______________________________________________________________ Alcohol and Alcohol Use Disorder
Miscellaneous Signs/Symptoms • Gout
Liver Transplantation The leading indication for liver transplantation in the United States is chronic hepatitis C [101]. Cirrhosis due to alcoholic liver disease is the second most common cause for a person to require a liver transplantation [101]. Candidates for liver transplantation should be adequately screened for alcohol use disorders and receive appropriate treatment both perioperatively and as part of long-term follow-up. Patient survival after transplantation for both of these conditions is surprisingly good, with 72% of patients surviving after five years [101]. Short-term survival is similar; however, long- term survival for patients with hepatitis C now appears to be compromised by universal recurrence. When patients have both alcohol use disorder and chronic hepatitis C, they do worse than when both diseases occur independently. One study demonstrated that patients’ short-term survival is the same for those who have alcohol use disorder, hepatitis C, or both diseases [102]. ALCOHOL/ACETAMINOPHEN INTERACTION Chronic heavy drinking appears to activate the enzyme CYP2E1, which may be responsible for transforming the over- the-counter pain reliever acetaminophen into toxic metabolites that can cause liver damage [103]. Even when acetaminophen is taken in standard therapeutic doses, liver damage has been reported in this population [104; 105]. A review of studies of liver damage resulting from acetaminophen-alcohol interaction reported that, in individuals with alcohol use disorder, these effects may occur with as little as 2.6 grams of acetaminophen (four to five “extra-strength” pills) taken over the course of the day by persons consuming varying amounts of alcohol [106]. The damage caused by alcohol-acetaminophen interaction is more likely to occur when acetaminophen is taken after, rather than before, the alcohol has been metabolized [107]. Moderate drinkers should also be made aware of this potential for interaction. There is now a warning label on the bottle that states, “If you consume three or more alcoholic drinks every day, ask your doctor whether you should take acetaminophen or other pain relievers/fever reducers.” Further, in 2014 the U.S. Food and Drug Administration (FDA) issued a statement that combination prescription pain relievers containing more than 325 mg acetaminophen per dosage unit should no longer be prescribed due to reported severe liver injury with acetaminophen in patients who took more than the prescribed dose in a 24-hour period; took more than one acetaminophen- containing product at the same time; or drank alcohol while taking acetaminophen products [108]. CARDIOVASCULAR DISORDERS Alcohol can have a detrimental effect on the heart, including a decrease in myocardial contractility, hypertension, atrial and ventricular arrhythmias, and secondary nonischemic dilated cardiomyopathy [109]. A common complication in alcohol use disorder is elevated pulse and blood pressure, often in the
• Impotence • Bloated face
• Parotid swelling • Trauma injuries • Aches and pains • Unusual accidents • Broken bones • Driving accidents, multiple citations, and other problems
COMPLICATIONS
Alcohol use disorders are often associated with physical disorders and related problems. LIVER DISEASE The liver is a particularly vulnerable organ to alcohol consumption, in large part because it is where alcohol is metabolized prior to elimination from the body. As few as six drinks a day for men have been found to be associated with liver damage. The most common manifestation among persons with alcohol use disorder is called “fatty liver.” Among heavy drinkers, the incidence of fatty liver is almost universal. For some, a fatty liver may precede the onset of alcoholic cirrhosis. Fatty deposits have been associated with men who have six or more drinks a day and women who have only one or two drinks daily. Alcoholic hepatitis is a condition that, when severe, is characterized by jaundice, fever, anorexia, and right upper- quadrant pain. Between 10% and 35% of heavy drinkers (those drinking five or six standard drinks a day or more) develop alcoholic hepatitis and 10% to 20% develop cirrhosis [96; 97]. More than 60% of persons who develop both alcoholic hepatitis and cirrhosis will die within four years. Drinking 12 beers a day for 20 years has been associated with a 50% incidence of cirrhosis. It is not known which individuals will develop cirrhosis. Studies have shown that women develop liver disease faster and at lower levels of alcohol consumption than men [97; 98]. Women also have a higher incidence of alcoholic hepatitis and higher mortality rate from cirrhosis [99]. Alcohol use disorder is also a strong predictive factor for the development of hepatocellular cancer [100]. The presence of other hepatic risk factors, including hepatitis C, fatty liver disease, smoking, and obesity, further increases this risk.
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MDMI1826
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