Alcoholic liver disease (patient information)

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 * Assistant Editor-in-Chief: Meagan Doherty.

Overview
Alcoholic liver disease is damage to the liver and its function due to alcohol abuse.

What are the symptoms of Alcoholic liver disease?
Changes start in the liver as inflammation (hepatitis) and lead to fatty liver and cirrhosis. Cirrhosis is the final phase of alcoholic liver disease.

Symptoms may not be present until the disease is advanced, and may include:
 * Abdominal pain and tenderness
 * Dry mouth
 * Excessive thirst
 * Fatigue
 * Fever
 * Fluid collection in the abdomen (ascites)
 * Jaundice
 * Loss of appetite
 * Mental confusion
 * Nausea
 * Unintentional weight gain (because of fluid collection)

Other symptoms that can occur with this disease:
 * Abnormally dark or light skin
 * Agitation
 * Bloody, dark black, or tarry bowel movements (melena)
 * Breast development in males
 * Changing mood
 * Confusion (encephalopathy)
 * Changed level of consciousness
 * Hallucinations
 * Impaired short- or long-term memory

Symptoms vary based on the severity of the disease. They are usually worse after a recent period of heavy drinking.
 * Difficulty paying attention (attention deficit)
 * Impaired ability to concentrate
 * Impaired judgment
 * Light-headedness or fainting, especially when standing
 * Paleness
 * Rapid heart rate (tachycardia) when rising to standing position
 * Redness on feet or hands
 * Slow, sluggish, lethargic movement
 * Vomiting blood or material that looks like coffee grounds

What are the causes of Alcoholic liver disease?
Alcoholic liver disease usually occurs after years of excessive drinking. The longer the alcohol use and the more alcohol that was consumed, the greater the likelihood of developing liver disease.

Acute alcoholic hepatitis can result from binge drinking. It may be life-threatening if severe.

People who drink excessively can become malnourished because of the empty calories from alcohol, reduced appetite, and poor absorption (malabsorption) of nutrients in the intestines. Malnutrition contributes to liver disease.

Other factors that contribute to the development of alcoholic liver disease:
 * Genetic factors
 * Personal susceptibility to alcohol-induced liver disease
 * Toxicity of alcohol (ethanol) to the liver

Alcoholic liver disease does not affect all heavy drinkers. Women may be more susceptible than men. It is not necessary to get drunk for the disease to develop.

Who is at highest risk?
Risk Factors include:
 * Heavy drinking/Binge drinking
 * Gender: Women are more susceptible than men
 * Genetic predisposition
 * Personal susceptibility to alcohol-induced liver disease
 * Toxicity of alcohol (ethanol) to the liver

Diagnosis
Diagnosing ALD is a challenge. A history of heavy alcohol use along with certain physical signs and positive laboratory tests for liver disease are the best indicators of disease. Alcohol dependence is not necessarily a prerequisite for ALD, and ALD can be difficult to diagnose because patients often minimize or deny their alcohol abuse. Even more confounding is the fact that physical exams and lab findings may not specifically point to ALD.

Diagnosis typically relies on laboratory tests of three liver enzymes: gamma–glutamyltransferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Liver disease is the most likely diagnosis if the AST level is more than twice that of ALT, a ratio some studies have found in more than 80 percent of alcoholic liver disease patients. An elevated level of the liver enzyme GGT is another gauge of heavy alcohol use and liver injury. Of the three enzymes, GGT is the best indicator of excessive alcohol consumption, but GGT is present in many organs and is increased by other drugs as well, so high GGT levels do not necessarily mean the patient is abusing alcohol.

Exams and tests

 * CBC
 * Liver biopsy
 * Liver function tests such as ALP
 * Serum ferritin

Tests to rule out other diseases include:
 * Abdominal CT scan
 * Blood tests for other causes of liver disease
 * Ultrasound of the abdomen

When to seek urgent medical care?
Call your health care provider if:
 * You develop symptoms of alcoholic liver disease
 * You develop symptoms after prolonged or heavy drinking
 * You are concerned that drinking may be damaging your health

Treatment options
The 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.

Diseases with similar symptoms

 * Cirrhosis
 * Hepatitis
 * Chronic hepatitis C, B or D
 * Liver disease
 * Cholecystitis
 * Cholelithiasis

Where to find medical care for Alcoholic liver disease?
Directions to hospitals treating alcoholic liver disease

Prevention of Alcoholic liver disease
Discuss your alcohol intake with your doctor. The doctor can counsel you about how much alcohol is safe to drink for your situation.

What to expect (Outlook/Prognosis)?
Continued excessive drinking can shorten your lifespan. The outcome will likely be poor if you keep drinking.

Possible complications

 * Bleeding esophageal varices
 * Cirrhosis
 * Hepatic encephalopathy
 * Increased pressure in blood vessels of the liver (portal hypertension)