Short-term or progressive liver damage due to excessive alcohol consumption
The most common cause of severe long-term liver disease in developed countries is excessive alcohol consumption (see Alcohol and health, and Alcohol dependence). More men than women have alcohol-related liver disease because more men drink heavily. However, women are more susceptible to liver damage from alcohol because of differences in the way that men and women metabolize alcohol. The longer excessive alcohol consumption continues, the greater the likelihood of liver disease developing. Long-term alcohol related liver disease is known to increase the risk of liver cancer.
Alcohol may cause three types of liver disease: fatty liver, alcoholic hepatitis, and cirrhosis. Typically, these conditions occur in sequence, but this is not always the case. Over a period of several years, most heavy drinkers develop a fatty liver, in which fat globules develop within liver cells. If alcohol consumption continues, hepatitis (inflammation of the liver) develops. With continued drinking, cirrhosis develops. In this condition, liver cells that are damaged by alcohol are replaced by fibrous scar tissue. If cirrhosis has developed, liver damage is usually irreversible. It is not known why some heavy drinkers go on to develop hepatitis or cirrhosis while others do not.
In many cases, fatty liver does not cause symptoms and often remains undiagnosed. However, in about 1 in 3 affected people, the liver becomes enlarged, which may lead to discomfort in the right upper abdomen.
Alcoholic hepatitis may also produce no symptoms at first, but after about 10 years of heavy drinking in men and sooner in women, the first symptoms usually develop. These may include:
Nausea and occasional vomiting.
Discomfort in the upper right side of the abdomen.
Yellowing of the skin and the whites of the eyes (see Jaundice).
Poor appetite and weight loss.
In some cases, severe cirrhosis may lead to a serious condition in which there is bleeding into the digestive tract from abnormal blood vessels that develop in the wall of the oesophagus (see Portal hypertension and varices). Severe alcoholic hepatitis and cirrhosis can lead to liver failure, which may result in coma and death.
A history of heavy alcohol consumption is essential for the diagnosis of alcohol-related liver disease. It is important that you are honest and tell your doctor exactly how much you drink. However, many people who drink heavily are reluctant to do this.
Your doctor may arrange for blood tests to evaluate your liver function. You may also have a liver biopsy, a procedure in which a hollow needle is inserted into the liver to obtain a sample of liver tissue. The sample is then examined under a microscope to look for cell abnormalities.
People with alcohol-related liver disease must stop drinking permanently. Many people need professional help to achieve this. If drinking continues, the disease will probably progress and may be fatal. If drinking stops, the outlook is likely to improve.
Fatty liver often disappears after 3–6 months of abstinence from alcohol. Some people with alcoholic hepatitis who stop drinking recover completely. However, in most cases damage to the liver is irreversible, and the condition progresses to cirrhosis. Severe alcoholic cirrhosis can cause a number of serious complications, which in some cases may be fatal. About half of all people who have cirrhosis die from liver failure within 5 years. More than 1 in 10 people who have cirrhosis go on to develop liver cancer. People who have alcohol-related liver disease but have no other serious health problems and have managed to stop drinking may be candidates for a liver transplant.
Many of the symptoms and some of the complications of alcohol-related liver disease can be treated successfully. For example, swelling of the abdomen as a result of fluid accumulating in the abdominal cavity can be reduced by diuretic drugs and by following a diet that is low in salt. Nausea and vomiting can frequently be relieved by antiemetic drugs.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.