Alcohol Liver Disease ALD and Cirrhosis

The liver is one of the largest and most complex organs in the body. It stores vital energy and nutrients, manufactures proteins and enzymes necessary for good health, protects the body from disease, and breaks down (or metabolises) and helps remove harmful toxins, like alcohol, from the body.

Because the liver is the chief organ responsible for metabolizing alcohol, it is especially vulnerable to alcohol-related injury. Even as few as three drinks at one time may have toxic effects on the liver when combined with certain over-the-counter medications, such as those containing acetaminophen.

Alcoholic Liver Disease (ALD)—From Steatosis to Cirrhosis

ALD includes three conditions: fatty liver, alcoholic hepatitis, and cirrhosis. Heavy drinking for as little as a few days can lead to “fatty” liver, or steatosis—the earliest stage of alcoholic liver disease and the most common alcohol-induced liver disorder.

Steatosis is marked by an excessive buildup of fat inside liver cells. This condition can be reversed, however, when drinking stops.

Drinking heavily for longer periods may lead to a more severe, and potentially fatal condition, alcoholic hepatitis— an inflammation of the liver. Symptoms of advanced ALD include; nausea, lack of appetite, vomiting, fever, abdominal pain and tenderness, jaundice (eg. yellow skin and eyes), and, sometimes mental confusion.

Scientists believe that if drinking continues, in some patients this inflammation eventually leads to alcoholic cirrhosis, in which healthy liver cells are replaced by scar tissue (fibrosis), leaving the liver unable to perform its vital functions.

The presence of alcoholic hepatitis is a red flag that cirrhosis may soon follow: Up to 70 percent of all alcoholic hepatitis patients eventually may go on to develop cirrhosis. Patients with alcoholic hepatitis who stop drinking may have a complete recovery from liver disease, or they still may develop cirrhosis.

Liver cirrhosis is a major cause of death. In 2000, it was the 12th leading cause of death.

Cirrhosis mortality rates vary substantially among age groups: They are very low among young people but increase considerably in middle age. In fact, cirrhosis is the fourth leading cause of death in people ages 45–54.

Other factors besides alcohol also may influence ALD development, including demographic and biological factors such as ethnic and racial background, gender, age, education, income, employment, and a family history of drinking problems.

Women

Women are at higher risk than men for developing cirrhosis. This higher risk may be the result of differences in the way alcohol is absorbed and broken down.

When a woman drinks, the alcohol in her bloodstream reaches a higher level than a man’s even if both are drinking the same amount.

The chemicals involved in breaking down alcohol also differ between men and women. For example, women’s stomachs may contain less of a key enzyme (alcohol dehydrogenase) needed for the initial breakdown of alcohol. This means that a woman breaks down alcohol at a slower rate, exposing her liver to higher blood alcohol concentrations for longer periods of time – a situation that is potentially toxic to the liver.

Differences in how a woman’s body breaks down and removes alcohol also may be linked to how much and how often she drinks, the fact that estrogen is present in her body, and even her liver size.

The liver is remarkably resilient in responding to disease and infection and, in fact, under certain circumstances, can even generate whole new sections of itself to replace those that are diseased once drinking alcohol has stopped.

Treatment for ALD includes making lifestyle changes, such as stopping or decreasing alcohol use, stopping smoking, and maintaining a healthy weight.

Health care providers may prescribe medications, such as pentoxifylline or prednisone, in cases of alcoholic hepatitis.

People may want to seek nutritional supplements or complementary and alternative medicine, such as SAMe for cirrhosis. Severe ALD is best treated with transplantation in selected abstinent patients.

Treatment for Alcoholic Liver Disease

• Lifestyle modification (stopping alcohol use, stopping smoking, losing weight
• Appropriate nutritional, vitamin supplementation.
• Use of pentoxifylline or prednisone for alcoholic hepatitis.
• Complementary and alternative medicine for cirrhosis.
• Transplantation in selected abstinent patients with severe disease.

From; U.S. Department of Health& Human Services. Alcohol Alert, Number 64.

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