Encyclopedia of Health and Medicine

72 The Gastrointestinal System
tic procedures might include abdominal ULTRA-
SOUND, COMPUTED TOMOGRAPHY (CT) SCAN, or PERCU-
TANEOUS LIVER BIOPSY.
Treatment Options and Outlook
Treatment is alcohol cessation and support for
symptoms. The doctor may recommend an alcohol
and SUBSTANCE ABUSE TREATMENT PROGRAM, counseling,
12-step program such as Alcoholics Anonymous,
and other efforts to help maintain SOBRIETY.
When liver disease of alcoholism reaches endstage
LIVER FAILURE, LIVER TRANSPLANTATION may be
an option for a person who has maintained sobriety
for at least six months and has a reasonable
expectation of doing so following the liver transplantation.
Though liver disease of alcoholism
continues if alcohol consumption resumes, with
alcohol abstinence the manifestations of liver disease
are generally reversible (except cirrhosis).
Risk Factors and Preventive Measures
Chronic alcohol use is the only cause of liver disease
of alcoholism. Though most often the use is
excessive, alcohol-related damage can occur to the
liver with moderate alcohol consumption that
extends over a long period of time. Alcoholic
steatohepatitis can develop in a person who consumes
as few as four alcoholic drinks a week. The
only, and absolute, preventive measure is abstinence
from alcohol.
See also ENCEPHALOPATHY; HEPATOTOXINS.
liver failure The inability of the LIVER to function.
Liver failure may be acute (comes on suddenly)
or chronic (develops over time). Because
the liver has the unique ability to regenerate, the
damage it takes to cause liver failure is substantial.
Liver failure generally occurs when more than 75
percent of the liver’s hepatocytes, the cells that
carry out most of the liver’s functions, die, a circumstance
called hepatocellular necrosis. LIVER
TRANSPLANTATION is the only curative treatment for
permanent liver failure.
The most common causes of hepatocellular
necrosis leading to liver failure are
• ALCOHOL
• acetaminophen and especially acetaminophen
OVERDOSE
• Amanita mushroom ingestion
• the illicit DRUG ecstasy (MDMA)
• isoniazid and rifampin in combination to treat
TUBERCULOSIS
• industrial chemicals such as arsenic, phosphorus,
carbon tetrachloride, and vinyl chloride
• disease processes
Hepatocellular necrosis is a SIDE EFFECT possible
with numerous prescription medications, notably
certain ANTIBIOTIC MEDICATIONS, “statin” lipid-lowering
medications, and tricyclic ANTIDEPRESSANT MED-
ICATIONS. In some circumstances prompt medical
intervention, such as with known overdose of
drugs, can slow or halt hepatocellular necrosis and
prevent liver failure, though liver damage may
still occur. Such interventions might include
aggressive medical efforts to remove or neutralize
the responsible drug, administration of acetylcysteine
for acetaminophen overdose, and liver
hemodialysis (though this is of limited availability).
In many circumstances, however, the
destructive action of the toxin or the inflammatory
process overwhelms the liver and attempted
medical interventions have little effect.
CONDITIONS THAT CAN CAUSE LIVER FAILURE
BILIARY ATRESIA
chronic HEPATITIS
CIRRHOSIS
HEAT STROKE
HEMATOCHROMATOSIS
HEMORRHAGIC FEVER
LIVER CANCER
LIVER DISEASE OF ALCOHOLISM
PORTAL HYPERTENSION
PRIMARY BILIARY CIRRHOSIS
PRIMARY SCLEROSING CHOLANGITIS REYE’S SYNDROME
secondary AMYLOIDOSIS
WILSON’S DISEASE
Acute liver failure Acute liver failure, also
called fulminant HEPATITIS, develops in days to
weeks. It nearly always follows a significant
assault to the liver, such as drug overdose or
severe trauma (such as gunshot wound) that
destroys liver tissue. Hepatitis A INFECTION also can
cause acute liver failure. Recovery without liver
transplantation is uncommon and is most likely to
occur with hepatitis A infection (about 50 percent
recovery rate) and promptly treated acetaminophen
toxicity.
Chronic liver failure Chronic liver failure, also
called nonfulminant hepatitis, develops over