely depends on the nutritional state - there is also a direct relationship between the probability of survival after liver transplantation and preoperative malnutrition. (17, 19, 20, 23 - 27, 29, 32)... 

Sarin, S.K., Dhingra, N., Bansal, A., Malhotra, S., Guptan, R.C. Dietary and nutritional abnormalities in alcoholic liver disease a comparison with chronic alcoholics without liver disease. Amer. X Gastroenterol. 1997 92 777-783... 

The serum zinc level of the alcoholic subjects tends to be lower in comparison with the controls. An absolute increase in renal clearance of zinc in the alcoholics demonstrable at both normal level and low serum zinc concentration has been observed (32). Thus the measurement of renal clearance of zinc may be clinically used for etiological classification of chronic liver disease attributable to alcohol in diflFerent cases. 

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