Alcoholic liver disease

Definition

Alcoholic liver disease is damage to the liver and its function due to alcohol abuse.

See also:

• Ascites
• Cirrhosis
• Alcoholism
• Bleeding varices
• Hepatic encelphalopathy

Alternative Names

Liver disease due to alcohol; Cirrhosis or hepatitis - alcoholic; Laennec's cirrhosis

Causes, incidence, and risk factors

Alcoholic liver disease usually occurs after years of excessive drinking. The longer the alcohol use and the more alcohol that was consumed, the greater the likelihood of developing liver disease.

Acute alcoholic hepatitis can result from binge drinking. It may be life-threatening if severe.

People who drink excessively can become malnourished because of the empty calories from alcohol, reduced appetite, and poor absorption (malabsorption) of nutrients in the intestines. Malnutrition contributes to liver disease.

Other factors that contribute to the development of alcoholic liver disease:

• Genetic factors
• Personal susceptibility to alcohol-induced liver disease
• Toxicity of alcohol (ethanol) to the liver

Alcoholic liver disease does not affect all heavy drinkers. Women may be more susceptible than men. It is not necessary to get drunk for the disease to develop.

Symptoms

Symptoms vary based on the severity of the disease. They are usually worse after a recent period of heavy drinking. Disease changes start in the liver as inflammation (hepatitis) and lead to fatty liver and cirrhosis. Cirrhosis is the final phase of alcoholic liver disease.

Symptoms may not be present until the disease is advanced, and may include:

• Abdominal pain and tenderness
• Dry mouth
• Excessive thirst
• Fatigue
• Fever
• Fluid collection in the abdomen (ascites)
• Jaundice
• Loss of appetite
• Mental confusion
• Nausea
• Unintentional weight gain (because of fluid collection)

Other symptoms that can occur with this disease:

• Abnormally dark or light skin
• Agitation
• Bloody, dark black, or tarry bowel movements (melena)
• Breast development in males
• Changing mood
• Confusion (encephalopathy)
  • Changed level of consciousness
  • Hallucinations
  • Impaired short- or long-term memory
• Difficulty paying attention (attention deficit)
• Impaired ability to concentrate
• Impaired judgment
• Light-headedness or fainting, especially when standing
• Paleness
• Rapid heart rate (tachycardia) when rising to standing position
• Redness on feet or hands
• Slow, sluggish, lethargic movement
• Vomiting blood or material that looks like coffee grounds

Signs and tests

• Complete blood count (CBC)
• Liver biopsy
• Liver function tests such as ALP

Tests to rule out other diseases include:

• Abdominal CT scan
• Blood tests for other causes of liver disease
• Ultrasound of the abdomen

Treatment

The most important part of treatment is to stop using alcohol completely. If liver cirrhosis has not yet occurred, the liver can heal if you stop drinking alcohol.

An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Vitamins, especially B-complex and folic acid, can help reverse malnutrition.

If cirrhosis develops, you will need to manage the complications of cirrhosis. You may need a liver transplant.

Support Groups

You can often ease the stress of illness by joining a support group whose members share common experiences and problems.

See:

• Alcoholism - support group
• Liver disease - support group

Expectations (prognosis)

Continued excessive drinking can shorten your lifespan. The outcome will likely be poor if you keep drinking.

Complications

• Bleeding esophageal varices
• Cirrhosis
• Hepatic encephalopathy
• Increased pressure in blood vessels of the liver (portal hypertension)

Calling your health care provider

Call your health care provider if:

• You develop symptoms of alcoholic liver disease
• You develop symptoms after prolonged or heavy drinking
• You are concerned that drinking may be damaging your health

Prevention

Discuss your alcohol intake with your doctor. The doctor can counsel you about how much alcohol is safe to drink for your situation.

References

Carithers RL, McClain C. Alcoholic liver disease. In: Feldman M, Friedman LS, Brandt LJ. Feldman: Sleisinger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006:chap 81.

Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.