Biochemical, Morphological and Clinical Correlates of Alcoholic Liver Disease

  • H. Orrego
  • Y. Israel

Abstract

One of the puzzling aspects of alcoholic liver disease is the lack of correlation between the classical morphological abnormalities found in the liver and the clinical manifestations of liver failure (Schaffner and Popper, 1970; Galambos, 1974; Birschbach et al., 1974; Bathal et al., 1975; Helman et al., 1971; Leevy et al., 1953; Green et al., 1963; Rankin et al., 1978; Leevy et al., 1976). Morphological changes in liver diseases have been grouped essentially into three categories, namely fatty liver, alcoholic hepatitis and cirrhosis (Leevy et al., 1976). It is generally agreed that as a group individuals presenting only fatty liver are clinically less severely ill than those with alcoholic hepatitis and cirrhosis (Rankin et al., 1978). The implication is that the three stages represent increasing degrees in the progression of the disease. Nevertheless, from the clinical point of view, the whole spectrum of severity of liver disease, from the clinically inapparent to death, can occur in patients in every category (Bathal et al., 1975; Helman et al., 1971; Leevy et al., 1953; Rankin et al., 1978; Leevy et al., 1976; Christoffersen and Neilsen, 1972; Nakamura et al., 1967; Goldberg and Thompson, 1961; Green, 1965; Leevy, 1962; Knott and Beard, 1966; Bordalo et al., 1974; Galambos, 1972; Popper and Szanto, 1957). These studies indicate that these three alleged progression stages do not adequately describe the disease, and warrant further investigation into the possible correlations of individual structural findings and the clinical manifestations. The possibility exists of finding new morphological parameters that might correlate better with the severity of the clinical features and with the progression of the functional deterioration of the liver.

Keywords

Fatty Liver Portal Hypertension Serum Bilirubin Alcoholic Liver Disease Portal Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Alexander, J.F., M.W. Lischner, and J.T. Galambos, 1971, Natural history of alcoholic hepatitis. II. The longterm prognosis, Amer. J. Gastroent., 56: 515.Google Scholar
  2. Baraona, E., M.A. Leo, S.A. Borowsky, and C.S. Lieber, 1977, Pathogenesis of alcohol-induced accumulation of protein in the liver, J. Clin. Invest., 60: 546.Google Scholar
  3. Bathal, P.S., P. Wilkinson, S. Clifton, J.G. Rankin, and J.N. Santamaria, 1975, The spectrum of liver disease in alcoholism, Aust. N.S.J. Med., 5: 49.Google Scholar
  4. Birschbach, H.R., U. Harinasuta, and H.J. Zimmerman, 1974, Alcoholic steatonecrosis. IT. Prospective study of prevalence of Mallory bodies in biopsy specimens and comparison of severity of hepatic disease in patients with and without this histological feature, Gastroent., 66: 1195.Google Scholar
  5. Bordalo, D., A. Batista, M. Noronha, J. Lamy, and D.A. Dreiling, 1974, Effects of ethanol on liver morphology and pancreatic function in chronic alcoholism, Mt. Sinai J. Med., 41: 722.Google Scholar
  6. Carlson, E., Ch. F. Zukoski, J. Campbell, and M. Chvapil, 1977, Morphologïc, biophysical, and biochemical consequences of ligation of the common bilïary duct in the dog, Amer. J. Path., 86: 301.Google Scholar
  7. Christoffersen, P., and K. Neilsen, 1972, Histological changes in human liver biopsies from chronic alcoholics, Acta Path. Micro. Scand., 80: 557.Google Scholar
  8. Davidson, Ch. S., and G.J. Gabuzda, 1950., Nutrition and disease of the liver, New Engl. J. Med., 243: 779.Google Scholar
  9. Foidart, J.M., G. Rorive, and B. Nusgens, 1978, Aortic collagen biosynthesis during renal hypertension, pregnancy and hypertension during pregnancy in the rat, Biomedicine, 28: 215.PubMedGoogle Scholar
  10. Galambos, J.T., 1974, The Liver and Its Diseases, New York, Intercontinental Medical.Google Scholar
  11. Galambos, J.T., 1972, Alcoholic hepatitis: Its therapy and prognosis, in Progress in Liver Diseases, H. Popper and F. Shaffner, ed., Grune and Stratton, New York.Google Scholar
  12. Goldberg, M., and C.M. Thompson, 1961, Acute fatty metamorphosis of the liver, Ann. Intern. Med., 55: 416.Google Scholar
  13. Green, J., S. Mistïlis, and Z. Schiff, 1963, Acute alcoholic hepatitis. A clinical study of fifty cases, Arch. Int. Med., 112: 67.Google Scholar
  14. Green, J.R., 1965,. Subclinical acute liver disease of the alcoholic, Aust. Ann. Med., 14: 111.Google Scholar
  15. Hardison, W.G., and F.I. Lee, 1966, Prognosis in acute liver disease of the alcoholic patient, N. Engl. J. Med., 275: 61.Google Scholar
  16. Harinasuta, U., and H.J. Zimmerman, 1971, Alcoholic steatonecrosis. I. Relationship between severity of hepatic disease and presence of Mallory bodies in the liver, Gastroent., 60: 1036.Google Scholar
  17. Helman, R.A., M.H. Temko, F.W. Nye, and H.J. Fallon, 1971, Alcoholic hepatitis. Natural history and evaluation of prednisolone therapy, Ann. Intern., Med., 74.: 311.Google Scholar
  18. Israel, Y., P.G. Walfish, H. Orrego, J. Blake, and H. Kalant, 1979, Thyroid hormones in alcoholic liver disease. Effect of treatment with 6-n-propylthiouracil, Gastroent., 76: 116.Google Scholar
  19. Iwatsuki, K., G.J. Cardinale, S. Spector, and S. Udenfriend, 1978, Hypertension: Increase of collagen biosynthesis in arteries but not in veins, Science, 198: 403.Google Scholar
  20. Kalager, T., O. Brunakk, and V. Lehmann, 1979, Intrehepatic pressures measured during laparoscopy, Scand. J. Gastroent., 14: 301.Google Scholar
  21. Knott, D.H., and J.D. Beard, 1966, Liver function in apparently healthy chronic alcoholic patients, Ann. J. Med. Sci., 252: 260.Google Scholar
  22. Lecompte, Y., J.M. Metreau, H.S. Sancho, and H. Bismuth, 1974, Prediction of mortality in cirrhosis of the liver, Surg. Gyn. Obst., 139: 529.Google Scholar
  23. Leevy, C.M., 1962, Fatty Liver; A study of 270 patients with biopsyproven fatty liver and a review of the literature, Medicine, 41: 249.PubMedCrossRefGoogle Scholar
  24. Leevy, C.M., H. Popper, and S. Sherlock, 1972, Disease of the liver and biliary tract. Standardization of nomenclature, diagnostic criteria and a diagnostic methodology, Washington, D.C.U.S. Govt. Printing Office (NIH).Google Scholar
  25. Leevy, C.M., W. ten Hove, A. Opper, and S. Popovic, 1970, Influence of ethanol and microsomal drugs on hepatic hemodynamics, Ann. N.Y. Acad. Sci., 170: 315.Google Scholar
  26. Leevy, C.M., M.A. Zinke, T.J. White, and A.M. Guessi, 1953, Clinical observations on the fatty liver, Arch. Intern. Med., 92: 527.Google Scholar
  27. Man. M., R.B. Nagle, and E. Adams, 1978, Chemical estimation of interstitial and basement membrane collagen in obstructive nephropathy, Exp. and Mol. Path., 29: 144.Google Scholar
  28. Nakamura, T., S. Nakamura, T. Aikawa, O. Suzuki, A. Onodera, and N. Karoji, 1967, Clinical studies of alcoholic hepatic disease, Tohoku J. Exp. Med., 93: 179.Google Scholar
  29. Ooshima, A., G.C. Fuller, G.J. Cardinale, S. Spector, and S. Udenfriend, 1977, Reduction of collagen biosynthesis in blood vessels and other tissues by reserpine and hypophysectomy, Proc. Natl. Acad. Sci. ( USA ), 74: 777.Google Scholar
  30. Orrego, H., E. Amenabar, G. Lara, E. Baraona, R. Palma, and F. Massad, 1964, Measurement of intrahepatic pressure as index of portal pressure, Amer. J. Med. Sci., 247: 278.Google Scholar
  31. Orrego, H., L.M. Blendis, I.R. Crossley, A. Medline, A. Macdonald, S. Ritchie, and Y. Israel, subm., Correlation of portal hypertension with collagen in the Disse space and hepatomegaly in humans and in the rat, submitted for publication.Google Scholar
  32. Orrego, H., H. Kalant, Y. Israel, J. Blake, A. Medline, J.G. Rankin, A. Armstrong, and B. Kapur, 1979, Effect of short-term therapy with propylthiouracil in patients with alcoholic liver disease, Gastroent., 76: 105.Google Scholar
  33. Orrego, H., A. Medline, L.M. Blendis, J.G. Rankin, and D.A. Kreaden, 1979, Collagenisation of the Disse space in alcoholic liver disease, Gut., 20: 673.PubMedCrossRefGoogle Scholar
  34. Popper, H., and P.B. Szanto, 1957, Fatty liver with hepatic failure in alcoholics, J. Mt. Sinai Hosp., 24: 1121.Google Scholar
  35. Powell, M.J., and G. Klatskin, 1968, Duration of survival in patients with Laennecs cirrhosis. Influence of alcohol withdrawal, and possible effects of recent changes in general management of the disease, Am. J. Med., 44: 406.Google Scholar
  36. Rankin, J.G.D., H. Orrego, J. Deschenes, A. Medline, J.E. Findlay, and A.I.M. Armstrong, 1978, Alcoholic liver disease: The problem of diagnosis, Alcoholism Clin. Exp. Res., 2: 327.Google Scholar
  37. Rankin, J.R., P. Wilkinson, and J.N. Santamaria, 1970, Factors influencing the prognosis of the alcoholic patient with cirrhosis, Aust. Ann. Med., 3: 232.Google Scholar
  38. Rothschild, M.A., M. Oratz, and S.S. Schreiber, 1970, Changing concepts of albumin metabolism and distribution in cirrhosis of the liver, Scand. J. Gastroent., Suppl. 7: 17.Google Scholar
  39. Rothschild, M.A., M. Oratz, and S.S. Schreiber, 1972, Albumin synthesis, New Engl. J. Med., 286: 748.Google Scholar
  40. Schaffner, F., and H. Popper, 1970, Alcoholic hepatitis in the spectrum of ethanol-induced liver injury, Scand. J. Gastroent., Suppl. 7: 69.Google Scholar
  41. Veenes, J.A., 1970, Transhepatic pressure measurements, Ann. N.Y. Acad. Sci., 170: 193.Google Scholar
  42. Walfish, P.G., H. Orrego, Y. Israel, J. Blake, and H. Kalant, 1979, Serum triiodothyronine and other clinical and laboratory indices of alcoholic liver disease, Ann. Intern. Med., 91: 13.Google Scholar
  43. Worner, T., and C.S. Lieber, 1978, Prognostic value of perivenular sclerosis in the progression of alcoholic liver injury, Gastroent, 75: 995.Google Scholar

Copyright information

© Springer Science+Business Media New York 1980

Authors and Affiliations

  • H. Orrego
    • 1
  • Y. Israel
    • 1
  1. 1.Departments of Pharmacology and MedicineUniversity of Toronto and the Addiction Research FoundationTorontoCanada

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