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Alcoholic liver disease

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

 

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

Causes

 

Alcoholic liver disease occurs after years of heavy drinking. Over time, scarring and cirrhosis can occur. Cirrhosis is the final phase of alcoholic liver disease.

Alcoholic liver disease does not occur in all heavy drinkers. The chances of getting liver disease go up the longer you have been drinking and more alcohol you consume. You do not have to get drunk for the disease to happen.

The disease seems to be more common in some families. Women may be more likely to have this problem than men.

 

Symptoms

 

There may be no symptoms, or symptoms may come on slowly, depending on how well the liver is working. Symptoms tend to be worse after a period of heavy drinking.

Early symptoms include:

  • Fatigue and loss of energy
  • Poor appetite and weight loss
  • Nausea or belly pain
  • Small, red spider-like blood vessels on the skin

As liver function worsens, symptoms may include:

  • Fluid buildup of the legs (edema) and in the abdomen (ascites)
  • Yellow color in the skin, mucous membranes, or eyes (jaundice)
  • Redness on the palms of the hands
  • In men, impotence, shrinking of the testicles, and breast swelling
  • Easy bruising and abnormal bleeding
  • Confusion or problems thinking
  • Pale or clay-colored stools

 

Exams and Tests

 

Your health care provider will do a physical exam to look for:

  • An enlarged liver or spleen
  • Excess breast tissue
  • Swollen abdomen, as a result of too much fluid
  • Reddened palms
  • Red spider-like blood vessels on the skin
  • Small testicles
  • Widened veins in the abdomen wall
  • Yellow eyes or skin (jaundice)

Tests you may have include:

  • Complete blood count (CBC)
  • Liver biopsy
  • Liver function tests
  • Coagulation studies

Tests to rule out other diseases include:

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

 

Treatment

 

LIFESTYLE CHANGES

Some things you can do to help take care of your liver disease are:

  • Drink less alcohol.
  • Eat a healthy diet that is low in salt.
  • Get vaccinated for diseases such as influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia.
  • Talk to your doctor about all medicines you take, including herbs and supplements and over-the-counter medicines.

MEDICINES FROM YOUR DOCTOR

  • "Water pills" (diuretics) to get rid of fluid build-up
  • Vitamin K or blood products to prevent excess bleeding
  • Medicines for mental confusion
  • Antibiotics for infections

OTHER TREATMENTS

  • Endoscopic treatments for enlarged veins in the throat (bleeding varices)
  • Removal of fluid from the abdomen (paracentesis)
  • Placement of a transjugular intrahepatic portosystemic shunt (TIPS) to repair blood flow in the liver

When cirrhosis progresses to end-stage liver disease, a liver transplant may be needed.

 

Support Groups

 

Many people benefit from joining support groups for alcoholism or liver disease .

 

Outlook (Prognosis)

 

Continued excessive drinking can shorten your lifespan. Your risk for complications such as bleeding, brain changes, and severe liver damage go up. The outcome will likely be poor if you keep drinking.

Cirrhosis is caused by scarring of the liver. In most cases, the liver cannot heal or return to normal function once the damage is severe. Cirrhosis can lead to serious complications.

 

Possible Complications

 

Complications may include:

  • Bleeding disorders (coagulopathy)
  • Buildup of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
  • Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal varices)
  • Increased pressure in the blood vessels of the liver (portal hypertension)
  • Kidney failure (hepatorenal syndrome)
  • Liver cancer (hepatocellular carcinoma)
  • Mental confusion, change in the level of consciousness, or coma (hepatic encephalopathy)

 

When to Contact a Medical Professional

 

Call your provider if:

  • You develop symptoms of alcoholic liver disease.
  • You develop symptoms after a long period of heavy drinking.
  • You are worried that drinking may be harming your health.

Get emergency medical help right away if you have:

  • Abdominal or chest pain
  • Abdominal swelling or ascites that is new or suddenly becomes worse
  • A fever (temperature greater than 101°F, or 38.3°C)
  • Diarrhea
  • New confusion or a change in alertness, or it gets worse
  • Rectal bleeding, vomiting blood, or blood in the urine
  • Shortness of breath
  • Vomiting more than once a day
  • Yellowing skin or eyes (jaundice) that is new or gets worse quickly

 

Prevention

 

Talk to your provider about your alcohol intake. The provider can counsel you about how much alcohol is safe for you.

 

 

Open References

References

Carithers RL, McClain C. Alcoholic liver disease. In: Feldman M, Friedman LS, Brandt LJ. Feldman: Sleisinger & Fordtran's Gastrointestinal and Liver Disease . 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 86.

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer Al, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 153.

Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol . 2009;104:1802-1829. PMID: 19455106 www.ncbi.nlm.nih.gov/pubmed/19455106 .

O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol . 2010;105(1):14-32. PMID: 19904248 www.ncbi.nlm.nih.gov/pubmed/19904248 .

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

 

  • Alcoholic liver disease

    Animation

    •  

    Alcoholic liver disease - Animation

    Long-term alcohol abuse can lead to dangerous damage called alcoholic liver disease. Let's talk today about alcoholic liver disease. Alcoholic liver disease usually occurs after years of drinking too much. The longer you've abused alcohol, and the more alcohol you've consumed, the greater likelihood you will develop liver disease. Alcohol may cause swelling and inflammation in your liver, or something called hepatitis. Over time, this can lead to scarring and cirrhosis of the liver, which is the final phase of alcoholic liver disease. The damage caused by cirrhosis is unfortunately irreversible. To determine if you have alcoholic liver disease your doctor will probably test your blood, take a biopsy of the liver, and do a liver function test. You should also have other tests to rule out other diseases that could be causing your symptoms. Your symptoms may vary depending upon the severity of your disease. Usually, symptoms are worse after a recent period of heavy drinking. In fact, you may not even have symptoms until the disease is pretty advanced. Generally, symptoms of alcoholic liver disease include abdominal pain and tenderness, dry mouth and increased thirst, fatigue, jaundice (which is yellowing of the skin), loss of appetite, and nausea. Your skin may look abnormally dark or light. Your feet or hands may look red. You may notice small, red, spider-like blood vessels on your skin. You may have abnormal bleeding. Your stools might be dark, bloody, black, or tarry. You may have frequent nosebleeds or bleeding gums. You may vomit blood or material that looks like coffee grounds. Alcoholic liver disease also can affect your brain and nervous system. Symptoms include agitation, changing mood, confusion, and pain, numbness, or a tingling sensation in your arms or legs. The most important part of treatment is to stop drinking alcohol completely. If you don't have liver cirrhosis yet, your liver can actually heal itself, that is, if you stop drinking alcohol. You may need an alcohol rehabilitation program or counseling to break free from alcohol. Vitamins, especially B-complex vitamins and folic acid, can help reverse malnutrition. If cirrhosis develops, you will need to manage the problems it can cause. It may even lead to needing a liver transplant.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Alcoholic liver disease

    Animation

    •  

    Alcoholic liver disease - Animation

    Long-term alcohol abuse can lead to dangerous damage called alcoholic liver disease. Let's talk today about alcoholic liver disease. Alcoholic liver disease usually occurs after years of drinking too much. The longer you've abused alcohol, and the more alcohol you've consumed, the greater likelihood you will develop liver disease. Alcohol may cause swelling and inflammation in your liver, or something called hepatitis. Over time, this can lead to scarring and cirrhosis of the liver, which is the final phase of alcoholic liver disease. The damage caused by cirrhosis is unfortunately irreversible. To determine if you have alcoholic liver disease your doctor will probably test your blood, take a biopsy of the liver, and do a liver function test. You should also have other tests to rule out other diseases that could be causing your symptoms. Your symptoms may vary depending upon the severity of your disease. Usually, symptoms are worse after a recent period of heavy drinking. In fact, you may not even have symptoms until the disease is pretty advanced. Generally, symptoms of alcoholic liver disease include abdominal pain and tenderness, dry mouth and increased thirst, fatigue, jaundice (which is yellowing of the skin), loss of appetite, and nausea. Your skin may look abnormally dark or light. Your feet or hands may look red. You may notice small, red, spider-like blood vessels on your skin. You may have abnormal bleeding. Your stools might be dark, bloody, black, or tarry. You may have frequent nosebleeds or bleeding gums. You may vomit blood or material that looks like coffee grounds. Alcoholic liver disease also can affect your brain and nervous system. Symptoms include agitation, changing mood, confusion, and pain, numbness, or a tingling sensation in your arms or legs. The most important part of treatment is to stop drinking alcohol completely. If you don't have liver cirrhosis yet, your liver can actually heal itself, that is, if you stop drinking alcohol. You may need an alcohol rehabilitation program or counseling to break free from alcohol. Vitamins, especially B-complex vitamins and folic acid, can help reverse malnutrition. If cirrhosis develops, you will need to manage the problems it can cause. It may even lead to needing a liver transplant.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

A Closer Look

 

Talking to your MD

 

    Self Care

     

      Tests for Alcoholic liver disease

       
       

      Review Date: 8/14/2015

      Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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