Alcoholic hepatitis

[Enzymes]

I am a little confused about this concept because Pathoma says its mostly related to binge drinking, but First Aid (p. 361 2014) says it is related to sustained, long term alcohol consumption.

Anyone understand the discrepancy? I was thining maybe ACUTE alcoholic hepatitis would be binge drinking, where as chronic alcoholic hepatitis would be sustained drinking, more likely to lead to alcoholic cirrhosis. But I am honestly not sure. Thanks for any insight!

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[Frozengrapes]

My understanding, based on Pathoma and what I read from Robbins during the school year, is that binge drinking will cause alcoholic hepatitis (acute), and chronic alcoholism will lead to hepatitis, and then cirrhosis of the liver (with an associated increased risk for hepatocellular carcinoma).

 

[nm825]

Can someone clarify this question? I've been wondering the exact same thing.

 

[worldbeater]

The answer to the question is how long does it take for alcohol to destroy the mitochondrial membrane? This is something I do not know. But the logic is as follows:

Alcohol destroys all membranes in the body. When the cell membrane is destroyed first, you will have one AST and one ALT leak out. This will give you that 1:1 ratio on a lab and show the patient has a liver disease like hepatitis. As you drink more alcohol, your mitochondrial membrane is destroyed. An additional AST will leak out plus a GGT. Your ratio of AST:ALT is now 2:1 and the patient now has alcoholic hepatitis.

Alcohol is the only compound that can destroy the mitochondrial membrane. You can see why that 2:1 ratio can confirm alcoholic hepatitis, and it would be even easier to identify with an elevated GGT because this is the only enzyme present within the mitochondria of the liver.

Cirrhosis is defined as when the liver can not do its most basic function. You will have the replacement of normal architecture by fibrous lined parenchymal nodules (UWorld Q). The PT will be elevated and used to determine the prognosis of the patient (UWorld Q) and your albumin will be less than 2.

So according to the timeframe of how alcohol damages each structure in the body, you can figure out when each disease presents.

 

[Mad Jack]

I initially read this as "allopathic hepatitis."