The Price You Pay (alcohol and liver)
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INTRODUCTION


What is Alcoholic Liver Disease?


As the name implies, alcoholic liver disease is liver injury attributed to alcohol abuse. Research suggests, however, that liver disease may begin to develop after a "threshold" dose of alcohol has been consumed—generally assumed to be four drinks a day (four 12 ounces beers, four glasses of wine, or four ounces of hard liquor) for men, and one half that quantity for women. Nearly everyone who consumes this amount or more will have some evidence of liver injury, although less than 50% will develop serious liver disease.

Symptoms


Cirrhosis is divided into two stages: Compensated and decompensated.
  • Compensated cirrhosis means that the body still functions fairly well despite scarring of the liver. Many people with compensated cirrhosis experience few or no symptoms.
  • Decompensated cirrhosis means that the severe scarring of the liver has damaged and disrupted essential body functions. Patients with decompensated cirrhosis develop many serious and life-threatening symptoms and complications.
Early symptoms of compensated cirrhosis may include:
  • Fatigue and loss of energy
  • Loss of appetite and weight loss
  • Nausea or abdominal pain
  • Spider angiomas may develop on the skin. These are pinhead-sized red spots from which tiny blood vessels radiate.
As cirrhosis progresses to a decompensated stage, patients may develop the following symptoms:
  • Fluid buildup in the legs and feet (edema) and in the abdomen (ascites). (Ascites is associated with portal hypertension, which is described in the Complications section of this report.)
  • Jaundice. This yellowish cast to the skin and eyes occurs because the liver cannot process bilirubin for elimination from the body.
  • Itching. Itching (pruritus) develops from buildup of bile products.
  • The palms of the hands may be reddish and blotchy, a condition known as palmar erythema
  • In men, swelling of breasts or shrinkage of the testicles may occur.
  • Easy bruising and excessive bleeding may occur.




Possible Complications

A damaged liver affects almost every bodily process, including the functions of the digestive, hormonal, and circulatory systems. Decompensated cirrhosis increases the risk of serious and potentially life-threatening complications. (Once decompensation occurs, mortality rates without liver transplantation can be as high as 85% within 5 years.) The most serious complications are those associated with portal hypertension (increased pressure in the portal vein that carries blood from the intestine to the liver). They include:
  • Ascites (fluid buildup in the abdomen)
  • Variceal hemorrhage (bleeding in the upper stomach and esophagus from ruptured blood vessels)
  • Spontaneous bacterial peritonitis is a form of peritonitis (inflammation of the membrane that lines the abdomen), which is associated with ascites. Other bacterial infections are also a common complication of cirrhosis.
  • Hepatic encephalopathy (damage to the brain). Impaired brain function occurs when the liver cannot detoxify harmful substances, and can lead to coma.
Liver cancer is a serious long-term risk with cirrhosis. Other complications also occur. 

Diagnosis

A physical examination may reveal the following in a patient with cirrhosis:
  • The cirrhotic liver is firm and often enlarged in early stages of the disease. The liver may feel rock-hard. (In advanced stages of cirrhosis, the liver may become small and shriveled.)
  • If the abdomen is swollen, the doctor will check for ascites by tapping the flanks and listening for a dull thud and feeling the abdomen for a shifting wave of fluid.
  • The doctor will also check for signs of jaundice, muscle wasting, and (in male patients) breast enlargement.
A patient’s medical history is another indicator of the risk for cirrhosis. Patients with a history of alcoholism, hepatitis B or C, or certain other medical conditions are at high risk.
Other tests (blood tests, imaging tests, liver biopsy) may also be performed. The results of these tests along with the presence of specific complications (ascites and encephalopathy) are used for calculating the Child-Pugh Classification. This is a staging system (A to C) that helps doctors determine the severity of cirrhosis and predict the development of future complications.


Treatment

Cirrhosis is an irreversible condition. Treatment goals are to slow the progression of liver damage and reduce the risk of further complications. There are currently no drugs available to treat liver scarring, although researchers are investigating various antifibrotic drugs.

DIETARY AND LIFESTYLE CHANGES

All patients with cirrhosis can benefit from certain types of lifestyle interventions. These include:
  • Stop drinking alcohol . It is very important for people with cirrhosis to completely abstain from alcohol.
  • Restrict dietary salt . Salt can increase fluid buildup in the body. Eating a variety of foods every day can help you limit the amount of salt you are getting. It is best to eat fresh vegetables and fruits whenever possible and to avoid eating processed foods.
  • Eat a healthy diet . People with cirrhosis are typically malnourished and require increased calories and nutrients. (Excess protein, however, can trigger hepatic encephalopathy.) They also need to avoid certain foods, such as raw seafood or shellfish, which carry risks of blood poisoning (septicemia). A dietician may help provide you with dietary guidelines.
  • Get vaccinations . Patients with cirrhosis should ask their doctors which vaccinations (such as hepatitis A, hepatitis B, influenza, pneumococcal pneumonia) they need.