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alcoholic liver disease

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Cirrhosis of the liver

Bleeding esophageal varices (varicose veins)

Alternative Names 
alcoholic fatty liver, alcoholic hepatitis, alcoholic cirrhosis

Habitual drinking of alcohol can damage the liver. There are 3 types of damage: alcoholic fatty liver, alcoholic hepatitis, and alcoholic Cirrhosis. The amount of damage depends on the amount of alcohol used and how long the drinking continues. The type of alcohol is not important.

What is going on in the body? 
Alcoholic fatty liver is found in most heavy drinkers. It is the most common liver problem in people with alcohol dependence. The liver is enlarged, firm, and yellowish. The liver cells are swollen with fat. This fat comes from the diet and the body's fat cells. Alcoholic fatty liver is reversible if a person stops drinking alcohol.

Alcoholic hepatitis is inflammation of the liver from alcohol, which can be severe. The liver is enlarged, firm, and yellowish. There is also death of liver cells. Alcoholic hepatitis is the middle step between fatty liver and alcoholic cirrhosis.

Alcoholic cirrhosis is an end-stage disease. If drinking is not stopped, more liver cells die. Scarring occurs throughout the liver. With continued scarring, the liver shrinks, becomes firm, and is no longer able to function. Cirrhosis is permanent, even if a person stops drinking.

What are the signs and symptoms of the disease? 
Alcoholic fatty liver often causes no symptoms. The disease may not be found until the person sees a doctor for another medical condition. Symptoms can include an enlarged liver and sometimes tenderness when the liver is touched.

Symptoms from alcoholic hepatitis can range from mild to critical and may include: There can be liver failure and death in severe cases.

Alcoholic cirrhosis usually takes at least 10 years or more of excessive drinking to develop. The symptoms develop slowly. The liver shrinks and is scarred, firm, and nodular. Scarring around the veins in the liver causes blood to find other routes of flow. This leads to big, swollen veins in the throat, rectum, abdomen, and chest. Common symptoms of alcoholic cirrhosis include: What are the causes and risks of the disease? 
The longer the drinking goes on and the larger the amounts of alcohol used, the greater the risk of developing hepatitis and cirrhosis. About 10% to 15% of alcoholics develop cirrhosis. Alcoholic women are at risk for developing liver disease from lesser amounts of alcohol than men. Additional risk factors include:
  • poor nutrition
  • past liver damage from infections
  • possibly, a genetic risk factor
What can be done to prevent the disease? 
Alcoholic liver disease can be prevented by not drinking alcohol.

How is the disease diagnosed? 
The history of alcohol dependence, symptoms, and physical examination may be all that is required to make the diagnosis. Blood tests, X-rays, and a liver biopsy may be needed in some cases. In a liver biopsy, a small piece of liver tissue is removed with a special needle and examined in the laboratory.

What are the long-term effects of the disease? 
The only long-term effect of alcoholic fatty liver is that it may progress to hepatitis or cirrhosis if drinking continues. Alcoholic hepatitis and cirrhosis can lead to death from liver failure. Infection, kidney failure known as chronic renal failure, and bleeding are other common causes of death in cirrhosis. Liver damage also leads to malnutrition, weakness, and jaundice.

What are the risks to others? 
Alcoholic liver disease is not contagious.

What are the treatments for the disease? 
In all forms of alcoholic liver disease, the person needs to stop drinking alcohol. Alcoholics Anonymous or other support groups are often a part of successful treatment for alcoholism. Other treatments will not work if the person keeps drinking.

Most other treatments depend on the symptoms and amount of liver damage. An appropriate diet for liver disease includes a daily multivitamin and adequate protein. Medications, blood transfusions, or surgery may be needed in cases of severe hepatitis or cirrhosis.

What are the side effects of the treatments? 
When an alcoholic stops drinking, severe alcohol withdrawal symptoms may occur. This may require a person to be admitted to the hospital. Seizures and even death can sometimes occur.

All medications have side effects, including allergic reactions and stomach upset. Blood transfusions can cause allergic reactions and infections. Surgery can result in bleeding, infection, and allergic reaction to anaesthesia.

What happens after treatment for the disease? 
If drinking stops, fatty liver and hepatitis are usually reversible. cirrhosis is not reversible but may stabilise. With advanced alcoholic cirrhosis, people usually die from liver failure even if they do stop drinking. If cirrhosis develops, lifelong treatment is required.

How is the disease monitored? 
Alcoholic liver disease is monitored through periodic visits to the doctor and liver function tests. Any new or worsening symptoms should be reported to the doctor.

Author: Susan Woods, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 25/04/2005
Potential conflict of interest information for reviewers available on request

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