Alcohol-Induced Liver Disease

• Helps filter waste from the body
• Makes bile to help digest food
• Stores sugar that the body uses for energy
• Makes proteins that work in many places in the body—for example, proteins that cause blood to clot

Types of alcohol-induced liver disease

There are 3 types. Many heavy drinkers progress through these 3 types over time:

• Fatty liver. Fatty liver is the build-up of fat inside the liver cells. It leads to an enlarged liver. It’s the most common alcohol-induced liver problem.
• Alcoholic hepatitis. Alcoholic hepatitis is an acute inflammation of the liver. There is death of liver cells, often followed by permanent scarring.
• Alcoholic cirrhosis. Alcoholic cirrhosis is the destruction of normal liver tissue. It leaves scar tissue in place of the working liver tissue.

Alcohol-induced liver disease is caused by heavy use of alcohol. The liver’s job is to break down alcohol. If you drink more than it can process, it can become badly damaged.

Fatty liver can happen in anyone who drinks a lot. Alcoholic hepatitis and alcoholic cirrhosis are linked to the long-term alcohol abuse seen in alcoholics.

Healthcare providers don’t know why some people who drink alcohol get liver disease while others do not. Research suggests there may be a genetic link, but this is not yet clear.

The effects of alcohol on the liver depend on how much and how long you have been drinking alcohol. These are the most common symptoms and signs:

Fatty liver:

• Often causes no symptoms
• Build-up of fat inside the liver cells enlarges the liver, causing upper abdominal (belly) discomfort on the right side
• Tiredness and weakness
• Weight loss

Alcoholic hepatitis:

• Pain over the liver
• Fever
• Weakness
• Nausea and vomiting
• Appetite loss
• Yellowing of the skin and eyes (jaundice)

Alcoholic cirrhosis, all of the symptoms of alcoholic hepatitis and:

• Portal hypertension (increased resistance to blood flow through the liver)
• Enlarged spleen
• Poor nutrition
• Bleeding in the intestines
• Ascites (fluid build-up in the belly)
• Kidney failure
• Confusion
• Liver cancer

The symptoms of alcohol-induced liver disease may look like other health problems. Always see a doctor for a diagnosis.

Your healthcare provider will do a complete health history and physical exam. Other tests used to diagnose alcohol-induced liver disease may include:

• Blood tests. Including liver function tests, which show whether the liver is working the way it should.
• Liver biopsy. This involves removing small tissue samples from the liver with a needle or during surgery. These samples are checked under a microscope to find out the type of liver disease.
• Ultrasound. This test uses high frequency sound waves to create a picture of the organs.
• CT scan. This imaging test uses X-rays and a computer to produce images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• MRI. MRI uses a magnetic field, radio frequency pulses, and a computer to make detailed pictures of internal body structures. Sometimes injecting dye into a vein is used to produce images of body parts. The dye helps show the liver and other organs in the abdomen (belly).

The goal of treatment is to restore some or all normal functioning to the liver.

You must completely stop drinking alcohol. This may involve an alcohol treatment program. Sometimes diet changes are advised, too. The liver is often able to fix some of the damage caused by alcohol, so you can live a normal life. The scarring from cirrhosis is sometimes partially reversible, and when liver tissue loss is severe enough to cause liver failure, most of the damage may be permanent. However, the damage won't have any chance of reversing if you continue to drink alcohol.

Different treatments are needed for different complications and symptoms of alcoholic liver disease. For example, dietary changes, vitamins, salt restriction, procedures to shrink swollen veins in the digestive tract, water pills (diuretics), medicines to treat confusion, and anti-inflammatory medicines.

In some cases, a liver transplant may be considered. But you must complete a rehab program and go through alcohol detox before this is even an option.

About 30% of people with alcohol-induced liver disease have hepatitis C virus. Others have hepatitis B virus. Your provider will test you for both and treat you if needed.

People with alcohol-induced liver disease are also at greater risk for liver cancer.

About 50% have gallstones.

Those with cirrhosis often develop kidney problems, intestinal bleeding, fluid in the belly, confusion, liver cancer, and severe infections.

Key points

• Alcohol-induced liver disease is a common, but preventable, disease.
• Alcohol-induced liver disease is caused by heavy use of alcohol. The liver breaks down alcohol. If you drink more than it can process, it can become seriously damaged.
• The effects of alcohol on the liver depend on how much and how long you have been drinking.
• The most important part of treatment is to completely stop drinking alcohol. Sometimes diet changes are advised, too.
• The liver is often able to repair some of the damage caused by alcohol so that you can live a normal life. In some cases, liver transplant may be considered. But you must complete a rehab program and go through alcohol detox before this is even an option.

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down the questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.