Volume 66 - 2003 - Fasc.4 - Symposium
Who gets alcoholic liver disease : nature o r nurture ? (extended abstract)
Alcoholic Liver Disease (ALD) represents a conside- rable burden to the practising Clinician. Between 1988 and 2000, ALD was the commonest indication for ortho- topic liver transplantation in Europe and remains the commonest reason for admitting patients with liver dis- ease to hospital. Despite this burden, surprisingly little consensus exists in the field. In particular there is no consensus on disease pathogenesis and, as a result, on the factors that determine susceptibility. Most heavy drinkers will develop some degree of steatosis (fatty liver) but only about a third go on to develop alcoholic hepatitis and only between 1 in 4 and 1 in 12 progress to cirrhosis. The most obvious explanation for susceptibili- ty to ALD is the dose and pattern of alcohol consumed. Epidemiological studies have certainly demonstrated that there is a linear correlation between the number of alcohol units consumed per day and the risk of liver dis- ease and cirrhosis. However, in these studies, less than 6% of those taking the highest number of drinks per day had cirrhosis. Several other studies have shown that the pattern of intake is important, with disease risk incre- ased by drinking alcohol away from meal times, drin- king several rather than a single type of alcoholic bever- age and drinking daily rather than weekend drinking. There has also been recent evidence that wine drinkers may have a lower risk of ALD than consumers of other alcoholic beverages but this may be due to confounding factors.
Who gets alcoholic liver disease : nature or nurture ? (Summary of the discussion)
The State of the Art lecture of C.P. Day was essen- tially dealing with mechanisms of susceptibility to alco- holic liver damage. In the discussion, diagnostic and the- rapeutic management of alcoholic liver disease (ALD) was dealt with.
Vascular disorders of the liver
Vascular disorders of the liver can be produced by a variety of lesions affecting various parts of the hepatic vasculature : the capillaries - the so-called sinusoids ; the hepatic arterial tree from the large arteries to the arterioles ; the portal venous system from the portal veins to the portal venules ; and the hepatic venous sys- tem from the central venules to the major hepatic veins. Obviously, for clinical consequences to arise, injury to the microcirculation must be diffuse, whereas limited injury to the large blood vessels can have serious conse- quences. In this talk, I shall consider only disorders of the portal veins and disorders of the hepatic veins and I will focus mainly on thrombosis.