Alcoholic Liver Disease

“Alcohol” thrills but “kills”

How does alcohol affect the liver?
Alcohol is a toxin that damages liver cells. The function of the liver is to break down alcohol so that it can be removed from your body. Your liver can become seriously damaged if you drink more alcohol than the liver can process.

What are the different types of alcohol-related liver disease?
There are three main types of alcohol-related liver disease: alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis.

Alcoholic fatty liver
Excess alcohol consumption leads to accumulation of excess fat in the liver. This is the earliest stage of alcohol-related liver disease and usually there are no symptoms. Some patients can however have fatigue and weakness. Fat in the liver will usually go away if one stops drinking alcohol. Patients who drink alcohol and are overweight or have diabetes have a higher risk of progressive liver damage.

Alcoholic hepatitis
In Alcoholic hepatitis, there is inflammation and swelling of the liver. Alcoholic hepatitis can develop in individuals who drink a large quantity of alcohol in a short period as well as in individuals who have been drinking alcohol since a long time. Symptoms may include loss of appetite, nausea, vomiting, abdominal pain, fever and jaundice. One out of three heavy drinkers develops alcoholic hepatitis. Alcoholic hepatitis can be mild or severe. If it is mild, liver damage may be reversed after stopping alcohol. If a patient has mild alcoholic hepatitis and continues to drink alcohol, it may quickly progress to severe alcoholic hepatitis and patient may develop liver failure. Signs of liver failure are accumulation of fluid in the belly, swelling of feet and mental confusion. Severe alcoholic hepatitis is a very serious condition and fifty percent of patients with severe alcoholic hepatitis die within one month.

Alcoholic cirrhosis
Alcoholic cirrhosis is scarring of the liver — hard scar tissue replaces soft healthy tissue. It is the most serious type of alcohol-related liver disease. Between 10 and 20 percent of heavy drinkers develop cirrhosis. The damage from cirrhosis cannot be reversed and usually leads to liver failure. Not drinking alcohol may help prevent further damage but complications may still develop. Symptoms of cirrhosis are similar to those of alcoholic hepatitis. Once liver failure develops there is accumulation of fluid in the abdomen, swelling of the feet, vomiting of blood, mental confusion and deep jaundice.

How does alcohol-related liver disease progress?
Many heavy drinkers will progress from fatty liver to alcoholic hepatitis to alcoholic cirrhosis over time. However, some heavy drinkers may develop alcoholic cirrhosis without having alcoholic hepatitis first. Heavy drinkers who also have a chronic hepatitis C infection, are obese or have diabetes are at higher risk for developing cirrhosis.

What are the complications of alcohol-related liver disease?
Complications from alcohol-related liver disease usually occur in patients with alcoholic hepatitis or cirrhosis. The complications can be serious and fatal.
Accumulation of fluid in the abdomen (ascites) and feet (edema)
Vomiting of blood due to rupture of veins in the food pipe or stomach
Mental confusion and coma
Kidney failure
Liver cancer

How is alcohol-related liver disease diagnosed?
Alcohol-related liver disease is diagnosed based on history, physical examination, blood tests and radiological investigations such as ultrasound or CT scan. Other causes of liver disease especially hepatitis B and C may also occur in the same patient. Sometimes a liver biopsy is required to check how much of the liver has been damaged. During a biopsy, a small piece of liver tissue is removed with a needle passed into the liver. This tissue is then studied in the laboratory.

How is alcohol-related liver disease treated?
The most important treatment for alcohol related liver disease is to stop drinking completely. A healthy and nutritious diet is also important. You may need to attend an alcohol de-addiction program. Certain behavioral changes and medicines can help you from going back to drinking alcohol. Attending support groups such as “Alcohol Anonymous” is also very helpful. Medications may be needed to manage the complications caused by liver damage. In advanced cases of alcoholic cirrhosis leading to liver failure, a liver transplant may be needed. Those with alcohol-related liver disease need to stop drinking alcohol for atleast 6 months to be considered for a liver transplant.

What are “alcohol units” and are there any safe limits for alcohol drinking?
One unit of alcohol is about 10 grams of pure alcohol. Approximately 250 ml of beer, 100 ml of wine or 30 ml of spirits (whisky, rum, vodka, brandy) constitutes one unit of alcohol. Healthy men can have up to 3 units of alcohol per day while healthy women should not have more than 1 unit per day. It is important to have “Alcohol free days” at least 2-3 days in a week. People who drink daily are at higher risk for liver disease than those who drink on some days only. It is also important to remember than patients with any form of underlying liver disease should not drink at all.