What is the liver’s role in processing alcohol?
The liver breaks down alcohol so it can be eliminated from your body. If you consume more alcohol than the liver can process, the resulting imbalance can injure the liver by interfering with its normal breakdown of protein, fats, and carbohydrates.
What are the types of alcohol-induced liver disease?
There are three kinds of liver disease related to alcohol consumption:
Fatty liver is marked by a build-up of fat cells in the liver. Usually there are no symptoms, although the liver may be enlarged and you may experience discomfort in your upper abdomen. Fatty liver occurs in almost all people who drink heavily. The condition will improve after you stop drinking.
Alcoholic hepatitis is an inflammation of the liver. Up to 35 percent of heavy drinkers develop alcoholic hepatitis. Symptoms may include loss of appetite, nausea, vomiting, abdominal pain and tenderness, fever and jaundice. In its mild form, alcoholic hepatitis can last for years and will cause progressive liver damage. The damage may be reversible if you stop drinking. In its severe form, the disease may occur suddenly, after binge drinking, and it can quickly lead to life-threatening complications.
Alcoholic cirrhosis is the most serious type of alcohol-induced liver disease. Cirrhosis refers to the replacement of normal liver tissue with scar tissue. Between 10 and 20 percent of heavy drinkers develop cirrhosis, usually after 10 or more years of drinking. Symptoms of cirrhosis are similar to those of alcoholic hepatitis. The damage from cirrhosis is not reversible, and it is a life-threatening disease. Your condition may stabilize if you stop drinking.
Many heavy drinkers will progress from fatty liver to alcoholic hepatitis and finally to alcoholic cirrhosis, though the progression may vary from patient to patient. The risk of developing cirrhosis is particularly high for people who drink heavily and have another chronic liver disease such as viral hepatitis C.
Liver disease is the fourth commonest cause of death in adults between the ages of 20 and 70. Alcohol is still the commonest cause of chronic liver disease in this country. Not all those who abuse alcohol develop liver damage: the incidence of cirrhosis among alcoholics is approximately 10-30%. The mechanism for the predisposition of certain people to develop cirrhosis is still unknown. The amount of alcohol ingested has been shown in epidemiological studies to be the most important factor in determining the development of cirrhosis. Males drinking in excess of 80 g and females in excess of 40 g of alcohol per day for 10 years are at a high risk of developing cirrhosis. The alcohol content rather than the type of beverage is important, and binge drinking is less injurious to the liver than continued daily drinking.
What are the complications of alcohol-induced liver disease?
Serious complications from alcohol-induced liver disease typically occur after many years of heavy drinking. Once they do occur, the complications can be serious and life-threatening. They may include:
- Accumulation of fluid in the abdomen
- Bleeding from veins in the esophagus
- Enlarged spleen
- High blood pressure in the liver
- Changes in mental function, and coma
- Kidney failure
- Liver cancer
How is alcohol-induced liver disease diagnosed?
Alcohol-induced liver disease may be suspected based on other medical and lifestyle issues related to alcohol abuse. Blood tests and imaging tests (MRI, CT scan, or ultrasound) may help in diagnosis and to rule out other causes of liver disease. Proof is best established by liver biopsy.
How is alcohol-induced liver disease treated?
First, you must stop drinking. Your doctor may suggest changes in your diet and certain vitamin supplements to help your liver recover from the alcohol-related damage. Medications may be needed to manage the complications caused by your liver damage. In advanced cases of alcoholic cirrhosis, the only treatment option may be a liver transplant. However, active alcoholics will usually not qualify as suitable organ recipients.
In order to stop drinking, you may need to participate in an alcohol recovery program. The best resource is likely to be an alcoholic support group, because you must stay sober to recover from your liver disease.
What is the outlook for people with alcohol-induced liver disease?
Anyone with alcohol-induced liver disease will improve their health and life expectancy if they stop drinking. For patients who do not stop drinking, the outlook is poor; they are likely to suffer a variety of life-threatening health problems caused by alcohol-related liver damage.
Is there a safe level of drinking?
For most people, moderate drinking will not lead to alcohol-induced liver disease. Moderate drinking means no more than one drink a day for women and two drinks a day for men. (A standard drink is one 12-ounce beer, one 5-ounce glass of wine or one 1.5-ounce shot of distilled spirits.) However, for people with chronic liver disease, especially alcohol-induced liver disease, even small amounts of alcohol can make the liver disease worse. Patients with alcohol-induced liver disease and those with cirrhosis from any cause should stop using alcohol completely.
Women are more likely to be affected by alcohol-induced liver disease because women can be affected by smaller amounts of alcohol than men.
Even small amounts of alcohol can be dangerous when taken with medications containing acetaminophen, found in many over-the-counter pain relievers. The combination of alcohol and acetaminophen can be very harmful to the liver for anyone who drinks. Never take acetaminophen with alcohol, or immediately after a period of heavy drinking.