What is alcohol-induced liver disease?

Alcohol-induced liver disease is common. But it can be prevented. There are three types. Many heavy drinkers progress through these three types over time:

• Fatty liver. Fatty liver is the build-up of fat inside the liver cells. It leads to an enlarged liver. It’s the most common alcohol-induced liver problem.

• Alcoholic hepatitis. Alcoholic hepatitis is an acute inflammation of the liver. There is death of liver cells, often followed by permanent scarring.

• Alcoholic cirrhosis. Alcoholic cirrhosis is the destruction of normal liver tissue. It leaves scar tissue in place of the working liver tissue. In this situation, the liver may stop working correctly.

The liver is a large organ that sits up under the ribs on the right side of the belly (abdomen). The liver:

• Helps filter waste from the body

• Makes bile to help digest food

• Stores sugar that the body uses for energy

• Makes proteins that work in many places in the body. For example, proteins that cause blood to clot.

What causes alcohol-induced liver disease?

Alcohol-induced liver disease is caused by heavy use of alcohol. The liver’s job is to break down alcohol. If you drink more than it can process, it can become badly damaged.

Fatty liver can happen in anyone who drinks a lot. Alcoholic hepatitis and alcoholic cirrhosis are linked to the long-term alcohol abuse seen in alcoholics.

Healthcare providers don’t know why some people who drink alcohol get liver disease while others do not. Research suggests there may be a genetic link, but this is not yet clear.

What are the symptoms of alcohol-induced liver disease?

The effects of alcohol on the liver depend on how much and how long you have been drinking alcohol. These are the most common symptoms:

Fatty liver

• Often causes no symptoms

• Build-up of fat inside the liver cells enlarges the liver, causing upper belly (abdomen) discomfort on the right side

• Tiredness and weakness

• Weight loss

Alcoholic hepatitis

• Pain over the liver

• Fever

• Weakness

• Nausea and vomiting

• Appetite loss

• Poor nutrition

• Yellowing of the skin and eyes (jaundice)

Alcoholic cirrhosis, all of the symptoms of alcoholic hepatitis and the following:

• Blood flow through the liver is limited (portal hypertension)

• Enlarged spleen

• Poor nutrition

• Bleeding in the intestines

• Fluid build-up in the belly (ascites)

• Kidney failure

• Confusion

• Liver cancer

The symptoms of alcohol-induced liver disease may look like other health problems. Always see a healthcare provider for a diagnosis.

How is alcohol-induced liver disease diagnosed?

Your healthcare provider will do a complete health history and physical exam. Other tests used to diagnose alcohol-induced liver disease may include:

• Blood tests. Including liver function tests, which show whether the liver is working the way it should and how advanced your liver disease may be.

• Liver biopsy. This involves removing small tissue samples from the liver with a needle or during surgery. These samples are checked under a microscope to find out the type of liver disease.

• Ultrasound. This test uses high frequency sound waves to create a picture of the organs.

• CT scan. This imaging test uses X-rays and a computer to makes detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• MRI. MRI uses a magnetic field, radio frequency pulses, and a computer to make detailed pictures of internal body structures. Sometimes injecting dye into a vein is used to make images of body parts. The dye helps show the liver and other organs in the belly (abdomen).

How is alcohol-induced liver disease treated?

The goal of treatment is to restore some or all normal functioning to the liver.

You must completely stop drinking alcohol. This may involve an alcohol treatment program. Sometimes you may also need to make changes to your diet. The liver is often able to fix some of the damage caused by alcohol so you can live a normal life. The scarring from cirrhosis is sometimes partially reversible. When liver tissue loss is severe enough to cause liver failure, most of the damage may be permanent. But the damage won't have any chance of reversing if you continue to drink alcohol. Different treatments are needed for different complications and symptoms of alcoholic liver disease. For example, you may need dietary changes, vitamins, salt limit, procedures to shrink swollen veins in the digestive tract, water pills (diuretics), medicines to treat confusion, and anti-inflammatory medicines.

In some cases, a liver transplant may be considered. But you must complete a rehab program and go through alcohol detox before this is even a choice.

Many people are embarrassed to tell their healthcare provider about their alcohol intake. But there is help out there. So, it's important to discuss your alcohol intake truthfully with your provider.

What are possible complications of alcohol-induced liver disease?

People with alcohol-induced liver disease are at increased risk of also having hepatitis C virus. Others have hepatitis B virus. Your provider will test you for both and treat you if needed.

People with alcohol-induced liver disease are also at greater risk for liver cancer.

Those with cirrhosis often develop kidney problems, intestinal bleeding, fluid in the belly, confusion, liver cancer, and severe infections.

Key points about alcohol-induced liver disease

• Alcohol-induced liver disease is a common, but preventable, disease.

• Alcohol-induced liver disease is caused by heavy use of alcohol. The liver breaks down alcohol. If you drink more than it can process, it can become seriously damaged.

• The effects of alcohol on the liver depend on how much and how long you have been drinking.

• The most important part of treatment is to completely stop drinking alcohol. Sometimes diet changes are advised, too.

• The liver is often able to repair some of the damage caused by alcohol so that you can live a normal life. In some cases, liver transplant may be considered. But you must complete a rehab program and go through alcohol detox before this is even a choice.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.