Date post: | 31-May-2015 |
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Alcoholic Liver Disease in Pregnancy
Dr Nasir Khokhar MD FACP FACGProf of Medicine and Gastroenterology
Shifa International Islamabad
Alcohol effect on fetus brain
Effects on Fetus
Alcohol effects
Women with ALD were generally of higher age and body mass index, more
likely to smoke cigarettes during pregnancy and to have a low socio-
economic status.
They had an increased risk of very preterm birth. Infants of were at increased
risk for low Apgar scores (<7) at 5 min.
Similar associations with slightly lower-risk estimates were found among
women diagnosed with ALD after birth.
Mothers with Alcoholic Liver Disease and the Risk for Preterm and Small-for-gestational-age Birth. Alcohol and Alcoholism 2013;48:166–171.
Pregnancy, Alcohol and fetus
Alcohol and liver
Clinical Presentations
Fatty liver Normal liver
Alcohol and HCV
Liver problems in pregnancy
Liver disease in pregnancy
Clinical Manifestations
Pathogenesis
Role of mitochondria
Mitochondrial Dysfunction
Role of mitochondria
Alcohol induced liver disease
Alcohol induced liver disease
Effects of acetaldehyde
Immunologic aspects
Treatment
Treatment of Fatty liver
Illness severity and risk of poor outcome in alcoholic hepatitis
• Maddrey discriminant function (MDF): based on PT and bilirubin: greater than 32 indicate severe disease; 30-day mortality approximately 50%
• Combined Clinical and Laboratory Index • Model for end-stage liver disease (MELD) score • Glasgow alcoholic hepatitis score (GAHS)• Asymmetric dimethylarginine (ADMA) score
Treatment of Acute Alcoholic Hepatitis With Prednisolone ± N-Acetyl Cysteine
Nguyen-Khac E, et al. AASLD 2009. Abstract 91.
Prednisolone 40 mg/day for 28 days + NAC IV on Days 1-5*
(n = 85)
Prednisolone 40 mg/day for 28 days + 5% Glucose (Carrier) IV on Days 1-5
(n = 89)
Pts with acute alcoholic
hepatitis
(N = 174)
Follow-up: Mos 1, 2, 3, 6
Stratified by center
*Day 1 NAC: 150 mg/kg in 250 mL 5% glucose over 15 mins; 50 mg/kg in 500 mL 5% glucose over 4 hrs; 100 mg/kg in 1000 mL 5% glucose over 16 hrs. Days 2-5 NAC: 100 mg/kg in 1000 mL 5% glucose.
Mortality, % Prednisolone + NAC(n = 85)
Prednisolone + Carrier (n = 89)
P Value
Mo 6 (primary endpoint) 27.1 38.2 .117
Mo 1 8.2 23.6 .005
Mo 2 15.3 32.6 .007
Mo 3 22.4 33.7 .095
N Engl J Med 2011;365:1781-9.
Management of alcoholic hepatitis
Management of cirrhosis and its complications
• Portal Hypertension: Variceal bleeding, Ascites, Hepato renal syndrome, Spontaneous Bacterial Peritonitis
• Hepato cellular failure: Hepatic encephalopathy
• Hepato cellular carcinoma
In pregnancy, Not this drink
But this drink
Thanks