Alcoholic liver disease results from excessive alcohol consumption, 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 more than 500 functions. These include:
– filter toxins from the blood
– energy store
– 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
Liver damage can affect the entire 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 already irreversible.
Signs and symptoms of alcoholic liver disease
The 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 discomfort. 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
Drinking a large amount of alcohol can cause fatty acids to build up in the liver. Sometimes heavy drinking over a short period of time, even less than a week, can be the cause. There are usually no symptoms, and fatty liver disease is usually reversible if the person abstains from alcohol thereafter.
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 heavy drinking.
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 greater than 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 microliter.
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 is not reversed.
Fibrosis is a buildup of certain types of proteins 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 evaluates 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 can improve liver function, but severe, permanent damage from cirrhosis may mean a person needs a liver transplant to survive. Since the liver no longer processes toxins properly, the person will be more sensitive to drugs and alcohol. Alcohol consumption accelerates liver destruction, reducing the liver’s ability 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 extremities
– an accumulation of fluid in the abdomen (ascites)
– fever and chills
– extreme itching of the skin
– nails that curve excessively (circles)
– significant weight loss
– general weakness and muscle atrophy
– 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 have 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. Women 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 your 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 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 have a higher chance of developing 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 drink again. Any condition that has been 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. Alcohol withdrawal can be life-threatening. People should seek help from a health professional to manage withdrawal safely.
Cognitive behavioral therapy (CBT) can relieve withdrawal symptoms in an alcohol dependent person. People with severe alcohol addiction may stay in an inpatient rehab facility for closer monitoring.
Changes in lifestyle
Doctors may also recommend losing weight and quitting smoking, as both being overweight and smoking have been shown to play a role in worsening alcoholic liver disease. Doctors may also recommend taking a daily multivitamin.
In people with liver failure, the liver stops working altogether. This can be the result of advanced liver disease, and often means that a liver transplant is the only option for long-term 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 the last resort. Stopping drinking and treating this disease early is the best way for a person to increase their chances of reversing or delaying the disease. Anti-rejection medications after transplant can increase the risk of serious infections and certain types of cancer.
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 starting at the 21 years. Binge drinking is generally defined as the consumption of 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 is able to compensate and control cirrhosis, the typical life expectancy is 6 to 12 years. People with less serious illnesses will survive longer if they abstain from alcohol. Not smoking and weight control are important lifestyle changes people can make to further reduce risk.
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