Alcoholic liver disease is a major cause of liver related mortality worldwide. Many years of heavy drinking of alcohol leads to damage of liver tissue and can lead to complications.

Not all heavy drinkers develop the disease but the chances of liver disease increases with longer duration and high amount of alcohol consumption.

Alcoholic liver disease progresses from fatty liver to hepatitis to cirrhosis and liver failure.

Causes of alcoholic liver disease

Damage from repeated and excessive alcohol abuse leads to alcoholic liver disease.

Women are more at-risk for alcoholic liver disease as they don’t have as many enzymes in their stomach to break down alcohol. Hence more alcohol is able to reach the liver leading to scar tissue.

According to the American College of Gastroenterology, women who consume more than two drinks a day and men who consume more than three drinks a day for more than five years are at an increased risk for alcoholic liver disease.

Symptoms of alcoholic liver disease

Symptoms of alcoholic liver disease appear as time progresses. Men are more likely to be affected. However, women may develop the disease after less exposure to alcohol than men. Some people may have an inherited risk for the disease.

There may be no symptoms initially but appear as disease progresses.

Early symptoms include-

  • Loss of energy
  • Poor appetite and weight loss
  • Nausea
  • Stomach ache

As liver function worsens,following symptoms appear-

  • Fever
  • Swelling of legs
  • Distention of abdomen
  • Yellow color in the skin, mucous membranes and eyes (jaundice)
  • Redness on the palms of the hands
  • In men, impotence, shrinking of the testicles, and breast swelling
  • Easy bruising and abnormal bleeding
  • Confusion
  • Pale or clay-colored stools
  • Weakness and weight loss

Diagnosis

Your physician after physical examination will order laboratory tests to confirm the diagnosis.These test results may show

  • Anemia(low blood levels due to low iron levels)
  • High levels of ammonia in blood
  • High blood sugar levels
  • Large amount of white blood cells
  • Scarred liver tissue on biopsy
  • Liver enzymes ALT and AST raised significantly
  • Low levels of magnesium, potassium and sodium

He/she may also order some tests to rule out any other cause of liver injury.

Stages of alcoholic liver disease

Alcoholic liver disease has mainly four stages

Alcoholic fatty liver disease-Drinking a large volume of alcohol can cause fatty acids to collect in the liver. There is generally no symptom and the condition is reversible on cessation of alcohol.

Alcoholic hepatitis-Continued alcohol intake can lead to inflammation and scarring of liver tissue.

Fibrosis-Fibrosis is a buildup of certain types of protein in the liver, including collagen. Mild to moderate form of fibrosis may be reversible, continued damage may to lead to liver failure.

Cirrhosis-Cirrhosis occurs when the liver has been inflamed for a long time, leading to scarring and loss of function. This can be a life-threatening condition. Cirrhosis damage is irreversible, but the patient can prevent further damage by continuing to avoid alcohol.

 Treatment

The first step towards treatment is to stop drinking. Those with alcoholic liver disease are mostly dependent on alcohol and might need medical assistance to stop drinking and to avoid withdrawal symptoms. Stopping of alcohol intake at an early stage can prevent further damage and delay disease progression.

Lifestyle changes like weight loss and quitting smoking might also be recommended since being overweight and smoking have both have a role in making alcoholic liver disease worse.

Medications like insulin, antioxidant supplements, multivitamin supplements and liver protective drugs may be prescribed by your physician.

In the advanced stage of the disease, liver completely ceases to function. In this case liver transplant is the last resort.Typically, people who abstain for at least six months from alcohol before the procedure, have no other health issue and are fit to undergo surgery are considered for transplant.

The life expectancy of a person with alcoholic liver disease reduces dramatically as the condition progresses.The only way is stopping of intake of alcohol and choosing healthier lifestyle habits.

See a physician if you have any symptoms or have been a heavy drinker.

-Dr Prerna Gaur

 

Acknowledgements-

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036962/

https://medlineplus.gov/ency/article/000281.htm

https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/

 

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