www.ijcmr.com International Journal of Contemporary Medical Research ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 98.46 | Volume 6 | Issue 9 | Sptember 2019 I1 Section: Psychiatry Alcoholic Liver Diseases: General Diagnostic Approach Nikhil Goel 1 , Bhuwan Bhaskar Agarwal 2 , Kapil Sharma 3 ORIGINAL RESEARCH ABSTRACT Introduction: Alcohol is consumed all over the world. It is toxic to liver. It causes different liver problems, like fatty liver, alcoholic hepatitis and cirrhosis. The disorders caused by alcohol use are main causes of mortality and morbidity. Excessive consumption of alcohol is one of the top 5 risk factors for death and disability globally. The present study was conducted to diagnose alcoholic liver diseases so that by proper approach patient can be brought to normal life. Material and methods: This prospective observational study comprising of 50 patients was conducted at SHKM Govt. Medical College, Nalhar, Haryana from April 2018 to March 2019. The detail history, Audit scoring, physical examinations, lab investigations and ultrasound studies were done. Proper ethical norms were maintained and statistical analysis was carried out. Results: Out of total of 50 patients, 12% patients were asymptomatic, 68% patients had fatty liver on the basis of ultrasonography and AST and ALT levels. 12% patients had alcoholic hepatitis and 8% patients had cirrhosis. AST and ALT were raised in most patients. AUDIT score was more than 8 in all patients of alcoholic hepatitis and cirrhosis. Discussion: Alcoholic liver disease affects only small percentage of regular drinkers. Since alcoholic liver disease in most of the patients is potentially reversible, hence after proper diagnosis and with a sober approach, regular efforts, psychological counselling and use of pharmacological agents we can treat the patients of alcoholic liver disease and bring them to the normal life, which is the aim of this study. Keywords: Alcoholic, Liver, AUDIT, Aspartate Transaminase, Alanine Transaminase, Diagnosis INTRODUCTION Alcohol is consumed all over the world. It is toxic to liver. It causes different liver problems, like fatty liver, alcoholic hepatitis and cirrhosis. Alcoholic liver diseases cover all these. 1 The disorders caused by alcohol use are main causes of mortality and morbidity. Alcohol is a risk factor for many diseases including cancers. Alcohol increases solubility of carcinogens. It decreases DNA repairs. 2 Excessive consumption of alcohol for long time is one of very important causes of liver disease. In case of severe liver disease, the prognosis is very poor. Mortality of alcoholic hepatitis and cirrhosis is about 60% at 4 years. 3 Although alcohol is directly toxic to liver, but only about 15% of alcoholics suffer from hepatitis. This is probably because of many factors. Most important risk factors are, the amount of alcohol which we take and for how long we are taking. The role of the type of the alcohol which we are taking is less clear. For telling the amount of alcohol causing liver disease, let us frame a unit pattern of amount of alcohol. 1 unit of alcohol is equal to 8 gm of 100% alcohol. 440 ml of 3.5% beer constitutes 2 units. 80 ml of 10% wine forms 1 unit. 20 ml of 40.0% vodka or rum or whisky forms 1 unit. Usually alcoholic liver disease will not occur, if a man takes >28 units, or a women takes >21 units of alcohol in a week. 4 The prevalence of alcoholic liver disease is more common in countries where annual per capita alcohol consumption is more, e.g. Eastern European countries and less common in North African and Middle East countries, where annual per capita alcohol consumption is lowest. 5 Other risk factors are like this. Chances of liver damage is more if a person consumes alcohol regularly rather than binge drinking. Because of lower body mass of females, the chances of alcoholic liver damage in them is more. A person taking choline-defcient diet has more chances of alcoholic liver damage. Alcohol is metabolised totally by liver, 80% to acetaldehyde and 20% is metabolised by oxidase enzymes of smooth endoplasmic reticulum. Microsomal peroxidation liberates oxygen free radicles which are liable to induce mitochondrial damage. In alcoholic hepatitis there is increased gut permeability which leads to release of endotoxins. There is increased production of TNF-α, release of IL-1, 2 and 8. They cause fbrogenesis. Other factors which can play part are ethnicity, obesity, co-existing viral hepatitis, smoking, iron overload, and host genetic factors. Fatty liver is the most common injury because of alcohol. The fat accumulates in the perivenular hepatocytes. Subsequently in whole of the hepatic lobule fat is desposited. If at this state a person stop drinking, the liver becomes normal again. From fatty liver to occurrence of hepatitis is blurred. In alcoholic hepatitis there is ballooning degeneration, neutrophil infltration, spotty necrosis and fbrosis. Alcoholic hepatitis is also very much reversible, if drinking is stopped. Alcoholic hepatitis leads to cirrhosis. Most of the patient are asymptomatic. Patient at times complains of pain in right upper quadrant, feeling of nausea and occasionally patient has jaundice. Fever, jaundice, spider 1 Assistant Professor, Department of Psychiatry, SHKM Government Medical College, Nalhar (NUH) Haryana, 2 Assistant Professor, Department of Radiology, SHKM Government Medical College, Nalhar (NUH) Haryana, 3 Assistant Professor, Department of Chest and TB, SHKM Government Medical College, Nalhar (NUH) Haryana, India Corresponding author: Dr. Bhuwan Bhaskar Agarwal, Assistant Professor, Department of Radiology, SHKM Government Medical College, Nalhar (NUH) Haryana, India. How to cite this article: Nikhil Goel, Bhuwan Bhaskar Agarwal, Kapil Sharma. Alcoholic liver diseases: general diagnostic approach. International Journal of Contemporary Medical Research 2019;6(9):I1-I6. DOI: http://dx.doi.org/10.21276/ijcmr.2019.6.9.30