Alcoholic Liver Disease

 Wide spectrum of disease ranging from subclinical to end-stage liver disease


image ∼ 20-40% of chronic alcoholics who undergo biopsy have histologic evidence of alcoholic liver disease (ALD)





Clinical Issues




• Very variable presentation

• Moderately elevated transaminases (AST/ALT ratio typically >2)


Microscopic




• Combination of hepatocyte injury, inflammation, steatosis, and fibrosis
image Hepatocytic ballooning

image Lobular inflammation with predominance of neutrophils

image Mallory-Denk bodies (Mallory hyaline)

image Megamitochondria

image Steatosis

image Fibrosis

– Most often pericellular and perivenular, especially initially

• Cholestatic features may be seen

• Iron deposition in hepatocytes and Kupffer cells is common


Top Differential Diagnoses




• Nonalcoholic steatohepatitis (NASH)
image Histology of ALD and NASH virtually identical; favor ALD when Mallory bodies, neutrophil aggregates, or sclerosing hyaline necrosis is present

• Chronic hepatitis C
image Many patients have both ALD and hepatitis C infection

image
Gross Appearance
This explant from a patient with end-stage alcohol-induced cirrhosis shows a brown, tan, fibrotic, and nodular cut surface.


image
Steatosis
Steatosis, most often macrovesicular (large droplets of fat within the hepatocytes that commonly push the nuclei to the periphery of the cytoplasm), is a typical finding in alcoholic liver disease (ALD).

image
Hepatocyte Ballooning
This high-magnification photomicrograph shows ballooned hepatocytes image with rarefied, clumped cytoplasm and Mallory-Denk bodies image typical of alcoholic steatohepatitis.

image
Mallory-Denk Bodies
Ballooned hepatocytes image containing many Mallory-Denk bodies are typical in alcoholic steatohepatitis, along with lobular inflammation featuring satellitosis of neutrophils around the ballooned cells.


TERMINOLOGY


Abbreviations




• Alcoholic liver disease (ALD)


Definitions




• Hepatocyte injury and inflammation resulting from chronic alcohol consumption
image Wide spectrum of clinical and pathologic disease ranging from mild/subclinical to end-stage cirrhosis and death


ETIOLOGY/PATHOGENESIS


Alcohol Consumption




• Alcohol is direct hepatotoxin

• Both genetic and environmental factors determine susceptibility to liver injury


CLINICAL ISSUES


Epidemiology




• Incidence
image ∼ 20-40% of chronic alcoholics who undergo biopsy have histologic evidence of ALD

Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Alcoholic Liver Disease
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