The liver is the site of alcohol metabolism. Excess of alcohol can overwhelm this capacity and lead to the development of what is called Alcoholic Liver Disease. The damage caused to the liver by alcohol can take the form of fatty liver, alcoholic hepatitis, or cirrhosis (permanent damage with scarring).
According to an estimate of around 1.4 lakh, people died of cirrhosis related to excessive alcohol consumption in the year 2016. Almost all of the heavy drinkers will have a fatty liver. Higher the amount of alcohol consumption and longer it is consumed bears a direct relation to the development of cirrhosis. Men are likely to have cirrhosis than women due to a higher amount of alcohol consumed. Women have twice the higher risk of developing cirrhosis than men.
Stages of Alcoholic Liver Disease
The spectrum includes a simple fatty liver, acute alcoholic hepatitis, and alcoholic cirrhosis. It is the natural history of the disease but the overlap can occur.
- Hepatic Steatosis or Fatty Liver: There is an accumulation of fat in the liver. This stage is reversible with alcohol abstinence i.e. quitting alcohol and modifying the sedentary lifestyle to a more active one.
- Acute Alcoholic Hepatitis: It is the stage in which alcohol causes inflammation of the liver substance. The reversibility of the process depends upon the damage already done. Long term survival in alcoholic hepatitis patients who stop consuming alcohol is significantly greater than the patients who continue taking alcohol.
- Alcoholic Cirrhosis: This is the end-stage liver disease which is considered to be irreversible. It is characterized by the scarring of the liver. It is the result of prolonged and severe liver damage.
Symptoms:
The patients with fatty liver are usually asymptomatic.
Alcoholic hepatitis varies in severity and similarly the symptoms. Symptoms can be mild such as anorexia, weight loss, abdominal distension, nausea, or vomiting. In severe cases, it can present with encephalopathy and liver failure.
Alcoholic cirrhosis presents with signs and symptoms of liver failure such as jaundice, itching, loss of body hails, bleeding tendencies, hematemesis, ascites (collection of fluid in the abdomen), and encephalopathy (sleeplessness, drowsiness, confusion and if severe unconsciousness).
Diagnosis: With the suspicion of the disease the treating doctor will be getting –
- Blood tests such as complete blood count, liver function test, coagulation profile, and others.
- Ultrasound of the abdomen or CT scan of the abdomen will also be done as the case may be.
- A liver biopsy may sometimes be needed.
- Fibroscan is also helpful in assessing the severity and progression of the disease.
Treatment: The mainstay of the treatment of alcoholic liver disease is quitting alcohol. Quitting alcohol may not be easy for many and therefore requires proper counseling and rehabilitation program. Patients with severe symptoms may require hospitalization for workup and management. Alcoholic hepatitis patients usually have some nutritional deficiencies. They require vitamin supplementations and a good protein and caloric intake.
Liver transplantation is required for advanced cirrhosis with decompensation (ascites, encephalopathy, jaundice, variceal bleed). The earlier the option is taken the better the prognosis.
Conclusion: The spectrum of alcoholic liver disease is varied from the reversibility of fatty liver to the irreversibility of cirrhosis. Alcohol silently kills the drinker every passing day. It destroys the social, personal, and professional life of the patient.
Stop and think what’s there in your next glass.
Dr. Neeraj Goel, Senior Consultant – Gastrointestinal Oncology, Liver Transplant & HPB Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi