Dr P Saha
The problem of alcoholism is a world wide phenomenon. In Manipur it is an even bigger problem than many other places. We will not go into the social factors which predisposes to alcoholism, but will concentrate on the hepatic (Liver) aspects of alcoholism. Very well worked out statistics exist for the developed countries regarding the effect of alcohol on the individual and society. In Manipur it is one of the commonest causes for getting admitted to the hospital leading to enormous suffering and expenditure.
American statistics shows that the percentage of drinking alcohol excessively i.e. more than social drinking is around 44%, exdrinkers are 22% and those who are dependent on or abusing alcohol is between 7 to 10% at any point in time. Of the patients admitted to the hospital about 20% were alcoholics. The prevalence of the problem is more in the lesser educated and poorer sections of society. The most dreaded end result of alcoholism is cirrhosis. It is a serious disease of the liver where the normal liver cells are destroyed, the liver structure is destroyed and it is replaced by fibrous tissue. It has been shown that the incidence of cirrhosis is directly related to the amount of alcohol consumed and the duration of intake. On an average drinking about 120 to 150 ml of Whisky, Rum, Gin or Vodka for a period of 10 years would lead to the development of cirrhosis in 10 to 15% of the drinkers. This amounts to drinking about 1/3rd of a 375 ml bottle daily. Many people are drinking far in excess of this amount. Drinking about 2/3rd of a 750 ml bottle of whisky or rum for 2-0 years would lead to cirrhosis in 50% of the drinkers. If the drinker has other diseases like infection with hepatitis B or C, the process of development of cirrhosis is hastened and the percentage would be higher. For some reason women are more susceptible to the ill effects of alcohol than men and drinking half the amount leads to the same end result. It may be mentioned that injury, road traffic accidents and cancers of the oral cavity (mouth), esophagus (food pipe) and the liver are significantly increased in alcoholism.
Cirrhosis can manifest in many different ways in different patients. Some patients present with jaundice, some have swelling of the abdomen due to collection of fluid in the abdomen. Some go to the doctor or the hospital with vomiting of blood or passing black tarry coloured stool. Some of them present with loss of consciousness or some people have lethargy, marked weakness or excessive sleepiness or in a state of confusion.
Once the background of alcoholism is known it is very easy to diagnose the condition of cirrhosis and investigations are done merely to confirm the diagnosis and to prognosticate i.e. to predict the outcome of the disease. The tests that the doctors do in suspected cases of cirrhosis are complete blood count, liver function tests-Serum Bilirubin-direct and indirect, AST also known as SGOT, ALT also known as SGPT, total protein, albumin. Usually AST, ALT, Serum Bilirubin are increased. Albumin usually is reduced from normal levels. An abdominal ultrasound is done for evaluation of the size and texture of the liver, the size of the portal vein ( vein carrying blood away from the liver to the heart enlarged in cirrhosis), and presence of fluid in the abdomen. Test is also done to look for any concomitant infection with hepatitis B and C. An upper Gastro-intestinal Endoscopy (a tube is put in through the mouth to look inside the food pipe) is also done to look for the presence of varices which are dilated veins at the lower end of the esophagus i.e. the food pipe at its junction with the stomach. The presence of varices becomes strong confirmatory proof of cirrhosis. Varices can also be graded according to their size and this also gives the doctor an idea about the future chances of bleeding from this site resulting in the vomiting of blood and the passage of blood in the stool. Prothrombin Time test is checked and is usually raised. Ascitic fluid i.e. the fluid which collects in the abdomen is taken out with a needle. It is tested to see whether its findings are consistent with the diagnosis of cirrhosis or whether there is in addition some infection in the abdomen. There are different methods of evalunting different clinical and laboratory parameters to find out statistically how long a patient is going to survive.
There are various methods of treating the patients with cirrhosis. The treatment is mainly medical with surgical support being required in some cases. The details of these modalities of treatment are beyond the scope of the article. For end stage cirrhosis the treatment of choice is liver transplantation which is available at exorbitant cost in very few centres in India. There are many other adverse effects of alcohol on the body particularly on the nervous system which also are beyond the scope of this article.
The writer is an M.D. (Medicine) AIIMS, D.M. (Neurology) AIIMS, Neurologist Shija Hospital.
The Sangai Express
The problem of alcoholism is a world wide phenomenon. In Manipur it is an even bigger problem than many other places. We will not go into the social factors which predisposes to alcoholism, but will concentrate on the hepatic (Liver) aspects of alcoholism. Very well worked out statistics exist for the developed countries regarding the effect of alcohol on the individual and society. In Manipur it is one of the commonest causes for getting admitted to the hospital leading to enormous suffering and expenditure.
American statistics shows that the percentage of drinking alcohol excessively i.e. more than social drinking is around 44%, exdrinkers are 22% and those who are dependent on or abusing alcohol is between 7 to 10% at any point in time. Of the patients admitted to the hospital about 20% were alcoholics. The prevalence of the problem is more in the lesser educated and poorer sections of society. The most dreaded end result of alcoholism is cirrhosis. It is a serious disease of the liver where the normal liver cells are destroyed, the liver structure is destroyed and it is replaced by fibrous tissue. It has been shown that the incidence of cirrhosis is directly related to the amount of alcohol consumed and the duration of intake. On an average drinking about 120 to 150 ml of Whisky, Rum, Gin or Vodka for a period of 10 years would lead to the development of cirrhosis in 10 to 15% of the drinkers. This amounts to drinking about 1/3rd of a 375 ml bottle daily. Many people are drinking far in excess of this amount. Drinking about 2/3rd of a 750 ml bottle of whisky or rum for 2-0 years would lead to cirrhosis in 50% of the drinkers. If the drinker has other diseases like infection with hepatitis B or C, the process of development of cirrhosis is hastened and the percentage would be higher. For some reason women are more susceptible to the ill effects of alcohol than men and drinking half the amount leads to the same end result. It may be mentioned that injury, road traffic accidents and cancers of the oral cavity (mouth), esophagus (food pipe) and the liver are significantly increased in alcoholism.
Cirrhosis can manifest in many different ways in different patients. Some patients present with jaundice, some have swelling of the abdomen due to collection of fluid in the abdomen. Some go to the doctor or the hospital with vomiting of blood or passing black tarry coloured stool. Some of them present with loss of consciousness or some people have lethargy, marked weakness or excessive sleepiness or in a state of confusion.
Once the background of alcoholism is known it is very easy to diagnose the condition of cirrhosis and investigations are done merely to confirm the diagnosis and to prognosticate i.e. to predict the outcome of the disease. The tests that the doctors do in suspected cases of cirrhosis are complete blood count, liver function tests-Serum Bilirubin-direct and indirect, AST also known as SGOT, ALT also known as SGPT, total protein, albumin. Usually AST, ALT, Serum Bilirubin are increased. Albumin usually is reduced from normal levels. An abdominal ultrasound is done for evaluation of the size and texture of the liver, the size of the portal vein ( vein carrying blood away from the liver to the heart enlarged in cirrhosis), and presence of fluid in the abdomen. Test is also done to look for any concomitant infection with hepatitis B and C. An upper Gastro-intestinal Endoscopy (a tube is put in through the mouth to look inside the food pipe) is also done to look for the presence of varices which are dilated veins at the lower end of the esophagus i.e. the food pipe at its junction with the stomach. The presence of varices becomes strong confirmatory proof of cirrhosis. Varices can also be graded according to their size and this also gives the doctor an idea about the future chances of bleeding from this site resulting in the vomiting of blood and the passage of blood in the stool. Prothrombin Time test is checked and is usually raised. Ascitic fluid i.e. the fluid which collects in the abdomen is taken out with a needle. It is tested to see whether its findings are consistent with the diagnosis of cirrhosis or whether there is in addition some infection in the abdomen. There are different methods of evalunting different clinical and laboratory parameters to find out statistically how long a patient is going to survive.
There are various methods of treating the patients with cirrhosis. The treatment is mainly medical with surgical support being required in some cases. The details of these modalities of treatment are beyond the scope of the article. For end stage cirrhosis the treatment of choice is liver transplantation which is available at exorbitant cost in very few centres in India. There are many other adverse effects of alcohol on the body particularly on the nervous system which also are beyond the scope of this article.
The writer is an M.D. (Medicine) AIIMS, D.M. (Neurology) AIIMS, Neurologist Shija Hospital.
The Sangai Express
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