Alcoholic Liver Disease − Symptoms, Stages and Treatment Options

Last Updated: May 27, 2024

Dr. Ash Bhatt Reviewed by Dr. Ash Bhatt
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Deaths caused by excessive alcohol use increased an alarming 29% in the U.S. over the past five years, placing alcohol as a silent killer.

As the liver is the primary site of ethanol metabolism, it’s the organ that usually sustains the most significant degree of tissue injury by heavy drinking. Hepatic lesions can take up to a decade to progress, often without presenting symptoms, making them easy to overlook in primary care settings.

Keep reading to learn about alcoholic liver disease, its symptoms and stages, and how to get help before it becomes too late.

Alcohol-induced liver diseases include a range of hepatic conditions, starting with fatty liver, progressing to alcoholic hepatitis, and ending in alcoholic cirrhosis —the most advanced and irreversible form of liver damage due to heavy alcohol consumption.

Alcohol is the primary cause of liver disease worldwide, and evidence suggests that the type of alcohol consumed may influence the risk of developing liver disease.

Alcoholic Liver Disease Stages

The spectrum of alcohol-related liver injury varies from simple steatosis to cirrhosis. These stages are not necessarily distinct phases of the liver disease evolution but rather represent multiple concurrent stages in an individual.

They are commonly grouped into three stages of ALD: 1) fatty liver or simple steatosis, 2) alcoholic hepatitis, and 3) chronic hepatitis with hepatic fibrosis or cirrhosis. Understanding these stages is crucial for the diagnosis, treatment, and management of alcohol-induced liver disease.

Stage Description Symptoms Causes
Fatty Liver (Steatosis) Accumulation of fat in the liver cells due to alcohol consumption Often asymptomatic; fatigue, abdominal discomfort. 100% potentially reversible with 4-6 weeks abstinence. Present in 90% of individuals who drink more than 60 g/day of alcohol
Alcoholic Hepatitis Inflammation and liver cell damage caused by alcohol abuse Jaundice, abdominal pain, fever, nausea, vomiting fever, increased thirst Prolonged and excessive alcohol intake; binge drinking
Hepatic Fibrosis (Cirrhosis) Severe scarring of liver tissue, irreversible damage Ascites (abdominal swelling), jaundice, severe fatigue, appetite loss, spider angiomas Long-term chronic and severe alcohol abuse; typically, 10-20 years of heavy drinking

Causes of Alcoholic Liver Disease

Alcohol-induced liver disease is primarily caused by excessive and prolonged alcohol consumption. The liver metabolizes alcohol, and chronic heavy drinking can overpower its capacity, leading to various forms of liver damage.

Besides heavy alcohol consumption, other main factors influencing the disease may be:

Genetic Factors

Studies have already identified gene variations associated with higher susceptibility to ALD, including genes that control inflammation and alcohol metabolism.

People with these genetic variations are more vulnerable to liver damage from alcohol.

Pattern of Drinking and Duration of Alcohol Use

Binge drinking or consuming large amounts of alcohol in a short time can significantly increase the risk of developing ALD, as it puts stress on the liver and increases the likelihood of liver inflammation and injury.

Gender

Due to differences in body composition, metabolism, and liver enzyme activity, a woman’s body is more susceptible to alcohol-related liver damage, even with lesser alcohol exposure. For example, the risk of developing cirrhosis is higher in men taking 60-80 g/day of alcohol for ten years or longer in men, but it takes 20g/day in women.

Nutritional and Lifestyle Factors

Chronic alcohol intake is associated with deficiencies of many micronutrients, such as thiamine, folate, pyridoxine, vitamin A, vitamin D, zinc and iron.

Most of the medical manifestations of alcoholic liver disease are related to vitamin deficiencies. A high-calorie diet causing obesity, as well as smoking, can also aggravate the effects of alcohol on the liver.

Other Health Conditions

Viral infections, which are concurrent liver diseases, such as hepatitis C and hepatitis B, as well as fatty liver disease, can cause rapid progression to fibrosis, cirrhosis, and even hepatocellular carcinoma.

Alcoholic Liver Disease Treatment

The primary focus to treat alcohol-related liver disease is 100% alcohol cessation and supportive care, although advanced stages may require additional interventions.

After medical screenings such as liver function tests (LFTs), complete blood count (CBC), FibroScan, or even a liver biopsy, a multidisciplinary team may follow the next series of treatments:

Nutritional Support and Lifestyle Changes

After patients have undergone alcohol detox, they receive medical and psychological support to help them overcome alcohol dependence; nutritional support and lifestyle change guidance may be included along with supplementation to improve liver function.

Medications

Management of Complications

A couple of health complications can be caused by alcoholic liver disease. In severe cases, ascites are managed with diuretics, dietary sodium limits, fluid removal, or shunt placement.

Hepatic encephalopathy is treated with ammonia-reducing medications like lactulose or rifaximin. Variceal bleeding is treated with medications and procedures like banding or sclerotherapy.

Liver Transplantation

In advanced cases of ALD with irreversible liver damage (cirrhosis), liver transplantation may be considered. This involves replacing the diseased liver with a healthy liver from a deceased or living donor.

As ALD is a complex diagnosis, identifying underlying factors such as depression or post-traumatic trauma contributing to alcohol use disorder is a crucial action.

While early-stage liver disease prognosis is favorable with alcohol abstinence, up to 20% of patients may progress to irreversible cirrhosis. At this stage, a multidisciplinary team is crucial for optimal treatment or supportive care. Screening for hepatocellular carcinoma is essential.

Preventing serious diseases like ALD requires awareness of one’s habits and lifestyle. If you or someone you know is concerned about potential alcohol dependence, promptly seek help from addiction specialists.

People Also Ask

What are the first signs of alcoholic liver disease?

Early signs of alcohol-induced liver disease include fatigue, jaundice (yellowing of the skin and eyes), abdominal pain, swelling in the abdomen, nausea, and loss of appetite. Early detection and intervention are crucial for managing the condition.

Can alcoholic liver disease be cured?

Alcohol-related liver disease can be managed and potentially reversed through abstaining from alcohol, adopting a healthy lifestyle, and receiving medical treatment. However, severe damage may be irreversible, requiring ongoing management to prevent further deterioration.

What are the three stages of alcoholic liver disease?

The three stages of alcohol-induced liver disease are fatty liver (steatosis), alcoholic hepatitis, and cirrhosis. These stages represent a progression of liver damage, with cirrhosis being the most severe and potentially life-threatening stage.

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Published on: March 9th, 2018

Updated on: May 27th, 2024

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