Alcohol and Liver Enzymes/Chronic Liver disease

[as90]

Hi,
I was just wondering, based on what I learned in class and Goljian.

The way I understood alcohol consumption's effects on liver in an accute situation is as follows:

If one decides to binge drink (i.e. a lot of alcohol in one night), AST and ALT elevations will not be seen at all. There will be no hepatitis.

However, if one is a chronic alcoholic (constantly using alcohol to destroy those mitochondria in hepatocytes), there will be eventual necrosis of the cells and firbosis as a result. The end state would be cirrhosis of the liver. Your constantly activating the CYP450's.


However, can we go from cirrhosis to fulminant hepatitis?

I thought the progression for chronic alcoholism would be fatty liver/steatosis--->necrosis---> cirrhosis and death from portal hypertension or even hepatocellular carcinoma.

I'm just not seeing how one would go to fulminant hepatitis with alcohol alone.

Thanks in advance for any help.

---

Members don't see this ad.

 

[Wolverines83]

alcoholic hepatitis does result in enzyme elevations.
AST>ALT
ALP and GGT will also be elevated (GGT way up)

alcoholic hepatitis is an acute problem, cirrhosis/fatty liver are chronic.

basically in alcoholic hepatitis you dump so much ETOH (and therefore acetaldehyde) into your liver in such a short time that it (the liver as a whole, not just small groups of hepatocytes) becomes inflamed, engorged with neutrophils and all that fun inflammatory stuff.

in fatty liver, consistently elevated levels of ETOH increase the NADH/NAD ratio, leading to more fatty acid synthesis. but that takes longer.

So...alcoholic hepatitis is pretty much its own acute beast (sort of). fatty liver--> cirrhosis is more of a drawn out, chronic process.

 

[as90]

Thank you for this.

I guess with regards to alcoholic hepatitis it can progress to fulminant hepatitis if we get enough necrosis of the hepatocytes.