DefinitionAlcoholic liver disease is damage to the liver and its function due to alcohol abuse.See also:AscitesCirrhosisAlcoholismBleeding varicesHepatic encelphalopathy
Alternative NamesLiver disease due to alcohol; Cirrhosis or hepatitis - alcoholic; Laennec's cirrhosis
Causes, incidence, and risk factorsAlcoholic liver disease usually occurs after years of drinking too much. The longer the alcohol use has occurred, and the more alcohol that was consumed, the greater the likelihood of developing liver disease.Alcohol may cause swelling and inflammation (hepatitis) in the liver. Over time, this can lead to scarring and then cirrhosis of the liver. Cirrhosis is the final phase of alcoholic liver disease.Other important factors include:Alcoholic liver disease may be more common in some familiesThis disease does not occur in all heavy drinkersYou do not have to get drunk for the disease to developWomen may be more susceptible than menPeople who drink too much, too often do not get enough healthy foods and nutrients. Poor nutrition may make liver disease worse.Acute alcoholic hepatitis may be caused by binge drinking (five drinks for men, four drinks for women). It may be life-threatening.
SymptomsSymptoms vary based on the severity of the disease. They are usually worse after a recent period of heavy drinking.Symptoms may not be present until the disease is advanced.General symptoms include:Abdominal pain and tendernessDry mouth and increased thirstFatigueJaundiceLoss of appetiteNauseaSwelling or fluid buildup in the legs (edema) and in the abdomen (ascites) when cirrhosis is presentWeight lossSkin changes include:Abnormally dark or light skinRedness on feet or handsSmall, red spider-like blood vessels on the skinYellow color in the skin, mucus membranes, or eyes (jaundice)Abnormal bleeding:Bloody, dark black, or tarry bowel movements (melena)Nosebleeds or bleeding gumsVomiting blood or material that looks like coffee groundsBrain and nervous system symptoms:Agitation (being stirred up, excited, or irritable)Changing moodConfusion (encephalopathy)
Periods of decreased alertness or awarenessHallucinationsImpaired short- or long-term memoryPain, numbness, or tingling in the arms or legsProblems paying attention or concentratingPoor judgmentSlow, sluggish movementsOther symptoms that can occur with this disease:Breast development in malesLight-headedness or fainting, especially when rising to standing positionPaleness
Signs and testsComplete blood count (CBC)Liver biopsyLiver function tests such as ALPTests to rule out other diseases include:Abdominal CT scanBlood tests for other causes of liver diseaseUltrasound of the abdomen
TreatmentThe most important part of treatment is to stop using alcohol completely. If liver cirrhosis has not yet occurred, the liver can heal if you stop drinking alcohol.An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Vitamins, especially B-complex and folic acid, can help reverse malnutrition.If cirrhosis develops, you will need to manage the complications of cirrhosis. You may need a liver transplant.See also: Alcoholic neuropathy
Support GroupsYou can often ease the stress of illness by joining a support group whose members share common experiences and problems.See:Alcoholism - support groupLiver disease - support group
Expectations (prognosis)Continued excessive drinking can shorten your lifespan. The outcome will likely be poor if you keep drinking.
ComplicationsBleeding esophageal varicesCirrhosisHepatic encephalopathyIncreased pressure in blood vessels of the liver (portal hypertension)
Calling your health care providerCall your health care provider if:You develop symptoms of alcoholic liver diseaseYou develop symptoms after prolonged or heavy drinkingYou are concerned that drinking may be damaging your health
PreventionDiscuss your alcohol intake with your doctor. The doctor can counsel you about how much alcohol is safe to drink for your situation.
ReferencesCarithers RL, McClain C. Alcoholic liver disease. In: Feldman M, Friedman LS, Brandt LJ. Feldman: Sleisinger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 84.Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.