Alcoholic Liver Disease

Alcoholic Liver Disease is a common disease that can be prevented. It is the damage to the liver and its functions due to the heavy use of alcohol. Excessive drinking causes swelling, inflammation, and scarring in the liver. Liver damage can affect the whole body, although it may take a long time to notice. Usually, the damage becomes irreversible till the time it is diagnosed. This is why the Alcoholic Liver Disease can be fatal. 

Read the article below to learn the causes, symptoms, and treatments of alcoholic liver disease. 

Causes of Alcoholic Liver Disease

Alcoholic liver disease is caused by prolonged consumption of alcohol. Heavy drinking of alcohol can reduce calcium levels and increase stress on your body and internal organs. The liver is the second largest organ in the body that breaks down alcohol. But if you drink more than it can process, the liver can become damaged and cause liver inflammation, including fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. Not just the liver, drinking too much alcohol can harm other body parts, including your heart, brain, immune system, and pancreas. 

There is no known reason why some people who are heavy drinkers get this disease while others do not. According to research, this can be related to a genetic link. 

Risk Factors for Alcoholic Liver Disease

1. Have a family history of the disease
2. Binge drink (long-term consumption of more than 30 g of absolute alcohol per day)
3. Poor nutrition - Alcohol can prevent the body from absorbing nutrients. Lack of nutrients can lead to liver cell damage.

The alcoholic liver disease symptoms depend on the stage of the disease 

1. Fatty Liver (Often causes no significant symptoms)

   1. Upper abdominal discomfort

   2. Unexplained Weight loss

   3. Tiredness

   4. Weakness

2. Alcoholic Hepatitis

   1. Fever

   2. Weakness

   3. Nausea

   4. Vomiting

   5. Stomach pain or pain in the abdomen

   6. Jaundice (yellowing of the skin and eyes)

   7. Loss of appetite

   8. Unexplained Weight loss

3. Alcoholic Cirrhosis: In addition to the symptoms of alcoholic hepatitis,

   1. Poor nutrition

   2. Confusion

   3. Mood swings

The signs of alcoholic cirrhosis include:-

1. Enlarged spleen

2. Portal hypertension

3. Ascites (build-up of fluids in the abdomen)

4. Kidney failure

5. Bleeding in the intestine

During the diagnosis of alcoholic liver disease, your doctor will ask you about your complete medical history and conduct a physical exam. They may also perform other exams, which include:-

1. Blood Tests: These include liver function tests to examine whether the liver is functioning properly. Common liver function tests include:-
2. Alanine Transaminase (ALT) test: The body uses alanine transaminase to metabolise protein. The normal range is 7 to 55 units per litre. A higher result is a sign of liver damage.
3. Aspartate Aminotransferase (AST) test is an enzyme found in several body parts. The normal range is 8 to 48 units per litre. A high result may indicate a problem with the liver or muscles.
4. Alkaline Phosphatase (ALP) test is an enzyme found in bones, bile duct, and liver. The normal range is 40 to 129 units per litre. A high result may indicate liver inflammation, blockage in the bile ducts or bone disease.
5. Albumin test: Albumin is a protein made by your liver. The normal range is 3.5 to 5 grams per decilitre. A low result indicates that the liver is not functioning properly.
6. Bilirubin test: Bilirubin is a waste product resulting from the breakdown of RBCs. The normal range is 0.1 to 1.2 milligrams per decilitre. A high result may indicate that the liver is not functioning properly. 
7. Ultrasound: The test uses high-frequency sound waves to create pictures of the liver. It can show the presence of abnormalities in the liver. It is especially useful for differentiating cysts from solid masses. Other findings in an ultrasound include changes in the size of the liver, dilation of the hepatic veins, and the presence of ascites (fluid collection near the liver). 
8. Liver biopsy: In this test, the surgeon uses a needle to remove a small tissue sample from the liver. The sample is checked under a microscope to detect the type of liver disease.
9. MRI: An MRI scan is used to make detailed pictures of the body’s internal structures. It can help detect liver disorders that affect the organ. Sometimes, the doctor may inject dye in a vein that helps to show the liver and other organs in the abdomen. An MRI can differentiate a benign tumour from a malignant one. Furthermore, it can check for blockages by examining blood vessels in and around the liver. 
10. CT scan: A CT scan uses X-rays and a computer to produce body images. The doctor uses this imaging test to see your abdominal cavity’s organs, bones, blood vessels, and fat. The test is beneficial for detecting tumours, bleeding, infections, injuries, and abscesses in the liver. Furthermore, CT scans help diagnose specific types of jaundice. 

1. Abstinence: The early stages of liver disease can be reversed by abstaining from alcohol. Any condition that has been reversed can return once you restart drinking. 
2. Alcohol Rehabilitation Programs: People who drink more than the recommended daily limit should not stop drinking without proper medical support. Why? Because the withdrawal symptoms of alcohol can be life-threatening. Cognitive behavioural therapy and medications can be useful to ease the withdrawal symptoms. 
3. Medications: Corticosteroids or pentoxifylline can be used to reduce inflammation in people with alcoholic hepatitis. Apart from that, multivitamins can be prescribed to treat anaemia or malnutrition. You can also take Vitamin K to prevent excessive bleeding. The doctor may prescribe medications for fluid buildup and mental confusion as well. 
4. Lifestyle Changes: Being overweight and smoking can make alcoholic liver disease worse. Therefore, you can make certain lifestyle changes, like weight loss and quitting smoking, to reverse the condition at the early stages. 
5. Treatment for Ascites: Ascites can be treated by paracentesis, followed by diuretic therapy. 
6. Treatment for Portal Hypertensive Bleeding: It can be treated by drug therapy with non-selective beta-blockers endoscopic variceal band ligation of varices. 
7. Treatment for Hepatic Encephalopathy: It includes supportive therapies, treatment of precipitating factors, lactulose and rifaximin. 
8. Treatment for Oesophagal Bleed: It can be treated by using elastic bands to tie the bleeding veins, placing pressure on varices to stop the bleeding, diverting blood flow away from the portal vein, or taking medications to slow the blood flow in the portal vein. 
9. Liver Transplant: Your doctor may recommend liver transplant surgery if your liver gets too scarred by cirrhosis to function properly. However, it is a last resort.

Please Note: The selection of the treatment approach is based on the stage of the alcoholic liver disease and your doctor’s opinion. 

If left untreated, Alcoholic Liver Disease may progress through the following stages:

1. Fatty Liver: Drinking excessive alcohol can build up fatty acids inside the liver cells, resulting in an enlarged liver. It is the most common liver disease induced by alcohol. 
2. Alcoholic Hepatitis: Continuous alcohol use results in acute inflammation of the liver. The death of liver cells can lead to scar tissue formation or fibrosis. 
3. Alcoholic Cirrhosis: Cirrhosis is a life-threatening condition resulting from the destruction of the normal liver tissue. The damage caused by cirrhosis is generally irreversible. 

The Complications of the Alcoholic Liver Disease include:-

1. Permanent liver scarring
2. Loss of liver function
3. Portal hypertension - high blood pressure in the liver’s blood vessels
4. Bleeding oesophageal varices - enlarged veins in the oesophagus, developed due to liver disease
5. Hepatic encephalopathy - nervous system disorder caused by severe liver disease