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Alcohol Abuse and Liver Disease

Tác giả: DiMartini, Andrea; Neuberger, James

Chủ đề:

Chủ đề: Medicine; Liver Disease; Alcohol Abuse

Nhà xuất bản: Wiley-Blackwell

Năm xuất bản: 2015

Loại tài liệu: Book

Mô tả vật lý: 262 p.

Định danh: 978-1-118-88728-8

Ngôn ngữ: en

Đọc trực tuyến

Tải tài liệu

For people with alcohol excess and liver disease, successful management must be two-fold with management of both their psychological/physical addiction to alcohol and their liver disease. Alcohol Abuse and liver disease, with its joint focus on hepatology and psychiatry, provides both hepatologists and psychiatrists of all levels with a practical, concise and didactic guide to the investigation and clinical management of those with alcohol-related problems

Cover
Title pages
Copyright Page
Contents
List of Contributors
Preface
Chapter 1 Epidemiology of alcohol use
- Introduction
- Methods of measuring alcohol use
- Why monitor alcohol use?
- Changes in national alcohol consumption over time
- National alcohol consumption estimates
- Patterns of alcohol use
- Factors determining use
- References
- The burden of alcohol use
Chapter 2 Epidemiology of alcohol-related liver disease
- Introduction
- Alcohol and liver disease: a historical perspective
- Current trends in alcohol consumption and cirrhosis
- Changing trends in alcohol consumption
- Associated risk factors for liver disease
  - Ethnicity
  - Gender
  - Obesity
  - Genetic polymorphisms
  - Socioeconomic status
- Methods for reducing the burden of liver disease attributable to alcohol
  - Population strategies to reduce the burden of disease
  - Individual strategies to reduce the burden of disease
- Methods for early detection of liver disease
- References
Chapter 3 Alcoholism: diagnosis and natural history in the context of medical disease
- Natural history and clinical assessment
  - Alcoholism frequency
- Differentiation by natural course
  - Alcohol use history
  - Making a diagnosis
- Physiological dependence: tolerance and withdrawal (ICD‐10 categories 1 and 2)
  - Alcohol withdrawal syndrome
  - Tolerance
- Loss of control phenomenon (ICD-10 category 4)
- Assessing prognosis
  - Positive versus negative
  - Abuse rather than dependence
  - Assessing ambivalence and continuing LOC risk
  - Behavioral versus hepatic diagnosis
  - Diagnosis is prognosis
  - Social stability
  - Vaillants four prognostic factors
  - Summing up prognosis
- Social or physical decline (ICD-10 categories 5 and 6)
- DSM-5 and alcoholism diagnosis: evolution of the new diagnostic criteria
- Other psychiatric assessment
  - Nicotine dependence
  - Psychiatric diagnoses
- Does liver transplant change the natural history of alcoholism?
- Conclusions
- References
Chapter 4 Alcohol and other substance misuse
- Alcohol and liver disease
- Introduction
- Disorders of alcohol regulation
  - Nature of alcohol use disorders
  - Spectrum of alcohol use and misuse
  - Implications of dependence
  - Neurobiology of alcohol dependence
- Alcohol and other substance use
  - Types of substance use
  - Reasons for multiple substance use
- Pathways to alcohol and other substance use
- Making the diagnosis of alcohol and substance use disorders
  - Approaches to the history
  - Three domains of enquiry
  - Key aspects of physical examination
  - Screening, assessment, and diagnostic schedules
- Laboratory tests
- References
Chapter 5 Risk factors for alcohol-related liver disease
- Evidence for risk modifiers in ARLD
- Environmental risk factors
- Genetic risk factors
- Geneenvironment interactions
- Relevance to practice
- References
Chapter 6 Mechanisms of alcohol toxicity
- Alcohol metabolism and impact
- Pathologic mechanisms
  - Metabolic impact and lipotoxicity
  - Lipopolysaccharide and endotoxemia
  - Oxidative stress
  - TLR4-mediated activation
  - Immunologic mechanisms inducing inflammation
  - Fibrosis
  - Epigenetic effects
  - Other contributing factors
- Conclusions
- References
Chapter 7 Extrahepatic manifestations of alcohol excess
- Overarching systemic effects
  - Central and peripheral nervous system
  - Endocrine organs
  - Carcinogenesis
  - Immune system
  - Lipid metabolism
- Specific organ systems
  - Cardiovascular system
  - Gastrointestinal tract
  - Oral cavity and esophagus
  - Pancreas
  - The lungs
  - Alcohol and the skin
  - The kidneys
- Alcohol consumption and pregnancy
- Conclusions
- References
Chapter 8 Patterns of alcohol-associated liver damage
- Alcoholic steatosis
  - Clinical presentation
  - Differential diagnosis
  - Investigations
  - Pathology
  - Natural history
- Alcoholic hepatitis
  - Clinical presentation
  - Differential diagnosis
  - Pathology
  - Investigations
  - Natural history
- Alcoholic cirrhosis
  - Clinical presentation
  - Differential diagnosis
  - Investigations
  - Natural history
- Hepatocellular carcinoma
  - Clinical presentation
  - Investigations
  - Natural history
- Conclusions
- Determinants of injury pattern
- Distinction from nonalcoholic fatty liver disease
- References
Chapter 9 Cofactors and alcohol-related liver disease
- Body weight, obesity, and diabetes mellitus
- Introduction
- Iron
- Alfa-1 antitrypsin phenotype
- Cofactors and liver histology
- Hepatitis C
- References
Chapter 10 Impact of alcohol and liver disease on prescribing
- Effect of liver disease on the metabolism of drugs
- Hepatic drug metabolism
- Effect of alcohol on metabolism of drugs
- Metabolism of alcohol
- Specific prescribing problems: hepatology
- Specific drug interactions: psychiatry
  - Antidepressants
  - Anxiolytics
  - Drugs used for treatment of alcohol abuse
- Other commonly used drugs
  - Analgesia
  - Cardiovascular drugs
- Monitoring therapy in liver disease
- Conclusions
- References
Chapter 11 Psychiatric examination of liver transplant patients with alcohol use disorders
- Introduction
- The patients perspective
  - Myth 1: Youre the last one I have to see to pass the test so I can get my liver
  - Myth 2: “I feel badly that someone died so I can live”
  - Myth 3: “There are so many others who deserve a liver more than I do, and besides, I am probably not going to get a liver anyway”
  - Myth 4: Youre saying Im an alcoholic, but Ill bet you think that because you never took a drink in your life
  - Myth 5: Im depressed, but I have to live with it because my doctors told me I cant take any medicine for depression; its not good for my liver
  - Myth 6: I dont need rehab, I am strong willed and I know I will never drink again
- The psychiatrists perspective
  - Structure of the psychiatric interview
  - The patient interview
  - Alcohol use history
- Conclusions
- References
Chapter 12 Abnormal liver tests in the context of alcohol excess
- Liver function tests
- Transaminases (ALT and AST)
- Albumin
- Alkaline phosphatase
- Bilirubin
- Gamma-glutamyl transpeptidase
- Liver function tests in asymptomatic individuals
- Patterns of liver function tests in alcoholic liver disease
  - Alcohol excess
  - Alcoholic hepatitis
  - Alcoholic steatosis
  - Cirrhosis of the liver secondary to alcohol excess
- References
Chapter 13 Biochemical determination of alcohol consumption
- Introduction
- Traditional biomarkers for alcohol consumption
  - Carbohydrate deficient transferrin
  - Gamma-glutamyl transferase
  - Mean corpuscular erythrocyte volume
  - Combination of individual markers
  - Serum transaminases
- Ethanol metabolites
  - Blood and urine analysis
  - Hair analyses
  - Ethanol metabolites and liver transplantation
- Conclusions
- References
Chapter 14 The role of histology
- Acute alcoholic hepatitis
- Background
- Pathology of alcoholic liver disease
- Summary of typical features of steatosis, steatohepatitis, and AAH
- Cofactors
  - A-1-antitrypsin globules
  - Hepatitis C virus
  - Iron
- Differentiation of ALD from NASH and other diseases with overlaping features
- HCC diagnosis
- Information in the pathology report
- Conclusions
- Post-transplant liver histology
  - Recurrent disease and de novo NAFLD or NASH
- References
Chapter 15 General assessment and management
- Introduction
- Laboratory evaluation
- Medical history
- Physical examination
- Imaging techniques
- Noninvasive tests
- Assessing the severity of liver disease
- Assessment and management of extrahepatic manifestations
  - Digestive tract
  - Heart and vascular system
  - Nutritional status
  - Bone disorders
  - Nervous system
  - Endocrine system
  - Psychiatric disorders
- Conclusions
- References
Chapter 16 Brief alcohol interventions
- Background
- What is brief intervention?
- Brief intervention structure and practice
- Brief intervention theory
- Evidence for brief interventions
- Implementing brief interventions
- Targeting key groups
- Key messages for practitioners
- Conclusions
- References
Chapter 17 Alcohol withdrawal syndrome: diagnosis and treatment
- Epidemiology
- Alcohol withdrawal syndrome, early experience and syndrome definition
- Methods of treatment of AWS
  - Front-loading
  - Fixed-schedule
  - System-triggered
- Pathophysiology of AWS
- Pharmacology of treatment
  - Anticonvulsants
  - Antipsychotics
  - Baclofen
  - Barbiturates
  - Benzodiazepines
  - Chlormethiazole
  - Propofol
  - Beta-blockers
  - Supportive care
  - α-2 Agonists
- Conclusions
- References
Chapter 18 Psychosocial treatments of alcohol use disorders
- Challenges unique to ALD patients with alcohol use disorders
- Rationale for treatment
- Relapse predictors
- Psychosocial treatments and Alcoholics Anonymous for alcohol use disorders in the general population
- Cognitive behavioral therapy
- Motivational enhancement therapy
- Network support and couples therapy
- 12-step facilitation and AA
- Pre-liver transplant alcohol treatment interventions
- Conclusions
- Post-liver transplant alcohol treatment interventions
- References
Chapter 19 Pharmacologic interventions
- Introduction
- Treatment of alcohol withdrawal
- Agents for reducing alcohol consumption
  - Disulfiram
  - Extended-release naltrexone
  - Oral naltrexone
  - Acamprosate
  - Nalmefene
  - Anticonvulsants
  - Baclofen
  - Lithium
  - Ondansetron
  - Selective serotonin reuptake inhibitors
- Conclusions
- References
Chapter 20 Treatment of extrahepatic manifestations of alcohol abuse
- Introduction
- Reasons for the multisystemic effects of ethanol
- Evaluation of alcohol toxicity
- Organ-specific damage in alcohol abuse
- Baseline considerations for treatment
- Treatment of systemic organ damage in alcohol abuse
  - Basic points
  - Specific points of treatment of organ damage
- References
Chapter 21 Treatment of liver disease
- Follow-up
  - General health
  - Immunization
  - Reproductive health
- Introduction
- Cirrhosis
- Detection and management of complications of portal hypertension
  - Varices
  - Ascites
  - Hepatocellular carcinoma
  - Renal impairment and hyponatremia
  - Spontaneous bacterial peritonitis
  - Cardiorespiratory problems
  - Hepatic encephalopathy
- Conclusions
- Further reading
Chapter 22 Treatment of alcoholic hepatitis
- Diagnosis of alcoholic hepatitis
  - Role of liver biopsy
- Determination of disease severity
  - Maddreys discriminant function
  - Model for end-stage liver disease
  - Age, bilirubin, INR, and creatinine score
  - Glasgow AH score
  - Histologic scoring
  - Summary
- General considerations
  - Abstinence from alcohol
  - Management of nutrition and fluid status
  - Screening and treatment of infection
- Specific treatments
  - Corticosteroids
  - Antitumor necrosis factor biologic therapies
  - Pentoxifylline
  - Anabolic steroids
  - Insulin and glucagon
  - Liver transplantation
  - N-acetylcysteine and antioxidants
  - Other agents
- Future therapeutic directions
- References
Chapter 23 Liver transplantation in people with alcohol‐related liver disease
- Introduction
- Importance of abstinence in recovery from ALD
- Referral of the patient with ALD for liver transplantation
- Spectrum of alcoholic liver disease
- Timing for liver transplantation and the concept of survival benefit
- Contrasting perspectives of addiction and transplant medicine
- How should abstinence be assessed and maintained?
- Outcome of liver transplantation in patients with ALD
- Relapse to alcohol use before or after liver transplantation
- Specific work-up for ALD candidate
- Role of liver transplantation in alcoholic hepatitis
- Quality of life
- References
- Treatment of addiction
Chapter 24 Future directions: the need for early identification and intervention for patients with excessive alcohol use
- Primary intervention strategies
- Secondary intervention strategies
- Tertiary intervention strategies
- Conclusions
- References
Index
Supplemental Images
EULA