A 40 Year Old Alcoholic Man With fatigue, Anorexia And Jaundice

A 40 year old man presents to the clinic with the complains of feeling tired with aches in his arms and legs for the past 2 months. He says he feels nauseous and has vomited multiple times in the last one month. He feels anorexic and has lost his appetite. He has also noticed having an intermittent right upper quadrant abdominal pain. He drinks approximately 20 alcoholic beverages per week. He denies any chest pain, cough, difficulty breathing, or any problems with urination or bowel habits. He did notice his skin to be mildly jaundiced. On examination he has mild abdominal tenderness in the right upper quadrant and has a palpable mild hepatosplenomegaly.

What is the Differential Diagnosis?

Differential Diagnosis:

• Hepatitis
• Alcohol related liver disease
• Cirrhosis
• Acute pancreatitis.
• Hepatocellular carcinoma. 

A biopsy from his liver shows following pathologic features:

The main pathologic features of alcoholic steatohepatitis include macrovesicular steatosis, hepatocellular damage, inflammation, and pericellular fibrosis.


The patient was diagnosed with Alcohol related liver disease.


Case Discussion

Alcohol Related Liver Disease:

• A pathological condition of progressive liver damage due to chronic alcoholism. 
• The early stage is characterized by fatty deposits in the liver i.e hepatic steatosis.
• Continued alcohol use leads to hepatic inflammation, tissue necrosis and cirrhosis.
• The patient may be asymptomatic for several years then may eventually develop non-specific symptoms of anorexia, nausea and vomiting. 
• Physical signs include abdominal tenderness, ascites, splenomegaly, hepatomegaly, fever, jaundice, testicular atrophy, gynecomastia and digital clubbing. 
• On laboratory workup there is increase ALT, AST ,gamma GGT, alkaline phosphatase, total and direct billirubin. 
• Biopsy is diagnostic and will show an increased fatty composition of the liver, areas of necrosis and many polymorponeutrophils. 
• CT, MRI or ultrasound of the liver may detect fatty liver.
• The main goal of the treatment is to stop alcohol consumption to prevent further damage.
• High calorie diet with thiamine and folate supplements are recommended. 
• Liver transplantation is an option for patients with cirrhosis and who are able to maintain abstinence from alcohol.