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Alcoholic liver disease

Definition

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

See also:

• Ascites
• Cirrhosis
• Alcoholism
• Bleeding varices
• Hepatic encelphalopathy

Alternative Names

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

Causes, incidence, and risk factors

Alcoholic liver disease usually occurs after years of drinking too much. The longer the alcohol use has occurred, and the more alcohol that was consumed, the greater the likelihood of developing liver disease.

Alcohol may cause swelling and inflammation (hepatitis) in the liver. Over time, this can lead to scarring and then cirrhosis of the liver. Cirrhosis is the final phase of alcoholic liver disease.

Other important factors include:

• Alcoholic liver disease may be more common in some families
• This disease does not occur in all heavy drinkers
• You do not have to get drunk for the disease to develop
• Women may be more susceptible than men

People who drink too much, too often do not get enough healthy foods and nutrients. Poor nutrition may make liver disease worse.

Acute alcoholic hepatitis may be caused by binge drinking (five drinks for men, four drinks for women). It may be life-threatening.

Symptoms

Symptoms vary based on the severity of the disease. They are usually worse after a recent period of heavy drinking.

Symptoms may not be present until the disease is advanced.

General symptoms include:

• Abdominal pain and tenderness
• Dry mouth and increased thirst
• Fatigue
• Jaundice
• Loss of appetite
• Nausea
• Swelling or fluid buildup in the legs (edema) and in the abdomen (ascites) when cirrhosis is present
• Weight loss

Skin changes include:

• Abnormally dark or light skin
• Redness on feet or hands
• Small, red spider-like blood vessels on the skin
• Yellow color in the skin, mucus membranes, or eyes (jaundice)

Abnormal bleeding:

• Bloody, dark black, or tarry bowel movements (melena)
• Nosebleeds or bleeding gums
• Vomiting blood or material that looks like coffee grounds

Brain and nervous system symptoms:

• Agitation (being stirred up, excited, or irritable)
• Changing mood
• Confusion (encephalopathy)
  • Periods of decreased alertness or awareness
  • Hallucinations
  • Impaired short- or long-term memory
• Pain, numbness, or tingling in the arms or legs
• Problems paying attention or concentrating
• Poor judgment
• Slow, sluggish movements

Other symptoms that can occur with this disease:

• Breast development in males
• Light-headedness or fainting, especially when rising to standing position
• Paleness

Signs and tests

• Complete blood count (CBC)
• Liver biopsy
• Liver function tests such as ALP

Tests to rule out other diseases include:

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

Treatment

The most important part of treatment is to stop using alcohol completely. If liver cirrhosis has not yet occurred, the liver can heal if you stop drinking alcohol.

An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Vitamins, especially B-complex and folic acid, can help reverse malnutrition.

If cirrhosis develops, you will need to manage the complications of cirrhosis. You may need a liver transplant.

See also: Alcoholic neuropathy

Support Groups

You can often ease the stress of illness by joining a support group whose members share common experiences and problems.

See:

• Alcoholism - support group
• Liver disease - support group

Expectations (prognosis)

Continued excessive drinking can shorten your lifespan. The outcome will likely be poor if you keep drinking.

Complications

• Bleeding esophageal varices
• Cirrhosis
• Hepatic encephalopathy
• Increased pressure in blood vessels of the liver (portal hypertension)

Calling your health care provider

Call your health care provider if:

• You develop symptoms of alcoholic liver disease
• You develop symptoms after prolonged or heavy drinking
• You are concerned that drinking may be damaging your health

Prevention

Discuss your alcohol intake with your doctor. The doctor can counsel you about how much alcohol is safe to drink for your situation.

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: Saunders Elsevier; 2010:chap 84.

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