Abstract
Aclinical and pathological study on chronic alcoholic patients showing acllte hepatic failure due to alcoholic liver disease without liver cirrhosis was performed.
The patients consisted of five male and one female. The mean (±S.D.) age was 46.1±8.7 years, total consumption of ethanol 810±550kg, and the average daily consumption of ethanol 143±33 g per day. All patients revealed an increase in consumption of ethanol and a poor dietary intake for from 5 days to four weeks before admission. Serum HBs antigen was negative in all cases. Icterus was seen in all patients, and ascites in five cases, Four patients showed deep hepatic coma (grade V) and three of the four patients died. The other two patients revealed moderate hepatic coma (grade II) and recovered. Liver specimens showed numerous Mallory bodies and neutrophil infiltration with necrosis of hepatocytes (typical alcoholic hepatitis) in two cases (died), alcoholic hepatitis with marked foamy degeneration in one case (died), hepatic fibrosis with conspicuous ballooning of hepatocytes and intrahepatic cholestasis in two cases (survived), and hepatic fibrosis without any necroinflammatory changes in one case (survived). In the latter three cases who survived, Mallory bodies were not observed by H & E and AZAN stains, electron microscopy, and indirect immunofluorescence method using anti-Mallory body antiserum. Neutrophil infiltration was also invisible in these three biopsy specimens.
These findings showed that even in severe acute alcoholic liver disease, histology of the liver varied from typical alcoholic hepatitis to hepatic fibrosis.
