Alcoholic Liver Disease

Alcohol-related liver diseases are among the most common liver diseases in the United States. The clinical manifestations of alcoholic liver disease can be divided into three disease processes: steatosis, alcoholic hepatitis, and alcoholic cirrhosis. A liver biopsy specimen may show evidence of all three forms of alcoholic liver disease. After ingestion, most ethanol is metabolized by hepatic alcohol dehydrogenase (ADH) to acetaldehyde, which is subsequently converted by acetaldehyde dehydrogenase (ALDH) to acetate. ADH is not inducible with chronic ethanol ingestion but several isoforms with disparate rates of ethanol metabolism have been associated with differences in the risk of alcoholism and alcohol-related liver disease among different ethnic groups. The rate of ethanol metabolism by ADH and ALDH may be crucial in determining the toxicity of alcohol. The chapter discusses the pathogenesis, clinical presentation, and management and prognosis of alcoholic liver disease.