Introduction Most common cause of cirrhosis in the United States. Pathophysiology ethanol metabolism presence of decreased NAD levels play a major role in altered metabolism Presentation Physical exam palmar erythema unique to alcoholic liver disease hepatosplenomegaly splenomegaly is secondary to portal hypertension ascites spider angiomas gynecomastia due to estrogen build up because it is not metabolized in the liver testicular atrophy Evaluation Hepatic panel elevated AST and ALT AST:ALT > 2 suggests alcoholic hepatitis Serum Protein Electrophoresis produces a very characteristic Serum Protein Electrophoresis called the beta-gamma bridge caused by an increased production of IgA and IgG. SPE will also show hypoalbuminemia Imaging CT and ultrasound imaging may show fatty deposition either focal or diffuse throughout the liver tissue Histology histology slides may show enlarged vacuoles of triglycerides within hepatocytes Treatment Cessation of alcohol can reverse disease Steroids Transplant Factor replacement of fresh frozen plasma (for bleeding) note that vitamin K replacement (phytonadione) works too slowly during acute bleeding