eMedicine Specialties > Gastroenterology > Liver

Alcoholic Fatty Liver: Follow-up

Author: Mohammad K Ismail, MD, Assistant Professor, Department of Internal Medicine and Gastroenterology, University of Tennessee at Memphis
Coauthor(s): Caroline Riely, MD, Professor, Departments of Medicine and Pediatrics, University of Tennessee Health Science Center
Contributor Information and Disclosures

Updated: Sep 15, 2008

Follow-up

Further Outpatient Care

  • Provide follow-up care for patients in an outpatient facility.
  • Determination of blood alcohol at every outpatient visit often is helpful in determining patient's compliance with abstinence.

Deterrence/Prevention

  • Almost all authorities agree that abstinence from alcohol improves survival and is the cornerstone of long-term management of patients with ALD.
  • Emphasize abstinence from alcohol early and continuously to optimize its beneficial effects. Abstinence improves histology, decreases portal hypertension, and decreases, but does not eliminate, development of cirrhosis.
  • Emphasize alcohol rehabilitation.

Complications

  • Continued alcohol consumption may result in a more advanced form of liver disease, either alcoholic hepatitis or cirrhosis.
  • In a study from Denmark, using a population-based National Registry, investigators noted an increased mortality and an increased cancer risk, particularly liver cancer, among patients discharged with a diagnosis of alcoholic fatty liver.

Prognosis

  • Alcoholic steatosis usually is considered a benign lesion with a favorable prognosis once alcohol consumption is discontinued.
  • Several prognostic factors have been described in the literature that may indicate advancement to more severe lesions in patients who continue to drink.
    • A study from England, for example, followed the cases of 88 patients with fatty liver for a mean of 10.5 years. Of these, 9 developed cirrhosis and 7 developed fibrosis. All but 1 of these 16 patients continued to use alcohol.
    • Histologic predictors of progression at the time of fatty liver included the presence of mixed macrovesicular/microvesicular fat and giant mitochondria.
    • Patients with alcoholic fatty liver have a high risk for development of cirrhosis and an increased mortality with the severity of steatosis in the index liver biopsy.
    • The presence of histologic cholestasis in association with alcoholic steatosis did not appear to be of prognostic significance in determining the risk of progression to cirrhosis.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider differential diagnosis
  • Failure to be aware of the rare complication of severe fatty liver, as death has been reported from this benign disease
 


More on Alcoholic Fatty Liver

Overview: Alcoholic Fatty Liver
Differential Diagnoses & Workup: Alcoholic Fatty Liver
Treatment & Medication: Alcoholic Fatty Liver
Follow-up: Alcoholic Fatty Liver
References
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Further Reading

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Keywords

alcoholic fatty liver, alcoholic steatosis, alcoholism, fatty liver, alcohol-related fatty liver, alcoholic liver disease, alcohol-related liver disease, simple steatosis, alcohol-related steatosis, fatty acids, alcoholic complications, alcohol-induced steatosis, alcohol-induced fatty liver

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Contributor Information and Disclosures

Author

Mohammad K Ismail, MD, Assistant Professor, Department of Internal Medicine and Gastroenterology, University of Tennessee at Memphis
Mohammad K Ismail, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Caroline Riely, MD, Professor, Departments of Medicine and Pediatrics, University of Tennessee Health Science Center
Caroline Riely, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Federation for Medical Research, American Gastroenterological Association, North American Society for Pediatric Gastroenterology and Nutrition, and Society of Obstetric Medicine
Disclosure: Nothing to disclose.

Medical Editor

Ann Ouyang, MBBS, Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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