Alcoholic liver disease has a known etiology but a complex pathogenesis. It is an extremely common disease with a high mortality, but the reason why only a relatively small proportion of heavy drinkers progress to advanced liver disease remains elusive. Accumulating evidence points towards an elaborate interplay between metabolism, inflammation and immunity in the development of steatosis, hepatitis and fibrosis. These complex pathways leading to liver injury offer many potential susceptibility loci, as well as sites for potential therapeutic intervention. Alcoholic liver disease (ALD) poses significant challenges to clinicians. Therapy depends on the spectrum of pathological liver injury. The key to effective management of ALD lies in abstinence of alcohol. But maintaining the patient in abstinence is an important challenge. Another liver disease, which is gaining attention, is NASH. In the past, non-alcoholic steatohepatitis (NASH) was widely considered to be a relatively uncommon condition occurring almost exclusively in obese females, with type 2 diabetes mellitus and it was considered to have a relatively benign prognosis. Therefore not surprisingly very little attention was paid to NASH in terms of research into the pathogenesis and treatment. But since 1994,these perceptions were challenged when it was found that NASH is not necessarily benign. An increasing prevalence of NASH has been noticed perhaps owing to the increased prevalence of the associated risk factors of NASH, namely: diabetes mellitus, and obesity. The effective treatment of both ALD and NASH has been a subject of intensive research. A better understanding of the pathogenic processes leading to the evolution of these disorders has paved the way for the development of newer and more effective treatment options.
Cessation of alcohol consumption is mandatory as it is the only way to reverse liver damage and to avoid liver cirrhosis
Pathogenesis of events Alcoholic Liver Disease (ALD) The 5 key Pathogenic Events involved in the pathogenesis of ALD are: 1. Acetaldehyde production 2. Oxidative stress 3. Endotoxemia 4. Nutritional deficits 5. Impaired hepatocyte regeneration
