Scientific Basis

Discussion Question 1

Nonalcoholic liver disease: As stated in your text, excessive alcohol consumption is a major cause of liver disease in this country. However, there are other conditions that can induce liver disease, many of which appear very similar to alcohol-induced liver damage. Viral hepatitis is one such disorder. Another is Nonalcoholic Steatohepatitis (NASH). NASH is usually “silent,” which is to say that it does not induce obvious physical symptoms, although blood tests for liver disease might reveal abnormal level of liver enzymes. Nonalcoholic fatty liver disease might induce nonspecific symptoms such as fatigue, pain in the upper right abdomen, and weight loss, but for many persons with this disorder it is only discovered when a physician orders routine blood tests as part of a general physical examination.

NASH is not automatically progressive, but can halt at an intermediate stage, go into remission, or progress to the point where scar tissue forms on the liver and cirrhosis of the liver develops. If the cirrhosis continues to progress, the individual will eventually suffer so much liver damage that he or she enters the stage of end-stage liver disease. As is seen with alcohol-induced liver disease, persons with nonalcoholic liver disease are at risk for premature death, although the death rate from nonalcoholic liver disease is lower than that seen in alcohol-related liver disease (Angulo, 2010; Soderberg, Stal, Askling, Glaumann, et. al., 2010). Treatment for NASH includes avoidance of alcohol, weight loss, and exercise, as well as control of possible concurrent medical problems such as diabetes, hypertension, and elevated cholesterol levels.

When NASH reaches the stage where it induces liver cirrhosis, it begins to follow a similar course to that seen in alcohol-induced liver cirrhosis. Radiological examination of the liver might reveal signs of fat deposits on the liver, but the definitive diagnosis is achieved through a biopsy of liver tissue. To obtain a sample of liver tissue a needle is inserted into the chest cavity and a small sample of liver cells is aspirated for microscopic examination. If the liver is severely damaged, it might become necessary for a liver transplant to be performed to save the patient’s life.

Another cause of non-alcoholic liver disease are the changes in the liver induced by diabetes, infectious disease, or exposure to toxins such as extreme levels of acetaminophen or allergic reactions to compounds such as disulfiram. Only a physician can determine whether a given patient has alcohol-induced, or nonalcoholic liver disease.

Question 2: Are there other diseases you can think of that have similar stigmas? Is there a scientific basis for these beliefs? If not, how do you think people develop them? (PLEASE FOLLOW DIRECTIONS FOR DISCUSSION LISTED ABOVE)