The long term results of excess alcohol is cirrhosis - this is scarring and nodularity of the liver


Excess fat in the liver - commonly caused by too much alcohol

Alcohol is one of the most common cause of liver disease and liver-related death in most western countries.

• Risk factors for developing alcohol-related liver disease.
  • the risk varies widely from person to person.
    • some people will never develop liver disease despite very high alcohol intake over many years.
    • some people will develop cirrhosis when they have consumed alcohol at only just over the considered safe limits.
  • “Safe levels” of alcohol are:
    • 21 units per week for men.
    • 14 units per week for women (1 unit = 10g of alcohol or one standard drink).
    • There is an increased risk of liver disease in females (given the same alcohol intake).
  • Only 10-20 % of people with major dependency on alcohols (alcoholics) develop cirrhosis. This suggests that there is a genetic susceptibility.
  • There is an increasing amount of alcohol-related liver disease in our community.
  • Poor nutrition and obesity aggravate the problem (see section on fatty liver).
  • Hepatitis B or Hepatitis C infection are important additional risk factors for serious liver disease.

How is the liver disease or "damage" from alcohol diagnosed?

• Blood tests.
  • Often the first indication of a problem is the “incidental finding” of abnormal liver enzymes on routine blood test.
  • The GGT liver enzyme may be disproportionately raised.
    • This doesn't prove alcohol as the problem as the same pattern of tests can be seen with fatty liver that is not due to alcohol.
  • A raised serum ferritin can be a clue.
    • Tests of iron studies may have been part of routine tests.
    • The ferritin level is high in fatty liver, particularly if due to alcohol.
• Abdominal ultrasound.
  • There may be an incidental finding of fatty liver on ultrasound. One significant risk factor for this condition is fatty liver.
• Some people are unaware of a problem until there is an admission to hospital with serious liver disease.
  • Alcoholic hepatitis is the consequence of heavy drinking over many years and can be fatal.
    • The symptoms are nausea, vomiting, upper abdominal pain, fever, and jaundice.
  • Cirrhosis of liver (a severe from of scarring of the liver) may have been slowly developing over years without any symptoms.
    • The condition becomes apparent because of complications of cirrhosis.
    • This can be the sudden accumulation of fluid in the abdomen or the sudden onset of vomiting of blood.
• A liver biopsy may be required to assess the severity of the liver disease.
  • It may show fatty liver only, alcoholic hepatitis or cirrhosis.

What is the treatment?

• The only successful treatment is complete abstinence from alcohol.
  • Fatty liver is a completely reversible condition.
  • Scarring, fibrosis or cirrhosis (a condition with severe fibrosis) is not reversible.
    • However even when this stage has been reached there is still a better outcome with abstinence from alcohol.
  • Alcoholic hepatitis often requires hospital admission.
    • A full recovery is possible with complete abstinence but may take several months.
    • The diagnosis of alcoholic hepatitis is a sign that cirrhosis will develop rapidly if there is ongoing alcohol intake.
• Liver transplantation is possible for advanced cirrhosis due to alcohol.
  • This would only be considered if there has been abstinence for a significant period of time.

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