What Is Alcoholic Liver Disease

Alcohol Abuse | December 3, 2009

Alcoholic Liver Disease (ALD) refers to the medical condition wherein the liver is damaged due to the excessive consumption of alcohol. Not only the liver is affected, but also the other organs of the body are prone to damage. We all know that consuming alcohol is injurious to health. So, you can realize that how excessive alcohol can be life threatening.

Alcohol Consumption Statistics in the United Kingdom

How common is the alcoholic liver disease among a given size of population is determined by computing the death rates due to alcoholic cirrhosis. Alcoholic cirrhosis is a condition wherein the strong liver tissue is converted into a scar tissue. These rates have been on its peak in the recent years. In the United Kingdom, the death rates have increased up to 88 percent between the period of 1974 and 1994. Here, the highest rates are of the young men whose ages ranged from 35 to 44, the figure been 7.6 men per 1,00,000 people per year.

If you carefully loo alcoholic liver disease k at the above statistics, it also indicates that the rate of alcohol consumption has also increased. According to a research, total alcohol consumption per head rose high in the United Kingdom. after the mid of the year 1990. Not only this, but the General Household Survey of 2001 concluded that around 39 percent of the males and 22 percent of the females have started taking alcohol beyond the recommended daily maximum units (4 for men and 3 for women). A unit refers to a half pint of beer or a regular glass of wine.

To support the above research, statistics reveal that there is remarkable increase in the past decade of women drinking more than 14 units each week, steep rise for the women under 16 to 24.

Alcohol – A Slow Killer

It is not certain to say what amount of alcohol is required for an individual to cause liver damage. This actually varies from individual to individual. However, the following facts are true and are globally applicable.

The vulnerability to the harmful effects of alcohol is genetically inherited.
Women are more vulnerable to the dangerous effects of alcohol as compared to men.
Daily drinking and drinking during eating times is very harmful as compared to drinking only at the weekends.
It has been scientifically proved that the more you drink, the more are the chances of inviting alcoholic liver disease into your life.

Stages of ALD

There are three stages of alcoholic liver disease that determines the degree up to which the liver has been damaged. How a patient passes through these stages is uncertain and therefore varies with each individual. To determine the stage, the doctor examines a sample of the liver from a biopsy under the microscope. Listed below are the three stages of alcoholic liver disease.

Minimal Change or Fatty Liver
This is common among heavy drinkers wherein some fatty change has taken place in the liver. This is not considered as deterioration in the functioning of the liver, but defects can be seen in some of the blood tests known as Liver Function Tests (LFTs). This is an indirect alarm of progressing towards the last (third) stage of liver disease. This stage can be treated well with abstinence from alcohol.
Alcoholic Hepatitis
This condition can have mild effects, but they can endanger your life. The LFTs will never have normal results and the patient is likely to suffer from jaundice (yellow coloring of the eyes and skin). Abstinence from alcohol is again the key to deal with the effects. However, even at this stage if continuous drinking is in practice, it increases the chances of developing cirrhosis.
Cirrhosis
This is the last, irremediable stage of ALD and involves scarring of the liver and growth of the liver nodules. It rigorously influences the functioning of the liver and decreases life expectancy. It goes without saying that the LFT’s will never show normal results. Such patients might suffer from jaundice, bruising, or bleeding that are due to the defects in the blood clotting system. In a severe alcoholic hepatitis or cirrhosis stage, the liver becomes completely stagnant to carry out its routine functions followed by the bad impact on the body’s metabolism. This is the advanced stage of ALD, which is known as decompensated ALD.

Alcoholic Liver Disease Symptoms

The doctor might not be able to make out from the symptoms of alcoholic liver disease about how severe the damage of the liver is. This is because it is not necessary that the symptoms will provide a signal on that aspect. Listed below are the symptoms of the alcoholic liver disease.

Unobvious symptoms of:
- Exhaustion
- Nausea and vomiting typically in the morning
- Diarrhea
- Abdominal pains
Liver-related symptoms only in decompensated ALD that need urgent medical treatment such as:
- Jaundice
- Ascites wherein fluid accumulates in the abdomen resulting in distension
- Haematemesis (vomiting of blood)
- Encephalopathy that is a state of confusion, low level of awareness, changed sleeping patterns; which finally results in coma

In reality, many patients suffering from advanced ALD do not exhibit any symptoms. In this case, such conditions are detected through liver blood tests done during the routine health check-up or during the assessment of other medical conditions.

Diagnosis

If the doctor gets enough evidence regarding the history of too much alcohol consumption, tests in hospitals can help in diagnosing the existence and severity of the liver damage. Listed below are the ALD tests.

Blood Tests
Such tests can only provide an idea of the damage, but do not provide with accurate information. Further tests are inevitable for the diagnosis of ALD that are given below.
Ultrasound Scans
Such tests develop an image of the liver and its adjacent organs that aid in liver biopsy, help in examining the severity of the damage, and rule out the other well-known reasons of abnormal LFTs such as gallstones.
Liver Biopsy
Such test is the accurate one that helps in identifying the ADL stage and confirming that alcohol is the reason of the liver damage. It is performed using local anesthetic and provides a small sample of the liver that can be kept under the microscope for analysis.

According to a research, approximately in 20 percent of heavy alcohol takers with abnormal LFTs, there is mostly another cause of liver damage that is detected upon investigation. The above assessments will exclude the following medical conditions that can be the cause of ADL symptoms.

Viral hepatitis including hepatitis B and C
Haemochromatosis, which is a genetic disorder of iron metabolism
Wilson’s disease, which is a genetic disorder of copper metabolism
Autoimmune hepatitis, which is caused by the immune system assaulting the liver

Two Good Tips

Do you want to know what you can do for yourself in case of ADL? This is maintaining a balanced diet and abstinence from alcohol.

Nutrition

It is obesity and malnourishment that increase the chances of advanced liver disease among heavy drinkers. Excessive consumption of alcohol leads to obesity and loss of appetite or nausea can result in the state of severe malnourishment in patients. This means that a good diet and a normal body weight can improve the state of alcoholic liver disease.

In the state of alcoholic hepatitis and cirrhosis, nutritional items can scientifically improve the results of the liver blood tests. These items are antioxidants such as vitamin E and selenium that can not only treat ALD, but can also even prevent it. Consuming more amounts of fresh fruit and vegetables is also recommended in the treatment of ALD.

Abstinence

It is still advisable to stop drinking even in the stage of alcoholic hepatitis and cirrhosis.
People who still drink at this stage are highly vulnerable to develop decompensated ALD, where on the other hand, the chances of survival for those who stay away from drinking are really as better as 89 percent. However, if drinking is not stopped at the stage of decompensated ALD, there are only 33 percent chances of survival.

However, the intake of alcohol should be safely reduced and that too under a supervision. This is because a rapid or sudden decrease can cause physical withdrawal syndrome in approximately 40 percent of the victims. This syndrome exhibits the following symptoms.

Agitation
Sweating
Anxiety
Fits
Visual hallucinations known as delirium tremens or the DTs (in 5 percent cases)

To note, the withdrawal syndrome can be endanger your life and therefore, sedatives and hospital admission are inevitable.

Alcoholic Liver Disease Treatment

According to the ALD stage, the doctor decides for an appropriate treatment.

Minimal Change or Fatty Liver

Treatment at this stage includes:

Abstinence from alcohol
Improved diet
No obesity

Alcoholic Hepatitis

The treatment actually depends on how severe is the alcoholic hepatitis.

Treatment in mild cases:

Abstinence from alcohol
Nutritional support

Admission in the hospital is the only treatment in case of acute severe alcoholic hepatitis wherein jaundice, bruising, abnormal blood tests, and ascites are apparent.

Steroids can be of some help, but despite of steroids; 90 percent of the patients lose their life within three months of the start of this stage. If unfortunately, there is a kidney failure, it ensures 100 percent death.

Cirrhosis

There are two types of liver cirrhosis namely, compensated or decompensated. The compensated one does not include complications. The complications include bleeding varices due to abnormal veins in the gullet, jaundice, ascites, and encephalopathy (reduction in conscious level that can cause coma). The treatment of compensated cirrhosis is the same as the treatment of the mild alcoholic hepatitis, which is abstinence from alcohol and nutritional support.

In case of decompensated cirrhosis, treatments are given as per the detected complications of ALD.

Bleeding Varices

Treatment of bleeding varices includes:

Endoscopy, wherein a flexible camera that is passed into the abdomen to wipe out the strange veins that forms a part of the gullet.
Beta-blockers such as propranolol (Inderal LA) might reduce further bleeding (long-term treatment).

In these patients, a ‘screening’ endoscopy test is performed to detect any abnormal varices before they actually start bleeding. To deal with these varices, beta-blockers are a good option to prevent the risk of initial bleeding.

Ascites

Treatment of ascites includes:

A low salt diet
Less fluid intake
Intake of diuretics (water tablets)
Alternating drainage of the accumulated fluid using a catheter or a drainage tube that is inserted into the abdomen (paracentesis)

Sometimes in a few cases, these treatments might not be effective, which stimulates the need of more treatments such as a liver transplantation.

Encephalopathy

This is a condition of intolerable physical stress. The causes of this state can be:

The use of unsuitable sedating or painkilling medication
Bleeding from the gullet or stomach
Constipation
Infections or abnormalities in the salts (electrolytes) of the blood

However, an increase in the ammonia levels of the brain is the major reason of encephalopathy. To treat this, the underlying problem is rectified with a liquid laxative known as lactulose. Lactulose aids in reducing the production of ammonia in the gut and its incorporation into the body. In addition, the drug reduces the levels of ammonia in the blood and therefore, might need to be taken for a long period to prevent future occurrence of encephalopathy.

Liver Transplantation

Despite abstinence and nutritional support, the last stage of alcoholic liver disease might continue to worsen further and that they might suffer from severe complications. In these cases, a liver transplant becomes inevitable. However, patients that are suggested transplantation must meet the listed below criteria.