Alcoholic Liver Disease

About 20 percent of heavy drinkers develop alcoholic hepatitis; about 25 percent develop cirrhosis

By Eva Briggs

AlcoholMany people are aware that there is a connection between drinking alcohol and developing liver disease. There are actually three broad categories of liver disease caused by alcohol: fatty liver, alcoholic hepatitis and cirrhosis.

Alcoholic fatty liver disease is the earliest form of liver disease to develop. It develops in almost every heavy drinker who consumes more than 60 grams of alcohol daily. Sixty grams is the equivalent of five 12-ounce beers, or five 5-ounce glasses of wine, or five 1.5-ounce shots 80-proof liquor. It’s the actual amount of alcohol that counts, no matter how it’s ingested. Beer and wine aren’t inherently any “safer” than hard liquor.

Up to 40 percent of moderate drinkers develop fatty liver disease.

Triglycerides and other fats accumulate in liver cells in fatty liver. How and why this happens isn’t completely known. It seems to be a combination of too much fat coming in (the body making too many fat molecules and delivering too much of ingested fat to the liver) plus too little fat out (decreased metabolism to break down and remove fat.) Risk factors for alcoholic liver disease include the amount of alcohol consumed, being a female, obesity, diabetes and viral hepatitis infections.

Alcoholic fatty liver disease often produces no symptoms. There isn’t any specific blood test, though substances called transaminases, or liver enzymes, may be two or more times higher than normal. Ultrasound reveals the fatty infiltration and sometimes liver enlargement.

The prognosis is good. The liver reverts to normal in almost everyone who stops drinking. But people with fatty liver disease who continue to drink have an increased risk of developing other more serious forms of alcoholrelated liver disease.

Alcoholic hepatitis is a more serious condition of liver inflammation. Symptoms can be mild, such as poor appetite, weight loss, abdominal pain and distention, nausea and vomiting. More severe alcoholic hepatitis can produce liver enlargement, yellow skin and eyes (jaundice), fluid in the abdomen (ascites), swollen skin blood vessels (spider angiomas), fever, and brain inflammation causing confusion (encephalopathy). There isn’t a specific blood test for alcoholic liver disease. It’s diagnosed based on history, exam and abnormal blood work. Sometimes liver biopsy is needed for diagnosis. The prognosis is variable. Some people improve greatly with treatment and alcohol abstinence, while more severely ill patients can become sicker and die of their disease.

Cirrhosis is the third and most serious form of alcoholic liver disease. Alcohol isn’t the only cause of cirrhosis, and about half of patients with cirrhosis have some other cause. Cirrhosis is the replacement of normal liver with fibrous scar tissue.

Patients initially develop fatigue. The liver no longer removes bilirubin, a waste product from the breakdown of red blood cells, so it accumulates to cause jaundice, yellow discoloration of the skin and eyes. The skin becomes itchy. The liver can’t make the normal amount of blood clotting factors, leading to bruising and abnormal bleeding. The fibrous tissue in the liver raises the pressure in the portal vein, a major blood vessel that transports blood form digestive organs to the liver. This makes fluid back up into the abdomen and legs. The abdomen becomes distended and bloated from the fluid, which sometimes becomes spontaneously infected. The legs and lower body can swell massively. Toxins building up the blood stream contribute to confusion and mental changes. Varices — internal varicose veins in the esophagus and stomach — can rupture and bleed. The presence of cirrhosis is a risk factor for liver cancer.

Cirrhosis is generally not reversible. Medicines and nutrition can help. Sometimes surgical procedures are used to alleviate portal vein hypertension. Select patients who stop drinking might be able to receive a liver transplant.

Not every heavy drinker goes on to develop severe liver disease, as environmental and genetic factors clearly play a role. Only about 20 percent of heavy drinkers develop alcoholic hepatitis and about 25 percent develop cirrhosis.

Alcohol-related conditions are the third most common cause of preventable death in the United States.

Eva Briggs is a medical doctor who works at two urgent care centers (Central Square and Fulton) operated by Oswego Health.

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