Alcohol is the most widely consumed mood-altering substance in the United States. It is a causal factor in more than 200 disease and injury conditions. Heavy drinking has many potential health consequences including liver disease. In the United States, it is the leading cause of liver disease. Alcohol related liver disease [ARLD] is a result of heavy, prolonged drinking that results in liver swelling and inflammation. Over time this can lead to cirrhosis, the final stage of liver disease. The symptoms of ARLD depend on the stage of the disease.
There are three stages:
- Fatty liver disease: This is the first stage of ARLD, where fat starts to accumulate around the liver. It can be cured by not drinking alcohol anymore.
- Alcoholic hepatitis: Alcohol abuse causes inflammation (swelling) of the liver in this stage. The outcome depends on the severity of damage. In some cases, treatment can reverse the damage, while more severe cases of alcoholic hepatitis can lead to liver failure.
- Alcoholic cirrhosis: This is the most severe form of ARLD. At this point, the liver is scarred from alcohol abuse, and the damage cannot be undone. Cirrhosis may eventually lead to liver failure.
The signs of liver disease can vary. In the first stage of liver disease termed alcoholic fatty liver disease there are no physical symptoms. The findings on examination of an enlarged liver and unexplained elevation of liver function tests can be a clue. Occasionally a fatty liver is discovered incidentally during an ultrasound of the abdomen or with a CT/MRI scan for another medical issue. Remember. At this stage the patient has no symptoms related to alcoholic fatty liver disease.
Acute alcoholic hepatitis, the second stage of ARLD, can present with nausea, loss of appetite, weight loss, swelling of the abdomen or legs, confusion, vomiting, fever, malaise, and jaundice [yellowing of the skin]. Patients at risk for more severe ARLD include persons that do not eat well, binge drinkers, and persons with a family history of liver disease.
Alcoholic cirrhosis is the most severe stage of alcohol related liver disease. Cirrhosis occurs in 30% of individuals with long-standing consumption of more than 3 drinks a day. Cirrhosis implies that scar tissue has replaced the normal liver cells after the liver cells die. Cirrhosis is marked by degeneration of cells, inflammation, and fibrous thickening of tissue. Once cirrhosis has developed, the liver damage is irreversible. The prognosis is improved with abstinence, but complications (e.g., gastrointestinal bleeding) often occur. Medications are available to assist in the management of more advanced liver disease including cirrhosis. Liver transplantation may be considered in patients with severe complications.
Making the diagnosis of alcoholic liver disease requires a detailed patient history with supportive laboratory and imaging studies. A liver biopsy may be useful to confirm the diagnosis, and to rule out other diseases.  By far the most important recommendation to the patient diagnosed with alcohol related liver abnormalities is to openly discuss their drinking habits. Lying to your doctor may result in numerous extraneous and unnecessary tests and can ultimately delay the diagnosis.
Treatment and management of alcohol liver disease depend on the extent of the disease. In general recommendations include:
- Alcohol abstinence, enrollment to detoxification programs and treatment to support long term recovery
- Nutritional support
- Screening for hepatocellular carcinoma with ultrasonography every six months and screening for esophageal varices in those with cirrhosis
- Chronic alcoholics are more prone to develop hepatotoxicity from acetaminophen, so dosing should not exceed more than 2000 mg per day. An average person can tolerate up to 4000 mg of acetaminophen per day.
- Treatment of co-existing liver diseases such as Hepatitis B and C viral infections
In summary the diagnosis of alcohol related liver disease at any stage can be treated once the diagnosis is established. The first step is to discuss openly your drinking behaviors with your physician. The second step is to be willing to address the drinking that got you there.
DABIM, ABAM, FASAM