Table of ContentsView AllTable of ContentsStagesPermanent DamageSymptomsComplicationsDiagnosisEarly TreatmentEnd-Stage TreatmentLiver Health
Table of ContentsView All
View All
Table of Contents
Stages
Permanent Damage
Symptoms
Complications
Diagnosis
Early Treatment
End-Stage Treatment
Liver Health
The liver is responsible for metabolizing or processing ethanol, the main component of alcohol. Over time, the liver of a person who drinks heavily can become damaged and cause alcoholic liver disease.
Early damage to the liver causes fat to deposit onto the liver, resulting in hepatic steatosis, or alcoholic fatty liver disease.Fatty liver diseaseoften has no symptoms and can usually be reversed.
If the alcoholic liver disease is not treated, it can progress to later stages which includealcoholic hepatitisand cirrhosis, a scarring of the liver.
This article will discuss the stages of alcoholic liver disease, the possibilities of reversing the disease, typical symptoms, complications, diagnosis, treatment options, and how best to support the liver during treatment.
Alcoholic Liver Disease Stages: Reversibility and Healing
Alcoholic liver disease ranges in severity. There are three stages of liver disease.
Alcoholic fatty liver diseaseappears early on as fat deposits accumulate in the liver. Often there are no symptoms. People who consume four to five standard drinks per day over decades can develop fatty liver disease.
Fatty liver disease can also develop afterbinge drinking, which is defined as drinking four to five drinks in two hours or less. About 90% of heavy drinkers will develop alcoholic fatty liver disease.
Alcoholic hepatitisoccurs when the liver becomes damaged and inflamed. Symptoms include fever,jaundice(yellowing of the skin), malnourishment, swelling, and accumulation of fluid around the liver.
Although 90% of people who drink heavily develop fatty liver disease, only 20% to 40% will go on to develop alcoholic hepatitis.
Alcoholic cirrhosisis a progression of ALD in whichscarring in the livermakes it difficult for that organ to function properly. Symptoms include weight loss, fatigue, muscle cramps, easy bruising, andjaundice.
Cirrhosis can lead toliver failure. In liver failure, the liver is severely damaged and can no longer function. Other organs, such as the kidneys, and body systems such as the respiratory system, may also begin to fail.
The prognosis for liver failure is poor and requires immediate treatment, often in the intensive care unit.
Though rare,liver cancercan develop from the damage that occurs with cirrhosis.
What Is Possible?
However, if the person drinks alcohol again heavily, the fatty deposits will reappear.
Alcohol and Liver Effects: What’s Reversible vs. Permanent?
What Stages Aren’t Reversible?
Although stopping drinking alcohol is the most effective treatment for alcoholic liver disease, it is not a complete cure. People who have progressed to alcoholic hepatitis or cirrhosis most likely will not be able to reverse the disease.
In these cases, treatment focuses on preventing further damage and treating other factors that can make the disease worse, such as infection and malnourishment.
Alcoholic Hepatitis vs. Viral Hepatitis
Permanent Damage From Alcoholic Liver Disease
The liver can usually repair itself and generate new cells. However, in advanced alcoholic liver disease, liver regeneration is impaired, resulting in permanent damage to the liver. This can result in liver failure.
Liver Failure Stages
Cirrhosis is considered end stage liver disease as it cannot be reversed and can lead to liver failure. Cirrhosis is further categorized as compensated and decompensated.
In compensated cirrhosis, the liver remains functioning, and many people have no symptoms. The median life expectancy from this point is 10 to 12 years.
In decompensated cirrhosis, symptoms become more apparent. Someone with decompensated cirrhosis may develop ascites (or fluid in the abdomen), gastrointestinal bleeding, and hepatic encephalopathy, in which the brain is affected. The median life expectancy drops to one to two years.
Help to Stop DrinkingIf you want to stop drinking, help is available. TheSubstance Abuse and Mental Health Services Administration (SAMHSA)has a free helpline you can call at 800-662-4357. You can also visitFindTreatment.govto discover resources near you.
Help to Stop Drinking
If you want to stop drinking, help is available. TheSubstance Abuse and Mental Health Services Administration (SAMHSA)has a free helpline you can call at 800-662-4357. You can also visitFindTreatment.govto discover resources near you.
When Does Alcoholic Liver Disease Cause Symptoms?
Alcoholic liver disease often begins without any symptoms.
Early Symptoms
Most people will not experience symptoms in the early stages of ALD. Some may experience mild pain in the upper right side of the abdomen.
Progressive Symptoms
Symptoms of ALD that has progressed include:
Untreated Alcoholic Liver Disease Complications
Left untreated, ALD can lead to other complications. ALD that has progressed can affect other parts of the body.
People with advanced ALD may experience complications such as:
Esophageal Varices With or Without Rupture
Confirming Alcoholic Liver Disease Through Diagnosis
To diagnose ALD, a healthcare provider will assess alcohol use, ask about symptoms, and conduct several tests. An assessment of alcohol use will establish when alcohol consumption started, how much a person drinks, and how often.
At times, it may become necessary for a healthcare provider to talk with friends and relatives of the person with suspected ALD to establish the amount of alcohol consumed, as it may be difficult for the person to self-assess.
The signs and symptoms of ALD include but aren’t limited to:
Tests that may be conducted look atliver function. These include blood tests that measure liver enzymes, imaging tests such as ultrasound of the liver, a specialized test called Fibroscan, which looks for fibrosis (scarring) in the liver, and, in some cases, a biopsy of the liver (removing a sample of tissue for analysis in a lab).
Initial Treatment for Early Alcoholic Liver Disease
Abstaining from drinking alcohol is the first step in treating ALD. A team of healthcare providers, which may include psychologists or addiction specialists, can help if you find it challenging to stop drinking.
Treatment also consists of evaluation for other risk factors that can damage the liver or put the liver at higher risk, such as infection with hepatitis C andmetabolic syndrome.
Havinghepatitis Cor other liver diseases with heavy alcohol use can rapidly increase the development of cirrhosis. These diseases will also be treated.
Having a highbody mass index(BMI, a calculation based on height and weight but not taking into account other variables affecting weight) has been shown to increase mortality rates (being subject to death) and the risk of liver cancer. Reducing weight if you’re overweight, eating a healthy diet, and regular exercise can help someone with early ALD who has stopped drinking decrease their risk of advanced liver disease.
BMI is a dated, flawed measure. It does not take into account factors such asbody composition, ethnicity, sex, race, and age. Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.
Why There’s Controversy About the Use of BMI Values
Treatment for End-Stage Alcoholic Liver Disease
After stopping drinking, which is the first step in any treatment of ALD, an assessment will be made as to the extent of the damage and the overall state of the body.
Many people with ALD are malnourished (lacking proper nutrition) due to a variety of factors, such as lack of eating, vomiting, and malabsorption (difficulty absorbing nutrients from food). In general, the more severe the ALD, the more malnourished someone becomes.
Getting adequate proteins, calories, and nutrients can alleviate symptoms, improve quality of life, and decrease mortality.
Aliver transplantmay become necessary in end-stage ALD. However, eligibility may depend on being abstinent from alcohol for a specific length of time.
Liver Health During Treatment
While treating ALD it is important not only to abstain from alcohol but also become conscious of other factors that could affect the liver.
What to Avoid
While treating ALD it is best to avoid:
How to Support Liver Function
To support liver function:
Your healthcare provider may also test you for individual nutrient deficiencies. Many people with alcoholic liver disease are deficient in B vitamins, zinc and vitamin D and it may become necessary to take supplements.
Summary
While the early stages may have no symptoms, later stages can cause symptoms such as fatigue, swelling in the hands and legs, jaundice, loss of appetite, and weakness.
Early treatment can reverse alcoholic fatty liver disease. However, if the disease progresses, it is often not reversible. The standard first-line treatment is to stop drinking. Medications and lifestyle modifications may also be prescribed depending on the stage.
Eating a healthy diet, getting regular exercise, and avoiding liver-damaging foods such as fried foods, can also help the liver heal during treatment. In some cases, supplementation with vitamins may be recommended.
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