Pathology of alcoholism.

The chronic abuse of alcohol often leads to rather specific pathologic changes that affect one or more organ systems; only a few are spared. Most commonly affected is the liver, where a wide range of abnormalities may occur. Acute liver disease includes one or more of the following: fatty liver with cholestasis, acute sclerosing hyaline necrosis (alcoholic hepatitis), lytic necrosis, or acute portal fibrosis. Progression to precirrhosis or cirrhosis may follow acute disease or may occur slowly and be undetected clinically. Complications of cirrhosis such as esophageal varices, ascites, muscle wasting, and renal failure are common. Severe siderosis also occurs. Hepatocellular carcinoma and, to a lesser degree, cholangiocarcinoma may arise in the cirrhotic liver. The pancreas, likewise, may be the seat of acute disease, alcoholic pancreatitis, or long-continued injury that leads to chronic calcifying pancreatitis. Pseudocysts or abscesses may complicate acute disease. Both acute and chronic myocardial injury have been noted and aptly named alcoholic cardiomyopathy. Alcoholic myopathy (rhabdomyolysis), affecting skeletal muscle, may occur alone or in conjunction with myocardial change. In severe disease, myoglobinemia and myoglobinuria result. Alcoholics are particularly prone to have severe infections, probably because of acquired defects in host defenses. Pneumonia is a common cause of death. Other fatal infections, such as renal papillary necrosis, meningitis, and endocarditis, are additional hazards. Untreated pulmonary tuberculosis is occasionally observed at autopsy. Bone marrow dysfunction with megaloblastic anemia, thrombocytopenia, and granulocytopenia may be present singly or in some combination. Hemolytic anemia also complicates alcoholism. Coagulation defects may occur in cirrhosis. Characteristic abnormalities of the central nervous system include Wernicke’s encephalopathy, central pontine myelinofysis, Marchiafava-Bignami’s disease, and cerebellar atrophy. Peripheral neuritis is a common complication. Premature testicular and ovarian atrophy appear in many patients. Bilateral ischemic necrosis of the femoral heads apparently due to obstruction of the venous outflow is a debilitating complication. Peptic ulcers of the stomach and duodenum, often of large size, may cause death. An unusually high frequency of carcinoma of the pharanyx, larynx, and esophagus has been reported, especially in alcoholics who smoke. Bilateral enlargement of the parotid glands (parotimegaly) due to fatty infiltration and possibly glandular hyperplasia is fairly common. The fetal alcohol syndrome includes a wide range of congenital defects, among which are central nervous system abnormalities, facial changes, and muscular disorders. Toxic amblyopia is rare, but may lead to optic atrophy. “Liver palms” and vascular spiders are stigmata of chronic liver disease. The most common pathologic change in the chronic alcoholic is fibrogenesis, especially in the liver, pancreas, myocardium, and skeletal muscle.