Cause & Risk Factors
Alcoholic Liver Disease (ALD) can damage to the liver induced by excessive alcohol consumption.
- Alcohol bingeing and abuse over a long period of time can lead to ALD. Almost all the alcohol ingested is metabolised in the liver. If the alcohol consumption is higher than the rate of metabolism, the probability of developing ALD is potentially greater. Males drinking in excess of 80g and females in excess of 40g of alcohol per day for 10 years are at higher risk. Women are more susceptible to developing cirrhosis at an earlier age, exhibit symptoms at advanced stage and have more complications than males.
- Genetics may play a role in the development of ALD.
- Malnutrition can contribute to liver disease and it develops as a result of empty calories from alcohol, loss of appetite, malabsorption (inadequate absorption of nutrients).
There are three primary types of liver conditions that are associated with alcohol abuse. A patient may experience these three disorders in a progressive nature of the disease, or have any or all at the same time.
- Fatty liver (steatosis) is the excessive accumulation of fats in the liver. Metabolic changes in the liver can result in an increased deposit of triglycerides in the liver cells. The liver in turn may become enlarged, causing abdominal discomfort on the right side. In itself, it is not usually serious and it is reversible with abstinence from alcohol. Fatty liver is not specific to alcohol ingestion. It is also a common finding in people who are obese, anorexic, diabetic and a side effect of certain medications.
- Alcoholic hepatitis is the inflammation of the liver and is also known as alcoholic steatohepatitis. It can be a progressive stage from fatty liver or a direct cause of excessive alcohol consumption. The symptoms can range from mild to severe. Acute alcoholic hepatitis is reversible with abstinence from alcohol but recovery is slow. Chronic hepatitis can lead to liver cirrhosis and liver failure.
- Alcoholic cirrhosis is the final and irreversible stage of ALD. The normal tissue is gradually replaced with scar tissue, which severely affects liver function. It can lead to end-stage liver disease (liver failure).
The risk of other types of liver disease increases with the quantity and duration of alcohol intake.
Symptoms of ALD depend on the stage of the disease though it is not uncommon to not exhibit any symptom even in the advanced stage.
Fatty liver usually shows no symptom or vague symptoms such as fatigue, nausea and pain in the right abdomen.
In moderate cases of alcoholic hepatitis, malnourishment and unexplainable weight loss are evident. In most severe cases, the symptoms may accelerate due to complications.
As most of these symptoms are associated with other medical conditions, it is always advisable to consult a doctor to get the correct diagnosis.
Because features of fatty liver, alcoholic hepatitis and cirrhosis overlap, a series of procedures is required to make a definitive diagnosis.
- Physical examination – the liver tends to be enlarged and tender
- Blood tests – A full blood count (FBC) and Liver Function Test (LFT) help to determine if there is inflammation or damage to the liver
- Ultrasound and Liver biopsy – help to identify severity of the liver disease
The most therapeutic treatment is total abstinence from alcohol. In addition, a nutritious diet can help to eliminate fatty liver. It has also been known that those who abruptly cease excessive intake of alcohol do develop problems that may become more pressing. Therefore, it is advisable to see a doctor to discuss ways to tackle alcohol withdrawal symptoms. These need to be assessed on a daily basis, recognised, and treated appropriately. Patients with severe alcoholic hepatitis and cirrhosis usually have accompanying complications. These complications need to addressed and treated appropriately. Liver transplantation is a treatment option for patients with end-stage ALD.
Serious complications can occur after many years of heavy drinking, and they can be serious and life-threatening.
Gross ascites with portal hypertension
- Hepatic encephalopathy is the damage to the brain and nervous system that occurs as a complication of liver disorders. It can result in irreversible coma and death Eight out of 10 patients die if coma develops.
- Portal hypertension with bleeding varices can rupture, leading to shock and is potentially fatal.
- Splenomegaly is the swelling of the spleen.
- Ascites (accumulation of fluid in the abdomen) can lead to further infection in the abdomen.
- Bleeding from veins in the oesophagus (varices)
- Kidney failure
- Liver cancer
A high-carbohydrate and high-calorie diet helps to reduce protein breakdown in the body. Vitamins, especially B1 and folic acid, are associated with improvement.
Abstinence from alcohol is the foundation of therapy for patients with alcohol-induced liver disease. An alcohol rehabilitation programme or counseling may be necessary to break the alcohol addiction. When fatty liver is not associated with alcoholic hepatitis, the prognosis is good. Continuous drinking is associated with a shorter life expectancy aided by multiple complications. Liver transplantation then becomes necessary to offer a longer and better quality of life.