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According to the published study in the journal of hepatology, an official journal of the European Association for the Study of the Liver, globally, the disease burden of alcohol-attributable liver cirrhosis and alcohol-attributable liver cancer were measured by deaths and disability adjusted life years (DALYs). Globally, in 2010, 493,300 deaths were due to alcoholic liver cirrhosis, representing 0.9% of all global deaths, and 47.9% of all liver cirrhosis deaths.
Alcoholic liver disease, also known as alcohol-related liver disease (ARLD), liver disease due to alcohol, cirrhosis or hepatitis – alcoholic, and Laennec's cirrhosis , refers to a range of conditions and associated symptoms that develop when the liver becomes damaged due to alcohol misuse. Alcoholic liver disease progresses through three stages of liver damage, which are alcoholic fatty liver disease, alcoholic hepatitis, and cirrhosis, but a patient may skip some stages, and not necessarily has to go through all of the three stages.
Alcoholic liver disease is caused by drinking large amounts of alcohol in a short time, or drinking more than the recommended limits. Alcohol use, obesity, gender, are some of the factors that increase the risk of developing alcoholic liver disease.
Alcohol is metabolized in the liver by two main pathways which are alcohol dehydrogenase and cytochrome P-450 2E1, where they go through two sets of different conversions that lead to fatty infiltration in the liver and free radicals, respectively. A third pathway is via chronic alcoholic exposure that results in hepatocyte necrosis and apoptosis, along with other possible damage. Acetaldehyde; the alcohol metabolite, and alcohol both induce inflammation by producing antigen adducts and disrupting the barrier function of the intestinal mucosa, respectively.
Several symptoms and signs for alcoholic liver disease, include abdominal (tummy) pain, loss of appetite and weight loss, fatigue and loss of energy, jaundice, and fluid buildup of the legs (edema) and in the abdomen (ascites).
Alcoholic liver disease can be diagnosed by several methods such as physical exam, lab tests, and imaging tests. The main treatment for alcoholic liver disease is stopping alcohol intake, while severe cases require liver transplants.
Alcoholic liver disease can cause serious problems, if untreated, like bleeding disorders (coagulopathy), buildup of fluid in the abdomen (ascites), and enlarged veins in the esophagus. Reducing or stopping alcohol intake can effectively prevent alcoholic liver disease.
According to the published study in the journal of hepatology, an official journal of the European Association for the Study of the Liver, globally, 493,300 deaths were because of alcoholic liver cirrhosis for the year 2010.
Alcoholic liver disease is a liver damage caused by excess alcohol intake.
There are two causes for alcoholic liver disease which are:
1- Binge drinking can cause fatty liver disease and at a lower rate alcoholic hepatitis.
2- Prolonged intake of alcohol in amounts more than the recommended limits can cause hepatitis and cirrhosis.
Several factors that increase risk of developing of alcoholic liver disease including:
1-Alcohol use
Drinking excessive amounts of alcohol may increase the risk of alcoholic liver disease.
2- Overweight
Overweight may increase the risk of alcoholic liver disease.
3- Gender
Alcoholic liver disease is more common in women than in men.
4- Liver disease
Having a pre-existing liver condition, such as hepatitis C may increase the risk.
5- Genetics
Mainly, alcohol dependence and problems processing alcohol are related to genetic factors.
The main site of alcohol metabolism is the liver. Alcohol is metabolized in the liver by two main pathways which are alcohol dehydrogenase and cytochrome P-450 2E1, with a third site in the case of chronic alcohol via the hepatic macrophages.
Alcohol metabolism via alcohol dehydrogenase goes through a series of conversions that render fatty infiltration in the liver.
The cytochrome P-450 2E1 pathway uses another set of conversion series to produce free radicals in chronic alcohol use.
Chronic alcohol exposure ends up in promoting hepatocyte necrosis and apoptosis, in addition to inflammation and fibrosis that are caused by lipid peroxidation by free radicals. Acetaldehyde; the alcohol metabolite, produces antigenic adducts which are complete antigens and induces inflammation when it attaches to cellular protein. The intestinal mucosa that functions as a barrier is affected by alcohol, producing endotoxemia, which leads to hepatic inflammation.
Stages of alcoholic liver disease
Excessive amounts of alcohol can lead to three stages of liver conditions, which are:
1- Alcoholic fatty liver disease
It is a reversible stage that happens when a large amount of alcohol is consumed, even for a really short time, can lead to fats to build-up in the liver. Fatty liver disease rarely causes any symptoms and once drinking alcohol is stopped it returns normal.
2- Alcoholic hepatitis
Alcohol misuse over a longer period leads to alcoholic hepatitis. It could also happen but to a much less extent with binge drinking, which involves drinking a large amount of alcohol in a short period of time. Alcoholic hepatitis is reversible once alcohol is stopped for good and can turn into a serious and life-threatening illness in severe cases.
3- Cirrhosis
It is the irreversible and final stage of alcoholic liver disease. It is divided into two stages; an early stage and an end stage where the former includes a partial loss of the liver’s function, while in the latter the majority or all of the liver’s functions are lost. Cirrhosis occurs when prolonged inflammation of the liver has caused scarring of the liver and subsequent loss of function. The loss of the liver’s function can result in death. Even at this stage, there may not be any obvious symptoms.
Damage to the liver can be stopped by immediate abstaining of alcohol, which significantly increases life expectancy.
Alcoholic liver disease could be symptomless or with slow progression. Elongated heavy drinking worsens symptoms. Symptoms of alcoholic liver disease include:
1-Abdominal (tummy) pain.
2- Loss of appetite and weight loss.
3- Fatigue and loss of energy.
4- Feeling sick.
5- Diarrhea.
6- Feeling generally unwell.
7- Nausea.
8- Small, red spider-like blood vessels on the skin.
1-Yellowing of the skin and whites of the eyes (jaundice).
2- Fluid buildup of the legs (edema) and in the abdomen (ascites).
3- In men, impotence, shrinking of the testicles, and breast swelling.
4- A high temperature (fever) and shivering attacks.
5- Very itchy skin.
6- Hair loss.
7- Unusually curved fingertips and nails (clubbed fingers).
8- Redness on the palms of the hands.
9- Significant weight loss.
10- Weakness and muscle wasting.
11- Confusion or problems thinking.
12- Vomiting blood and black, tarry stools due to internal bleeding.
13- A tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums.
14- Increased sensitivity to alcohol and drugs.
There are many ways to diagnose alcoholic liver disease, including:
1-Physical exam to detect:
2-Lab tests that provide:
3-Imaging tests:
The following techniques are generally able to detect an underlying cause for liver disease but without identifying alcohol as the reason for liver’s disease, in addition to excluding other causes for abnormal liver tests in alcohol consuming individuals. They are able to detect cirrhosis along with other abnormalities such as:
CT scans of the liver and biliary tract (the liver, gallbladder, and bile ducts) provide greater details than X-ray for such parts, which allows a better knowledge about injuries and/or diseases of the liver and biliary tract. CT scans that do not use contrast are able to detect macroscopic fat in the liver, in the fatty liver stage.
. It is able to detect enlarged caudate lobe; one of the liver’s lobes, visualization of the right posterior hepatic notch and smaller size regenerative nodules.
It serves the same functions as the ultrasound.
4-Endoscopy
This technique is used to detect swollen veins that indicate cirrhosis by inserting an endoscope; a long, thin, flexible tube with a light and a video camera at one end, across the esophagus, which is a connecting tube between the throat and stomach that carries food, and into the stomach. Afterwards, these images are displayed onto an external screen for evaluation.
Treatment highly depends on changing the individual’s lifestyle, in addition to discontinuation of drinking. Treatment of alcoholic liver disease includes:
1-Stopping drinking alcohol
Abstinence from drinking alcohol depends on the stage of the condition. In the fatty liver stage, at least two weeks of abstinence are required to reverse the case and can be resumed later on but only if NHS guidelines on alcohol consumption are followed, whereas the more advanced stages require a life-long abstinence.
Advanced stages without abstinence will cause liver failure with no possible medical or surgical interventions.
2-Diet and nutrition
Malnutrition; a serious condition that lacks correct amounts of nutrients in the diet, is common in people with alcoholic liver disease. This requires introducing a balanced diet that provides all of the necessary nutrients. Patients with alcoholic liver disease may require changes to their dietary habit, such as reducing salt intake so that fluid retention is avoided, in addition to consuming extra amounts of energy and proteins so that muscles are not weakened or wasted. This could happen due to a decreased ability of a damaged liver to store carbohydrates which forces the body to use its muscle’s tissue for energy. Serious cases of malnutrition require food to be administered through intubation via the nose and into the stomach.
3-Medication for symptoms
For people with severe alcoholic hepatitis, treatment in hospital may be necessary for inflammation reduction. Specific treatment with corticosteroids or pentoxifylline medication.
4-Liver transplants
This is the only way to treat irreversible liver failure. This applies to cases such as progressive liver failure despite alcohol abstinence, good health that allows operation endurance, and a life-time commitment for alcohol abstinence.
Measures to manage or treat alcoholic liver diseases symptoms or complications:
If untreated, alcoholic liver disease can cause serious problems such as:
1- Bleeding disorders (coagulopathy).
2- Ascites where fluid builds up in the abdomen and when this fluid is infected it is called bacterial peritonitis.
3- Esophageal varices which are enlarged veins in the esophagus, stomach, or intestines that bleed easily.
4- Portal hypertension which is an increased pressure in the blood vessels of the liver.
5- Hepatorenal syndrome which is kidney failure.
6- Hepatocellular carcinoma or so called liver cancer.
7- Hepatic encephalopathy which includes mental confusion, change in the level of consciousness, or coma.
Reducing or stopping alcohol intake are the most effective ways for prevention.
Most heavy drinkers progress through the stages of this disease, while some immediately skip the second stage to the final stage (cirrhosis). Others may have a symptomless second stage. In general, people with alcoholic liver disease will improve their health and life expectancy if they stop drinking. People with fatty liver may be able to use alcohol in amounts recommended by NHS after liver recovery. People with advanced stages which are alcoholic hepatitis or alcoholic cirrhosis should completely stop drinking, or the outcome will likely be poor if alcohol intake is continued, including a variety of life-threatening health problems caused by alcohol-related liver damage.
According to the published study in the journal of hepatology, an official journal of the European Association for the Study of the Liver, globally, the disease burden of alcohol-attributable liver cirrhosis and alcohol-attributable liver cancer were measured by deaths and disability adjusted life years (DALYs). Globally, in 2010, 493,300 deaths were due to alcoholic liver cirrhosis, representing 0.9% of all global deaths, and 47.9% of all liver cirrhosis deaths.
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