What is Alcoholic Liver Disease?
Alcoholic Liver Disease is damage to the liver and loss of normal liver functions due to alcohol abuse.
There are 3 different types of liver disease related to alcohol abuse:
- Heavy drinking causes the liver to lose its ability to break down fats, and fats builds up in the liver. This is known as Alcoholic Fatty Liver Disease or ALFD. ALFD is the earliest stage of alcohol-related liver diseases. It may be reversible with abstaining from alcohol.
Alcoholic hepatitis is severe inflammation in your liver caused by heavy drinking over an extended period of time.
- The condition usually occurs over time but severe acute alcoholic hepatitis can occur suddenly leading to acute liver failure and death. It's made worse by binge drinking and continuing to drink alcohol.
- Over time, alcoholic hepatitis leads to liver failure, cirrhosis of the liver, portal hypertension, liver cancer, and even death.
Cirrhosis of the liver
- Damage from repeated and excessive alcohol abuse can lead to cirrhosis or hardening of the liver. This is the latest stage of alcohol-related liver diseases.
- Repeated damage to the liver causes excessive scar tissue to form. Over time this scar tissue builds up and the liver itself hardens.
- The liver loses its ability to function normally. It is unable to produce proteins, enzymes, clotting factors, immune factors, and vitamins. It can’t do its normal work. Toxins are unable to be filtered from the blood and they build up in the blood. Portal hypertension, liver failure, liver cancer, and ultimately death can occur.
What causes Alcoholic Liver Disease?
Alcoholic liver disease typically occurs after years of heavy drinking. Over time, repeated damage to the liver caused by alcohol consumption causes scarring and cirrhosis (or hardening) of the liver to occur. Cirrhosis is the final stage of alcoholic liver disease.
Alcohol affects the liver more so than any other organ in our body because it is the primary site of alcohol metabolism. This is where our bodies break down alcohol. Chronic and excessive alcohol consumption produces a variety of changes in the liver. Steatosis or fatty deposits are the earliest changes seen in the liver as a result of heavy drinking. Steatosis can progress to steatohepatitis, which is severe inflammation and damage in the liver. This can then lead to fibrosis (or abnormally large amounts of scar tissue formed as a result of damage) and cirrhosis (or hardening) of the liver.
Alcohol-related cirrhosis is the most serious form of alcohol-related liver disease. The damage from alcohol-related cirrhosis is not reversible and can lead to portal hypertension, liver cancer, liver failure, and ultimately death.
How common is Alcoholic Liver Disease?
- Virtually all heavy drinkers develop fatty liver. Fatty liver is universal amongst heavy drinkers.
- Up to 40% of moderate drinkers also show fatty liver changes. Moderate drinking is defined as 1 drink per day for women and up to 2 drinks per day for men.
- Up to 35 percent of heavy drinkers develop alcoholic hepatitis.
- 10-20% or more of heavy drinkers will develop cirrhosis.
- In the U.S., alcohol remains the second most common cause of Cirrhosis of the Liver after Hepatitis C viral infections. It contributes to
- approximately 20-25% of cases of Cirrhosis.
What are the Symptoms of Alcoholic Liver Disease?
Some people may not have any symptoms until later in the disease course. Symptoms may include:
- Upset stomach, abdominal pain (especially in the right upper quadrant), gas or bloating
- Loss of appetite or early satiety (feeling full sooner than usual)
- Jaundice or yellowing of the skin and whites of the eyes
- Fatigue or generalized malaise (not feeling well)
- Increased thirst
- Swelling in the legs or abdomen (known as ascites)
- Weight loss or gain (especially in the abdomen, central obesity and thin extremities)
- Changes in the skin,
- Itchy skin
- Red hands or feet
- Black, tarry looking stools (suggestive of upper GI bleeding)
- Dizziness or fainting
- Agitation, mood swings, changes in cognition, memory loss
- Bleeding gums
- Easy bruising or excessive bleeding
- Enlarged breasts (in men)
What are the Risk Factors for Alcoholic Liver Disease?
- Binge Drinking
- Drinking Heavily
- The more you drink and the longer you abuse alcohol the greater your risk for developing Alcoholic Liver Disease.
- Consuming more than 60 grams of alcohol in men daily, and 20 grams of alcohol in women daily significantly increases your risk of developing cirrhosis.
- 12 ounces of beer has roughly 14 grams of alcohol, and
- 5 ounces of wine has roughly 14 grams of alcohol
- Daily drinking appears to be more harmful than binge drinking.
- Men are more likely to develop Alcoholic Liver Disease than women.
- BUT women may develop the disease after less exposure to alcohol than men. Women are more susceptible to liver toxicity, and have twice the risk of cirrhosis compared with men.
- Having a Family History of Alcoholic Liver Disease increases your risk substantially.
- Having a higher body mass index increases your risk.
- Having a history of nonalcoholic fatty liver disease (NAFLD or NASH) increases your risk.
- Having poor nutrition, and
- Certain ethnic groups are at increased risk for complications. For example, Hispanics, Native Americans, and native Alaskan men.
How is Alcoholic Liver Disease Diagnosed?
By a combination of history, physical exam, laboratory and imaging study findings. Lab tests may include CBC, Liver Function Tests including AST, ALT, AST to ALT ratio, GGT, and Fibroscore. Imaging studies may include abdominal ultrasound, CT or MRI. Sometimes liver biopsy is necessary.
What is the Treatment for Alcoholic Liver Disease?
There are no drug or nutritional therapies available for alcoholic liver disease. Abstinence is key. This is the first goal. You must stop drinking alcohol. This can prevent any further damage, and slow the progression of the disease. Alcoholic rehabilitation programs may be necessary for some individuals.
Since the liver activates and transports many vitamins, individuals with alcoholism often suffer from vitamin deficiencies such as B1 (thiamine) and B6 (pyridoxine). Thiamine deficiency is a common complication of Alcoholic Liver Disease and can lead to Wernicke's encephalopathy and Korsakoff's syndrome.
Liver transplant may be required for some patients with end-stage alcoholic liver disease.
What are the Complications of Alcoholic Liver Disease?
Complications may include:
- Cirrhosis of the Liver
- Liver Cancer
- Liver Failure
- Bleeding esophageal varices (or enlarged fragile veins in the esophagus)
- Portal Hypertension (high blood pressure in the blood vessels of the liver)
- Hepatic encephalopathy (a decline in brain function caused by the buildup of toxins in the blood due to liver disease)
- Vitamin deficiencies such as Vitamins A, B1, and B6
- Wernicke's encephalopathy and Korsakoff's syndrome.
What other risk are associated with Alcohol Abuse?
Over time, excessive alcohol use can lead to many serious health problems including:
- High blood pressure,
- Heart disease,
- Liver disease,
- GI disorders
- Breast cancer
- Head and neck cancers
- Throat and mouth cancers
- Esophageal cancer
- Liver cancer
- Colon cancer
- A weakened immune response to infections
- Mental health problems like depression and anxiety.
- Alcohol abuse places a huge burden on individuals, families, and our society as a whole. It leads to mental health problems, family problems, unemployment, and lost productivity at work. It contributes to motor vehicle accidents, injuries, falls, drownings, accidental burns, violence, homicide, suicide, sexual assault, risky sexual behaviors and the transmission of sexually transmitted diseases. In pregnant women, alcohol increases the risk for miscarriage, stillbirth, and can lead to fetal alcohol disorder.
What is a standard drink of Alcohol?
In the US a standard drink contains 14.0 grams of pure alcohol. This equates to roughly:
- 12 ounces of beer (5% alcohol).
- 8 ounces of malt liquor (7% alcohol).
- 5 ounces of wine (12% alcohol).
- 1.5 ounces of 80-proof liquor (40% alcohol, such as vodka or rum).
What is excessive drinking?
Excessive drinking includes binge drinking and heavy drinking
- Binge drinking is the most common form of excessive drinking, and is defined as consuming
- 4 or more drinks during a single occasion (typically 2 hours) for women, and
- 5 or more drinks during a single occasion for men.
- Heavy drinking is defined as consuming
- 8 or more drinks per week for women, and
- 15 or more drinks per week for men.
What is moderate drinking?
Moderate drinking is defined as 1 drink per day for women and up to 2 drinks per day for men. There are NO recommendations that individuals who do not drink alcohol should start drinking for any reason whatsoever.
What is alcoholism?
It’s also known as alcohol use disorder. This is a broad term for any drinking of alcohol that results in mental or physical health problems. Depending upon the source cited, roughly 1 in 8 adults are affected by alcohol use disorder. Alcoholism is most common in men and young adults, and decreases life expectancy by about 10%.
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The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self diagnoses should not be made based on information obtained online. It is important to consult a best in class gastroenterologist regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.