Alcoholic Liver Disease: Act Before it’s Too Late!

Alcoholic Liver Disease (ALD) is a silent but increasingly prevalent health concern in today's society, and its impact on individuals and communities is profound. The journey from moderate alcohol consumption to advanced stages of liver damage is a complex and often misunderstood process. In this article, we delve into the stages of ALD, shedding light on the progression from a seemingly harmless habit to a life-threatening condition. Understanding these stages is not only crucial for those who may be at risk but also for people looking to support their affected loved ones. Starting with some basics.

What are the Causes and Risk Factors for Alcoholic Liver Disease?

Alcoholic Liver Disease develops and involves a range of liver-related problems, from mild fatty liver to severe cirrhosis. The causes and risk factors of ALD can be broken down as follows:

Alcohol Consumption: The primary cause of ALD is heavy and chronic alcohol consumption. The more alcohol a person consumes and the longer they have been drinking, the greater the risk of developing ALD. While all types of alcoholic beverages can contribute to ALD, some studies suggest that hard liquor (spirits) might be more damaging to the liver than beer or wine due to its higher alcohol content.

Genetic Factors: Genetic predisposition can play a role in the development of ALD. Some individuals may be more genetically susceptible to liver damage caused by alcohol.

Gender and Age: Women tend to be more susceptible to ALD than men, even with lower alcohol consumption. This is partly due to differences in body composition and the way alcohol is metabolised. In addition, the risk of ALD increases with age, as the liver's ability to metabolise alcohol decreases over time.

Nutrition: Poor nutrition, particularly a deficiency in essential nutrients like folate, can exacerbate the damaging effects of alcohol on the liver.

Drinking Patterns: Binge drinking or heavy episodic drinking, even without regular daily drinking, can increase the risk of ALD.

Hepatitis: Coexisting viral hepatitis, especially hepatitis C, can accelerate liver damage when combined with alcohol.

Obesity: Obesity can worsen the effects of alcohol on the liver and increase the risk of ALD.

Other Health Conditions: Liver diseases, such as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), can compound the effects of alcohol on the liver, increasing the risk of ALD.

Metabolism: The rate at which an individual metabolises alcohol varies from person to person. Slow metabolizers may be at higher risk for ALD.

It's important to note that ALD can affect individuals differently, and not everyone who drinks heavily will develop this condition. Recognizing the causes and risk factors is essential for individuals to make informed decisions about alcohol consumption.

What are the Possible Complications of Alcoholic Liver Disease?

Alcoholic Liver Disease can lead to a range of complications, some of which can be life-threatening. These complications may vary in severity depending on the stage of ALD and an individual's overall health. Common complications of ALD include:

• Ascites: Ascites is the accumulation of fluid in the abdominal cavity, leading to abdominal swelling and discomfort. It is a common complication of advanced cirrhosis.
• Hepatic Encephalopathy: This condition occurs when the liver is unable to effectively process toxins, leading to a buildup of ammonia in the bloodstream. Hepatic encephalopathy can cause confusion, forgetfulness, personality changes, and, in severe cases, coma.
• Variceal Bleeding: Cirrhosis can lead to the development of enlarged blood vessels (varices) in the oesophagus and stomach. These varices can rupture and cause life-threatening bleeding.
• Portal Hypertension: The scarring of the liver tissue can lead to increased pressure in the portal vein, which carries blood from the digestive organs to the liver. Portal hypertension can result in complications like variceal bleeding and ascites.
• Liver Cancer (Hepatocellular Carcinoma): Individuals with ALD, especially those with cirrhosis, have an increased risk of developing liver cancer.
• Coexisting Viral Hepatitis: Chronic alcohol use can weaken the immune system and increase the risk of contracting or exacerbating viral hepatitis (e.g., hepatitis B or C).
• Kidney Dysfunction: ALD can lead to kidney problems, including acute kidney injury and impaired kidney function.
• Bone Diseases: ALD can affect bone health, leading to conditions like osteoporosis.
• Cardiovascular Issues: Individuals with ALD are at higher risk of heart-related problems, including high blood pressure, cardiomyopathy, and an increased risk of heart attacks.
• Gastrointestinal Complications: ALD can lead to issues like gastritis, esophagitis, and gastrointestinal bleeding.
• Weakened Immune System: Chronic alcohol use can suppress the immune system, making individuals more susceptible to infections.

It is important to note that the complications of ALD can develop gradually over time and may not be apparent until the disease has reached an advanced stage. 

What are the Symptoms of Alcoholic Liver Disease?

While the symptoms and their severity depend on several factors, individuals having Alcoholic Liver Disease may experience one or more of the following symptoms:

• Jaundice: Yellowing of the skin and eyes
• Abdominal pain and tenderness, often in the upper right side
• Fatigue and weakness
• Loss of appetite and weight loss
• Nausea and vomiting
• Swelling in the abdomen due to fluid accumulation (ascites)
• Swelling in the legs and ankles (edema)
• Easy bruising and bleeding
• Spider-like blood vessels on the skin (spider angiomas)
• Itchy skin
• Breast enlargement in men (gynecomastia)
• Shrinkage of the testicles in men (testicular atrophy)
• Reddening of the palms (palmar erythema)

How is Alcoholic Liver Disease Diagnosed?

The diagnosis of Alcoholic Liver Disease typically involves a combination of medical history, physical examinations, laboratory tests, and imaging studies. To diagnose ALD, the doctor may follow these steps:

Medical History and Physical Examination

The doctor gathers information about the patient's drinking history, including the duration and amount of alcohol consumed. This is followed by a physical examination that may reveal symptoms such as jaundice, abdominal tenderness, and signs of liver disease.

Blood Tests

• Liver Function Tests: These blood tests, including measurements of liver enzymes (e.g., ALT, AST), bilirubin, albumin, and prothrombin time (INR), can indicate liver damage and dysfunction.
• Complete Blood Count (CBC): To assess for anaemia and to detect possible bleeding disorders.
• Serum electrolytes: To evaluate the balance of electrolytes in the blood.

Imaging Tests

• Abdominal Ultrasound: Ultrasound imaging can help identify liver abnormalities, such as fatty liver or signs of cirrhosis.
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): These CT scan tests can provide more detailed images of the liver and help assess the extent of liver damage.
• FibroScan or Transient Elastography: This non-invasive test measures liver stiffness and can help determine the degree of fibrosis or scarring in the liver.

Liver Biopsy

A liver biopsy is considered the most definitive diagnostic test for ALD. It involves the removal of a small piece of liver tissue for examination under a microscope. This can help determine the severity of liver damage and the presence of fibrosis or cirrhosis.

Other Tests

• Viral Hepatitis Screening: Testing for hepatitis B and hepatitis C, which can coexist with ALD and exacerbate liver damage.
• Assessment of Nutritional Status: Nutritional deficiencies are common in individuals with ALD, so tests for vitamin and mineral deficiencies may be conducted.

Alcohol Screening

The Alcoholic liver disease doctor may also use standardised questionnaires to assess the patient’s alcohol consumption and dependence.

What are the Stages of Alcoholic Liver Disease?

ALD occurs in three stages viz. Fatty Liver, Alcoholic Hepatitis, and Liver Cirrhosis.

Fatty Liver

It is the first stage of ALD, and is also known as steatosis. Fatty Liver is a highly prevalent liver disease, which is characterised by an excessive accumulation of fat inside the liver cells. It makes it hard for the liver to function properly. Heavy drinkers usually get to the fatty liver stage in their early years of alcohol abuse. This is reversible if alcohol use is stopped.

Alcoholic Hepatitis

The second stage of ALD, Alcoholic Hepatitis is characterised by the inflammation of the liver leading to the degeneration of liver cells quickly. This stage might last for some years but will eventually progress to absolute liver damage if the patient continues to drink. In critical cases, it can lead to life-threatening complications like liver cirrhosis and absolute liver damage. Jaundice is the most common symptom in this stage along with the following:

• Nausea
• Vomiting
• Loss of appetite
• Abdominal tenderness
• Fatigue and weakness
• Weight loss

Liver Cirrhosis

Liver cirrhosis is the last and final stage of Alcoholic Liver Disease where permanent scarring of healthy liver tissue occurs. It is a severe condition and an irreversible one. A patient with liver cirrhosis will witness liver failure symptoms, along with the symptoms of alcoholic hepatitis:

• Fluid accumulation in the abdomen
• Spleen enlargement
• Bleeding from veins
• Confusion

Related read: Liver Cirrhosis Treatment

What Are The Treatment Options For Alcoholic Liver Disease?

Abstinence

Complete abstinence from alcohol is the most important therapeutic intervention for people with Alcoholic Liver Disease. Abstinence from alcohol reduces the risk of further damage to the liver, but it also provides it with a chance to recover. Patients suffering from ALD should completely refrain from drinking, thereby improving the outcome & histological features of hepatic injury. They should give their body a chance to reduce portal pressure and decrease progression to cirrhosis. It eventually helps to improve survival at all ALD stages.

Nutritional Therapy

One of the major complications of ALD is malnutrition, especially in patients who are in the second stage of alcoholic hepatitis. In patients with ALD, protein-calorie malnutrition is highly prevalent. Patients in any stage of alcoholic liver disease must consult a hepatologist and get started with nutritional therapy at the earliest. It can help in alleviating the symptoms and improving the present stage of the liver.

Medications (Pharmacological Therapy)

For ALD patients, a hepatologist is likely to prescribe various drugs and medications after carefully screening the symptoms and stages of the disease. Depending on the stage and severity of ALD, healthcare providers may prescribe certain medications, including:

• Alcohol Withdrawal Medications: Benzodiazepines and antipsychotic medications may be used to manage withdrawal symptoms when alcohol is stopped.
• Medications to Manage Alcohol Cravings: Drugs like acamprosate and naltrexone can help reduce alcohol cravings and support abstinence.
• Liver Health Medications: Ursodeoxycholic acid (UDCA) and S-adenosylmethionine (SAMe) may be used to support liver function and reduce inflammation.
• Symptom Management: Medications can be prescribed to manage specific symptoms or complications, such as ascites, hepatic encephalopathy, or variceal bleeding.

Please note that it's important to consult with a healthcare provider who is knowledgeable about ALD to determine the most appropriate medications for an individual's specific condition and needs. Medication management should always be part of a comprehensive alcoholic liver disease treatment plan that includes alcohol cessation, dietary changes, and regular medical monitoring to ensure the best possible outcomes in the management of ALD.

Liver Transplant

A liver transplant may be the only treatment option in severe cases of ALD where the liver has stopped functioning, and there is no improvement even after the patient stops drinking. The consideration for a liver transplant is different, and it is only taken into account when the patient has developed complications of cirrhosis or if the body does not respond to other treatments including medications. However, ALD is one of the most common indications of a liver transplant.

It is vital for the person with ALD to completely abstain from alcohol if they want to improve their chances of survival. A change in lifestyle is necessary for the life of a person suffering from alcoholic liver disease. In case of liver failure due to advanced stages of ALD, only a liver transplant can save the person. So, it is important to start today and abstain from alcohol altogether. You can also visit the hospital which provides the best liver transplant in India for more information.

How to Prevent Alcoholic Liver Disease?

Preventing ALD primarily involves making healthy lifestyle choices and, most importantly, avoiding or minimising alcohol consumption. Here are steps to help prevent the condition:

Recognize and Address Alcohol Dependency

If you find it difficult to control your alcohol consumption or if you believe you may have an alcohol use disorder, seek help from a healthcare professional or support group.

Eliminate or Moderate Alcohol Consumption

The most effective way to prevent ALD is to either abstain from alcohol or drink in moderation. If you choose to consume alcohol, follow the recommended guidelines: no more than one drink per day for women and up to two drinks per day for men.

Promote a Healthy Diet

Consume a well-balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Proper nutrition can help support liver health.

Stay Hydrated

Drinking an adequate amount of water helps maintain liver function and overall health. This is particularly important for those who consume alcohol. 

Exercise Regularly

Engage in regular physical activity to maintain a healthy weight and improve overall health. Exercise can also help reduce the risk of fatty liver disease.

Avoid Other Risk Factors

Stay clear of other risk factors that can contribute to liver disease, such as excessive use of over-the-counter pain relievers (like acetaminophen) and exposure to toxins or chemicals.

Mental Health Support

If needed, address stress, anxiety, and depression through counselling, therapy, or support groups, to ensure these factors don’t influence alcohol consumption.

Seek Professional Help

If someone’s struggling with alcohol abuse or dependence, they must not hesitate to seek help from healthcare professionals, therapists, or support groups. Treatment programs and counselling can provide the necessary support to overcome alcohol addiction.

Overall, preventing ALD requires a combination of personal commitment, awareness, and access to healthcare resources. While it's possible to prevent ALD by making healthy choices and moderating or eliminating alcohol consumption, early intervention is crucial if there is a suspected problem. If you or someone you know is struggling with alcohol abuse, seeking help is an important step toward preventing ALD.