Acute Cholestasis, Hepatic Failure, and Fatty Liver in the Alcoholic

Abstract

Three alcoholic patients are described who presented with acute cholestasis and liver cell failure. In each patient the liver biopsy showed severe fatty change with cholestasis, but without typical alcoholic hepatitis. There was no evidence of extra-hepatic biliary obstruction, although one patient had chronic pancreatitis. Two of the three patients died of hepatic failure, but the third recovered and has remained well while abstaining from alcohol.

Alcoholic foamy degeneration and alcoholic fatty liver with jaundice: Often overlooked causes of jaundice and hepatic decompensation that can mimic alcoholic hepatitis

“…[3][4][5][9][10][11][12][13] In a study of 124 patients who died of alcohol-related liver disease, 51 (35%) had autopsy evidence of AH, whereas only 5 (4%) had AFD. Although Morgan et al 6 reported death from hepatic failure in two of three patients with AFD, the biopsies of both deceased patients showed evidence of acute inflammation that may have represented coexisting AH. Specific therapies such as corticosteroids or pentoxifylline have not been studied in patients with AFLJ or AFD and are not indicated.…”

“…[3][4][5][6][7] These presenting symptoms and signs are clinically indistinguishable from those of AH. Laboratory findings in patients with AFLJ or AFD include elevations in serum levels of alkaline phosphatase, bilirubin, gamma-glutamyltranspeptidase (GGT), and aminotransferases, 6,7,9-13 often with a ratio of the aspartate aminotransferase (AST) level to the alanine aminotransferase (ALT) level of greater than 2. Liver synthetic dysfunction as indicated by decreased serum albumin and prolonged prothrombin time is variable.…”

“…Case reports of such episodes, which we refer to as alcoholic fatty liver with jaundice (AFLJ), have been published since the 1950s. [2][3][4][5][6] Episodes of jaundice have also been reported in patients whose liver biopsies showed diffuse microvesicular steatosis, an entity termed alcoholic foamy degeneration (AFD) by Uchida et al 7 in 1983. Despite similarities in their clinical presentations, AFLJ and AFD are often overlooked in the differential diagnosis of AH.…”

Intrahepatic Cholestasis

“…Initial reports associated alcoholic intrahepatic cholestasis with marked steatosis [78,79]. Initial reports associated alcoholic intrahepatic cholestasis with marked steatosis [78,79].…”

Alcoholic Liver Disease. Histological Features and Evolution

“…Some subcategories have already been proposed, including e.g. central sclerosing hyaline necrosis (10); alcoholic foamy degeneration (1 1) and alcoholic cholestasis (12,13). It seems possible that in some cases alcoholic cirrhosis develops without passing through the stage of alcoholic hepatitis (14).…”