Long term excessive alcohol intake causes chronic diseases in several organ systems, particularly the liver. Alcohol causes a range of liver diseases. It can cause the liver to become fatty, termed alcoholic steatosis. The liver may become inflamed, called alcoholic hepatitis. It can also lead to complete liver failure or cirrhosis.
Mechanism
Fatty liver is characterized by the liver cells filling with fat. The liver is responsible for breaking down fat; in the presence of alcohol it does so less effectively. The condition is benign and can reverse with abstinence from alcohol. Hepatitis, or inflammation occurs when the liver cells are injured, leading to an immune response. Chemical reactions with alcohol in the liver lead to the production of free radicals, which are chemicals that can damage cells. Cirrhosis occurs when the liver cells are replaced with scar tissue such as collagen.
Prevalence
A study in Digestive Diseases noted that the frequency of fatty liver in alcoholics approaches 90 percent. The authors note that there is an increased risk of severe liver disease with the ingestion of 60 to 80 grams per day of alcohol in men and greater than 20 grams in women. A beer, a glass of wine or a shot of liquor averages about 12 grams of alcohol, so this would be the equivalent of about five beers for men or two beers for women. The prevalence of fatty liver is very high among heavy drinkers; 20 percent will develop alcoholic hepatitis and 25 percent will develop cirrhosis. The risks of liver disease rise as the amount and duration of alcohol consumption increase.
Symptoms and Signs
The symptoms of alcoholic liver disease depend on the severity. Fatty liver disease is generally without symptoms, but can cause an enlarged liver, located in the upper right side of the abdomen, and tenderness in the area. Alcoholic hepatitis may cause weight loss, nausea, vomiting and abdominal distension if mild. If more severe, it can cause confusion and bleeding problems. Liver failure leads to bleeding problems,yellowing of the skin, itching, a fluid-filled abdomen and confusion.
Diagnosis
Physical exam findings may reveal an enlarged, tender liver, a distended abdomen, enlarged breast tissue and shrunken testicles in men, abnormal blood vessels under the skin called telangiectasias and yellowing of the skin. Lab values will generally be abnormal. Imaging such as ultrasound, CT scan or MRI may be used. A liver biopsy may also be necessary in diagnosis. A needle is be used to remove a small amount of tissue for examination under a microscope or other studies.
Treatment
The most important method of treatment is to stop drinking alcohol, allowing the body to heal. A proper diet, as prescribed by a nutritionist or other qualified health care professional is also important. Potential drug treatments include immune suppressant steroids and a drug called pentoxyfylline. Fluid in the abdomen may need to be drained. Antibiotics may need to be given to prevent infection of the abdomen from organisms in the GI tract and prevent them from making ammonia. Ammonia leads to confusion if the liver cannot clear it. If the damage is severe, a liver transplant may be required.
References
- "Digestive Diseases"; Clinical syndromes of alcoholic liver disease; Adachi, Brenner; 2005
- Cleveland Clinic: Alcoholic Liver Disease
- GPNotebook: Alcoholic Steatosis
- Mayo Clinic: Liver Failure: Tests and Diagnosis
- Mayo Clinic: Liver Failure: Treatment and Drugs
