Alcoholic liver disease results from overconsumption of alcohol, which damages the liver and leads to fat accumulation, inflammation and scarring. The liver is one of the most complex organs in the human body, with over 500 functions. These include:
– filter toxins from the blood
– energy storage
– production of hormones and proteins
– regulation of cholesterol and blood sugar
This article explores the early signs and symptoms of alcoholic liver disease, its stages, causes, risk factors, treatments, and prevention.
The stages of alcoholic liver disease
Alcoholic liver disease has four main stages:
alcoholic fatty liver disease
Liver damage can affect the whole body. Once the damage starts, it can take a long time to show up because the liver is usually very good at regenerating and repairing itself. Often, by the time doctors detect the damage, it is irreversible.
Signs and symptoms of alcoholic liver disease
Early signs of alcoholic liver disease are vague and affect many body systems. In addition to a general feeling of being unwell, signs may include the following:
– pain in the abdomen
– nausea and vomiting
– decreased appetite
It can be easy for someone to dismiss early symptoms as the effects of gastro or general malaise. However, failure to diagnose and treat these symptoms, especially if one continues to drink alcohol, can lead to more rapid progression of liver disease over time.
Alcoholic fatty liver disease
Consuming a large amount of alcohol can cause fatty acids to build up in the liver. Sometimes excessive alcohol consumption over a short period of time, even less than a week, can be the cause. There are normally no symptoms, and fatty liver disease is often reversible if the person abstains from alcohol from then on.
Alcoholic hepatitis is a severe syndrome of alcoholic liver disease. Hepatitis is a general term for swelling and inflammation of the liver, whatever the cause. If a person continues to drink alcohol, it will lead to permanent inflammation of the liver. This can happen after several years of heavy drinking. It can also occur acutely during periods of excessive alcohol consumption.
Common symptoms of alcoholic hepatitis are:
– jaundice, or a yellow tint to the whites of the eyes and skin
– an enlarged liver, called hepatomegaly
– the characteristics of a systemic inflammatory reaction such as:
– body temperature below 36°C or above 38°C
– heart rate above 90 beats per minute
– respiratory rate greater than 20 breaths per minute
– number of white blood cells greater than 12,000 or less than 4,000 per microlitre.
Alcoholic hepatitis usually progresses to cirrhosis if the person continues to drink alcohol. Hepatitis can be cured in a person who stops drinking alcohol, but possible cirrhosis does not reverse.
Fibrosis is a buildup of certain types of protein in the liver, including collagen. It is present in most types of chronic liver disease.
To determine the extent of fibrosis, doctors use the Metavir grading system on a scale from A0 to A3:
A0: no activity
A1: light activity
A2: moderate activity
A3: severe activity
Mild to moderate forms of fibrosis may be reversible.
The Metavir system also assesses the level of fibrosis from F0 to F3:
F0: absence of fibrosis
F1: fibrosis without scar tissue
F2: fibrosis with occasional scar tissue
F3: extensive scar but no cirrhosis
Cirrhosis occurs when the liver has been inflamed for a long time, leading to scarring and loss of function. This condition can be life-threatening. The damage caused by cirrhosis is irreversible, but a person can prevent further damage by continuing to avoid alcohol. Lifelong abstinence may improve liver function, but permanent and severe damage from cirrhosis may mean the person needs a liver transplant to survive. As the liver no longer processes toxins properly, the person will be more sensitive to drugs and alcohol. Alcohol consumption accelerates the destruction of the liver, reducing the ability of the liver to compensate for current damage.
As alcoholic liver disease progresses, its symptoms become easier to recognize. The most distinctive signs of advanced liver disease, such as cirrhosis or fibrosis, are:
– edema, or swelling of the lower limbs
– an accumulation of fluid in the abdomen (ascites)
– fever and chills
– extreme itching of the skin
– nails that curl excessively (circles)
– significant weight loss
– general weakness and muscle wasting
– blood in vomit and stool
– bleeding and bruising more easily
– more sensitive reactions to alcohol and drugs
Several factors increase the risk of alcoholic liver disease. People who drink beer and hard liquor are more likely to suffer from liver disease than those who drink other alcoholic beverages, such as wine. Women are more susceptible to the negative effects of alcohol, even at the same levels of consumption as men, and are therefore more likely to rapidly develop fibrosis, inflammation and liver damage from alcohol. Those who drink more than two drinks a day and men who drink more than three drinks a day for more than five years are at increased risk of alcoholic liver disease. Women who drink large amounts of alcohol and who are also overweight have a higher chance of developing chronic liver disease. However, obesity is also a risk factor for men.
Having hepatitis C increases the risk, and someone who regularly drinks alcohol and has had any type of hepatitis is more likely to develop liver disease. Genetic changes can affect the risk. If a person experiences changes in the genetic profile of certain enzymes essential for alcohol metabolism, such as ADH, ALDH and CYP4502E1, they will be more likely to develop alcoholic liver disease.
The first step in treating alcoholic liver disease at any level is to eliminate alcohol from the diet.
It can help reverse some early stages of liver disease. For example, stopping drinking once you’ve been diagnosed with fatty liver disease can reverse the disease in 2 to 6 weeks.
When a doctor diagnoses alcoholic liver disease at any stage, he recommends that the person never start drinking again. Any condition that has reversed will usually reappear when the person resumes drinking. People who regularly drink more than the recommended daily alcohol limits should not stop drinking without medical support. Withdrawal from alcohol can be life-threatening. People should seek help from a healthcare professional to manage withdrawal safely.
Cognitive-behavioral therapy (CBT) can ease withdrawal symptoms in someone dependent on alcohol. People with severe alcohol addiction may stay in an inpatient rehabilitation facility for closer monitoring.
Doctors may also recommend losing weight and quitting smoking, as both being overweight and smoking have been shown to have a role in worsening alcoholic liver disease. Doctors may also recommend taking a multivitamin daily.
In people with liver failure, the liver completely stops working. This can be the result of advanced liver disease and often means that a liver transplant is the only option for prolonged survival. A liver transplant is a complicated procedure that depends on the availability of a donor. As a general rule, only people who can justify abstinence from alcohol for at least six months before the operation are eligible for a transplant. A liver transplant is a last resort. Stopping alcohol and treating this disease at an early stage is the best way for a person to increase their chances of reversing or slowing the disease. Anti-rejection drugs after transplantation can increase the risk of serious infections and certain cancers.
To prevent alcoholic liver disease and other alcohol-related conditions, doctors advise moderate alcohol consumption: “one drink a day” for women, and “two drinks a day” for men , and this only from the age of 21. Heavy drinking is generally defined as consuming five or more alcoholic drinks for men or four or more alcoholic drinks for women on the same occasion, on at least one day in the past month.
The life expectancy of a person with alcoholic liver disease decreases significantly as the disease progresses. On average, 1 in 3 people with the most advanced stages of liver disease and cirrhosis are still alive after 2 years. When the body can compensate for and manage cirrhosis, the typical life expectancy is 6 to 12 years. People with less severe illnesses will survive longer if they abstain from alcohol. Not smoking and controlling weight are important lifestyle changes people can make to further reduce risk.