The diagnosis of alcoholic liver disease depends on demonstration of alcohol abuse, the presence of hepatic disease, and evidence that the disease is due to alcohol. Documentation of hepatotoxic alcohol intake depends on a combination of history from the patient and his or her family, blood and urine alcohol levels, serum markers (γ-glutamyl transferase, mean corpuscular erythrocyte volume, carbohydrate-deficient transferrin [CDT]), and sometimes liver biopsy. CDT appears to have higher 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. Different factors may influence the development of alcoholic liver disease, including high lipid intake (mostly unsaturated fatty acids), coinfection with hepatitis C, lower first pass effect in women, and genetic factors, eg, polymorphism of alcohol dehydrogenase. The spectrum of alcoholic liver disease includes fatty liver, alcoholic hepatitis, and cirrhosis. Oxidative stress, aldehyde adducts, and endotoxin are some of the proposed mechanisms for alcohol-induced liver damage. The interaction of alcohol with other drugs, like acetaminophen and isoniazid, is increasingly appreciated. Chronic alcohol consumption may lower the toxic dose of acetaminophen for the liver, and it is recommended that chronic alcoholics limit their daily intake to no more than 2 g/d. Abstinence from alcohol, proper nutrition, and corticosteroids (for selected patients) are some of the well-known therapeutic approaches for alcoholic liver disease. There has been much discussion about the role of liver transplantation; concerns include survival relative to other recipients, 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 transplantation should be evaluated on the same basis as for other types of liver disease.
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