Alcoholic liver disease is a broad term for illnesses of the liver due to alcohol overconsumption and includes fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. The liver is a very important organ in the body, and is responsible for filtering waste products, storing nutrients, and moderating chemical levels in the body. When these functions are compromised, complications such as excessive bleeding and increased pressure in the brain may occur.
Cessation of alcohol use is very important with any form of alcoholic liver disease and failure to do so may result in progression of the disease, causing symptoms to worsen leaving the patient with fewer treatment options. Many heavy drinkers will progress from fatty liver disease to alcoholic hepatitis to alcoholic cirrhosis over time. However, some heavy drinkers may develop cirrhosis without developing hepatitis first. Others may have alcoholic hepatitis but never have symptoms.
Fatty liver: Fatty liver disease is the build up of extra fat in liver cells. It is the earliest stage of alcohol-related liver disease.
Alcoholic hepatitis: Alcoholic hepatitis causes the liver to swell, inflame and become damaged. The onset may be sudden or develop over time.
Alcoholic cirrhosis: Alcoholic cirrhosis is the scarring of the liver with hard scar tissue replacing soft healthy tissue. It is the most serious type of alcohol-related liver disease. The damage from cirrhosis cannot be reversed and can cause liver failure.
Alcohol abuse: Alcohol is filtered through the liver and many heavy drinkers will progress from fatty liver disease to alcoholic hepatitis to alcoholic cirrhosis over time. However, some heavy drinkers may develop cirrhosis without having alcoholic hepatitis first.
Hepatitis: Hepatitis is a virus that may cause inflammation and scarring which may impair the liver’s ability to function. Hepatitis A, B, and C may result in scarring of the liver and potentially liver failure. Autoimmune hepatitis is known to cause the body to attack the liver.
Patients with alcoholic liver disease may not experience any symptoms. In fatty liver disease in particular, often there is no indication that anything is wrong. As the diseases progress, symptoms become more noticeable. They include:
• Fatigue • Hardening of the liver tissue (cirrhosis)• Yellowing of the skin or whites of the eyes (jaundice)• Liver enlargement• Excess fluid in the abdomen (ascites)• Weight loss• Itching (pruritus)• Fever• Shortness of breath (due to ascites)• Nausea and vomiting• Confusion (encephalopathy)
Patients should see a physician as soon as possible for any symptoms, or call 911 or seek emergency care if they are severe. Patients may need to be referred to a hepatologist who is a liver specialist for advanced care.
To diagnose alcoholic liver disease the patient’s physician will complete a thorough history and physical assessment. Patients should bring all over the counter and prescription medications plus vitamins and herbal supplements to their appointment, or a list of all medications, their dose and frequency of use. The provider will also listen to and feel the patient’s abdomen to examine the liver. Patients maybe asked difficult questions about sexual health, drug and alcohol use and it is important that patients answer them truthfully to assure the best care, and assist the provider in making a correct diagnosis. Patients may also complete the following tests:• Blood work• Ultrasound, MRI or CT imaging• Abdominal x-ray• Liver Biopsy
Due to the numerous causes of alcoholic liver disease, treatment may vary due to the underlying cause of the liver dysfunction. Most treatments rely on alleviating the complications of alcoholic liver disease, including draining of excess abdominal fluid or fluid on the brain. Patients will be monitored closely and may need to be admitted to intensive care for stabilization.
Dependent upon the underlying cause, several different medications may be utilized such as the diuretics Lasix and spironolactone may be used to control fluid accumulation. Medications such as lactulose and Xifaxan may be used to combat the confusion associated with hepatic encephalopathy.
At times, medication and close monitoring are not effective. This may result in the need for a liver transplant.
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