Alcoholic liver disease

Alkoholna bolest jetre obuhvaća spektar promjena u jetri uzrokovanih dugotrajnom konzumacijom pretjeranih količina alkohola i važan je uzrok pobolijevanja i smrti u cijelom svijetu. Najvažniji etiološki čimbenik u razvoju bolesti je ukupna doza alkohola, a težini oštećenja mogu doprinijeti i neki dodatni čimbenici poput genetske osnove, spola i pothranjenosti. Alkohol putem brojnih mehanizama uzrokuje u jetri karakteristične patološke promjene s pripadajućim kliničkim manifestacijama. Alkoholna masna jetra je najblaži oblik bolesti i uz apstinenciju može biti potpuno reverzibilna. Uglavnom je asimptomatska uz moguću hepatomegaliju. Alkoholni hepatitis obilježavaju upalne promjene u jetri, a simptomi variraju ovisno o težini bolesti. Alkoholna ciroza je terminalni stadij bolesti u kojem dolazi do zamjene oštećenih hepatocita vezivnim tkivom i stvaranja regenerativnih čvorića. Prezentira se uglavnom simptomima koji su posljedica oštećenja jetrene funkcije i razvijenih komplikacija portalne hipertenzije. Dijagnoza alkoholne bolesti jetre uglavnom se postavlja kombinacijom značajki kliničke slike i laboratorijskih nalaza, nakon isključenja drugih etioloških čimbenika oštećenja jetre. U postavljanju dijagnoze pomažu nam i slikovne metode poput ultrazvuka, kompjutorizirane tomografije ili magnetske rezonancije. Biopsija jetre je uvijek bila metoda zlatnog standarda za procjenu fibroze, no danas se sve više upotrebljavaju različite neinvazivne metode poput elastografije i određivanja seroloških biljega. Liječenje svih oblika bolesti se temelji na apstinenciji od alkohola i nutritivnoj terapiji, dok se u teškim oblicima hepatitisa ponekad koriste kortikosteroidi. U liječenju razvijenih komplikacija ciroze provode se specifične simptomatske mjere, a jedini djelotvorni oblik liječenja u fazi ciroze je transplantacija jetre. Prognoza alkoholne bolesti jetre ovisi prvenstveno o stadiju bolesti, a preživljenje je bolje u svim stadijima za pacijente koji apstiniraju u usporedbi s onima koji nastavljaju s konzumacijom alkohola.Alcoholic liver disease encompasses a spectrum of changes in the liver caused by a long-term and excessive alcohol consumption, and it is an important cause of morbidity and death around the world. The main etiologic factor for the development of the disease is the overall amount of alcohol, and some other factors, such as genetic factors, sex and malnutrition, may also contribute to the severity of the disease. Alcohol induces characteristic pathological changes in the liver with correlating clinical manifestations. Alcoholic fatty liver is the mildest form of the disease and may be fully reversible with abstinence from alcohol. It is usually asymptomatic or hepatomegaly may be found on clinical examination. Alcoholic hepatitis is characterized by inflammatory changes in the liver, and symptoms vary depending on the severity of the disease. Alcoholic cirrhosis represents an end-stage of the disease in which damaged hepatocytes are replaced by connective tissue and regenerative nodules are formed. It is mostly presented by symptoms that are due to damaged liver function and existing complications of portal hypertension. Diagnosis of alcoholic liver disease is mostly based on the combination of clinical features and laboratory findings, upon exclusion of other possible etiologic factors. Various imaging methods, such as ultrasound, computed tomography and magnetic resonance imaging may also be used. Liver biopsy has always been the gold-standard method in the evaluation of fibrosis, but different non-invasive methods like elastography and serum markers are being used more and more today. Treatment of all forms of the disease is based on the abstinence from alcohol and the nutritional support, while corticosteroids are sometimes used in severe forms of alcoholic hepatitis. Specific procedures are used for the treatment of complications of cirrhosis, and the only effective method for the treatment of cirrhosis is liver transplantation. Prognosis of alcoholic liver disease primarily depends on the stage of the disease, and the survival at every stage is better for patients who abstain from alcohol compared to those who continue to drink