1. Alcoholic cirrhosis and acute alcoholic fatty liver with cholestasis
Chapter 3
Fatty Liver Diseases 1
Alcoholic cirrhosis and acute alcoholic fatty liver with cholestasis
Case 3.13

2. Clinical Presentation3
Fatty Liver Diseases 2
Clinical Presentation
A 46-year-old woman with a history of chronic alcohol intake and hypothyroidism presented with symptoms of alcohol withdrawal.
Physical exam revealed jaundice, palmar erythema, spider angioma, and telangiectasia formation over her face.
Ultrasound showed a fatty liver with cirrhosis.

3. Laboratory Values Course in Hospital Total Protein: 5.4 AST: 83
Fatty Liver Diseases 3
Laboratory Values
AST: 83
ALT: 27
Alk Phos: 120
Total Bilirubin: 8.9
Total Protein: 5.4
Albumin: 3.1
AFP 4.7
Serologies:
HIV, HBsAg, anti-HCV: Negative
Course in Hospital
Concerns for the possibility of alcoholic hepatitis due to the liver test abnormalities and worsening INR necessitated liver biopsy for confirmation before potential treatment.

4. Pathology A well-established micronodular cirrhosis was present (a).3
Fatty Liver Diseases 4
Pathology
A well-established micronodular cirrhosis was present (a).
Diffuse 4+ macrovesicular steatosis and cholestasis (arrows) were present (a, b).
There was no evidence of liver cell ballooning, Mallory-Denk body formation, or lobular inflammation, with sinusoidal collagen deposition minimal to absent.
Figure 3.13(a)
Figure 3.13(b)

5. 3
Fatty Liver Diseases 5
Diagnosis
Alcoholic cirrhosis and acute alcoholic fatty liver with cholestasis

6. 3
Fatty Liver Diseases 6
Comment
Although the aminotransferases were under 100 IU/L, the mildly abnormal AST with normal ALT, maintaining the AST:ALT ratio of >2:1 for alcoholic hepatitis, was still present.
The presence of diffuse steatosis without the characteristic changes of alcoholic hepatitis (liver cell ballooning, sinusoidal collagen deposition, Mallory-Denk bodies, lobular inflammation with neutrophils) is an infrequent variant of acute alcoholic liver disease (acute alcoholic fatty liver, AAFL), with the overall outcome more favorable compared to alcoholic hepatitis.