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Alcohol-related liver disease

Alcohol-related liver disease (ARLD) refers to liver damage caused by alcohol misuse. It

covers a range of conditions and associated symptoms.

ARLD does not usually cause any symptoms until the liver has been severely damaged.

When this happens symptoms can include!

• feeling sic" 

• #eight loss

• loss of appetite

• yello#ing of the eyes and s"in ( $aundice)

• s#elling in the an"les and tummy

• confusion or dro#siness

• vomiting blood or passing blood in your stools

%his means that alcohol-related liver disease is fre&uently diagnosed during tests for other 

conditions.

If you consistently or intermittently drin" alcohol to e'cess you should tell your so they

can chec" if your liver is damaged.

Alcohol and the liver

With the e'ception of the brain the liver is the most comple' organ in the body. It*s functions

include!

• filtering to'ins from the blood

• aiding digestion of food

• regulating blood sugar and cholesterol levels

• helping to fight infection and disease

%he liver is very resilient and is capable of regenerating itself. +ach time your liver filters

alcohol some of the liver cells die. %he liver can develop ne# cells but prolonged alcohol

misuse over many years can reduce your liver,s ability to regenerate resulting in serious

damage to the liver.

ARLD is #idespread in the and the number of people #ith the condition has been

increasing over the last fe# decades because of increasing levels of alcohol misuse.

Stages of alcohol-related liver disease

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%here are three main stages of ARLD although there is often an overlap bet#een each

stage. %hese stages are e'plained belo#.

 

Alcoholic fatty liver disease

Drin"ing a large amount of alcohol even for only a fe# days can lead to a build-up of fats inthe liver. %his is called alcoholic fatty liver disease and it*s the first stage of ARLD.

/atty liver disease rarely causes any symptoms but it is an important #arning sign that you

are drin"ing at a level harmful to your health.

/atty liver disease is reversible. If you stop drin"ing alcohol for t#o #ee"s your liver should

return to normal.

 

Alcoholic hepatitis

Alcoholic hepatitis (not related to infectious hepatitis) is often the second more serious stageof ARLD. It occurs #hen alcohol misuse over a longer period causes the tissues of the liver to

 become inflamed. Less commonly alcoholic hepatitis can occur if you drin" a large amount

of alcohol in a short period of time ( binge drin"ing).

%he liver damage associated #ith mild alcoholic hepatitis is usually reversible if you stop

drin"ing permanently.

0evere alcoholic hepatitis ho#ever is a serious and life-threatening illness. 1any people die

from the condition each year in the . nfortunately some people #ill only find out they

have liver damage for the first time #hen their condition reaches this stage.

 

Cirrhosis

2irrhosis  is the final stage of alcohol-related liver disease #hich occurs #hen the liver 

 becomes significantly scarred. 2irrhosis is generally not reversible but stopping drin"ing

alcohol immediately can prevent further damage and significantly increase your life

e'pectancy.

If you have alcohol-related cirrhosis and you do not stop drin"ing you have a less than 345

chance of living for at least five more years.

How alcohol-related liver disease is treated

%here is currently no specific medical treatment for ARLD. %he main treatment is to stop

drin"ing preferably for the rest of your life. %his #ill prevent further damage to your liver 

and in some cases can allo# your liver to repair itself.

If you are dependent on alcohol stopping drin"ing can be very difficult. 6o#ever support

advice and medical treatment may be available to help you through  local alcohol support

services.

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In severe cases #here the liver has stopped functioning despite being completely abstinent

from alcohol a liver transplant may be re&uired. 7ou #ill only be considered for a liver 

transplant if you have developed complications of cirrhosis despite abstinence from alcohol.

7ou #ill also need to remain abstinent from alcohol #hile a#aiting the transplant and for the

rest of your life after#ards.

Complications

Death rates lin"ed to ARLD have risen considerably over the last fe# decades and alcohol is

no# one of the most common causes of death in the along #ith  smo"ingand high blood

 pressure.

Life-threatening complications of ARLD can develop. %hese include internal (variceal)

 bleeding a build-up of to'ins in the brain (encephalopathy) fluid accumulation in the

abdomen (ascites) #ith associated "idney failure and also liver cancer .

Preventing alcohol-related liver disease

%he most effective #ay to prevent ARLD is to stop drin"ing alcohol or stic" to the

recommended daily limits and have at least t#o alcohol-free days a #ee".

%he recommended limits of alcohol consumption are!

• 1en should not regularly drin" more than 8-9 units of alcohol a day.

• Women should not regularly drin" more than :-8 units a day.

A unit of alcohol is e&ual to about half a pint of normal strength lager or a pub measure

(:3ml) of spirits. 7ou can use the drin"ing self-assessment tool to #or" out #hether you*re

drin"ing too much.

+ven if you have been a heavy drin"er for many years reducing or stopping your alcohol

inta"e #ill have important short- and long-term benefits for your liver and your overallhealth.

0ymptoms of alcohol-related liver disease

In many cases people #ith alcohol-related liver disease (ARLD) do not have any noticeable

symptoms until their liver is badly damaged.

+arly symptoms

If you do e'perience early symptoms of ARLD these are often &uite vague such as!

• tummy (abdominal) pain 

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• loss of appetite

• fatigue

• feeling sic" (nausea)

• diarrhoea

• feeling generally un#ell

Advanced symptoms

As your liver becomes more severely damaged you #ill usually develop more obvious and

serious symptoms such as!

• yello#ing of the s"in and #hites of the eyes ( $aundice)

• s#elling in the legs an"les and feet due to a build-up of fluid (oedema)

• s#elling in your abdomen due to a build-up of fluid "no#n as ascites

• a high temperature (fever) and shivering attac"s

• very itchy s"in

• hair loss

• unusually curved fingertips and nails (clubbed fingers)

•  blotchy red palms

• significant #eight loss

• #ea"ness and muscle #asting

• confusion and memory problems problems sleeping (insomnia) and

changes in your personality due to a build-up of to'ins in the brain

• vomiting blood and blac" tarry stools due to internal bleeding

• a tendency to bleed and bruise more easily such as fre&uent nosebleeds and

 bleeding gums

• increased sensitivity to alcohol and drugs (because the liver cannot process

them)

When to seek medical advice

ARLD often causes no symptoms until it has reached an advanced stage. If you misuse

alcohol you may have liver damage even though you have none of the symptoms above.

It is recommended that you contact your for advice if you have a history of regular

alcohol misuse.

http://www.nhs.uk/livewell/tiredness-and-fatigue/Pages/tiredness-and-fatigue.aspxhttp://www.nhs.uk/Conditions/Diarrhoea/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Jaundice/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Oedema/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/hair-loss/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/nail-abnormalities/Pages/Introduction.aspx#clubbedhttp://www.nhs.uk/Conditions/Insomnia/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Nosebleed/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Nosebleed/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/alcohol-misuse/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/alcohol-misuse/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/alcohol-misuse/Pages/Introduction.aspxhttp://www.nhs.uk/livewell/tiredness-and-fatigue/Pages/tiredness-and-fatigue.aspxhttp://www.nhs.uk/Conditions/Diarrhoea/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Jaundice/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Oedema/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/hair-loss/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/nail-abnormalities/Pages/Introduction.aspx#clubbedhttp://www.nhs.uk/Conditions/Insomnia/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/Nosebleed/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/alcohol-misuse/Pages/Introduction.aspxhttp://www.nhs.uk/conditions/alcohol-misuse/Pages/Introduction.aspx

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A good #ay to assess your history and pattern of drin"ing is to use a short test "no#n as the

2A+ test #hich consists of four &uestions!

• 6ave you ever thought you should cut down on your drin"ing;

•6ave people annoyed you by criticising your drin"ing;

• 6ave you ever felt guilty about your drin"ing;

• 6ave you ever drun" an ‘eye-opener’ #hich means have you ever drun"

alcohol first thing in the morning to get over a hangover and steady your

nerves;

If you ans#er yes to one or more of the &uestions above you may have an alcohol misuse

 problem and are advised to see your .

7ou should see your as soon as possible if you have symptoms of advanced alcohol-

related liver disease.

Causes of alcohol-related liver disease

Alcohol-related liver disease A!"#$ is caused %y drinking too much alcohol& 'he more

you drink a%ove the recommended limits( the higher your risk of developing A!"#&

%here are t#o #ays that alcohol misuse can cause ARLD!

• drin"ing a large amount of alcohol in a short amount of time ("no#n as binge

drin"ing) can cause fatty liver disease and less commonly alcoholic hepatitis

• drin"ing more than the recommended limits of alcohol over many years can

cause hepatitisand cirrhosis the more serious types of ARLD

+vidence suggests that people #ho regularly drin" more than the ma'imum amounts of

alcohol recommended by the

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• having a pre-e'isting liver condition such as hepatitis 2 (a chronic viral

infection of the liver)

• genetics - dependence on alcohol and problems processing alcohol often run in

families

#iagnosing alcohol-related liver disease

Alcohol-related liver disease (ARLD) is often first suspected #hen tests for other medical

conditions sho# that the liver has been damaged.

%his is because the condition causes fe# obvious symptoms in the early stages.

If a doctor suspects you may have ARLD they #ill usually arrange a blood test to chec" ho#

#ell your liver is #or"ing. %hey may also as" you about your alcohol consumption.

It is important to be totally honest about ho# much and ho# often you drin" alcohol. If you

say you drin" less alcohol than you do or deny drin"ing any alcohol you may be referred for 

further unnecessary testing. %his could lead to a delay in the treatment you need.

 

)lood tests

>lood tests used to assess the liver are "no#n as liver function tests. %hey can detect en?ymes

in your blood that are normally only present if your liver has been damaged.

>lood tests can also detect if you have lo# levels of certain substances such as a protein

called serum albumin #hich is made by the liver. Lo# levels of serum albumin suggest that

your liver is not functioning properly.

A blood test may also loo" for signs of abnormal blood clotting #hich can indicate

significant liver damage.

Lab %ests @nline has more information about liver function tests.

  *urther testing

If your symptoms or liver function test suggest that you may have an advanced form of 

alcohol-related liver disease either alcoholichepatitis or  cirrhosis you may need further tests

to assess the state of your liver. %hese are described belo#.

 

+maging tests

An ultrasound scan computerised tomography (2%) scan or a magnetic resonance imaging

(1RI) scan may also be carried. %hese scans can produce detailed images of your liver. 0ome

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scans may also measure the stiffness of the liver #hich is a good indication of #hether your 

liver is scarred.

 

"iver %iopsy

During a liver biopsy a fine needle is inserted into your body (usually bet#een your ribs). Asmall sample of liver cells is ta"en and sent to a laboratory to be e'amined under a

microscope. %he biopsy is usually carried out under  local anaesthetic as a day case or #ith an

overnight stay in hospital.

0pecialist doctors are able to e'amine the liver biopsy tissue under the microscope to

determine the degree of scarring in the liver and the cause of the damage.

 

,ndoscopy

An endoscope is a thin long fle'ible tube #ith a light and a video camera at one end. Duringan endoscopy the instrument is passed do#n your oesophagus (the long tube that carries food

from the throat to the stomach) and into your stomach.

ictures of your oesophagus and stomach are transmitted to an e'ternal screen. %he doctor 

#ill be loo"ing for s#ollen veins (varices) #hich are a sign of cirrhosis.

'reating alcohol-related liver disease

0uccessful treatment for alcohol-related liver disease (ARLD) often depends on #hether someone is #illing to stop drin"ing alcohol and ma"e changes to their lifestyle.

 

Stopping drinking alcohol

%reatment for alcohol-related liver disease involves stopping drin"ing alcohol. %his is "no#n

as abstinence. Abstinence can be vital depending on #hat stage the condition is at.

If you have fatty liver disease the damage may be reversed if you abstain from alcohol for at

least t#o #ee"s. After this point it is usually safe to start drin"ing again if you stic" to

the 

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If you are abstaining from alcohol you may suffer #ithdra#al symptoms. %hese #ill be at

their #orst for the first 9= hours but should start to improve as your body ad$usts to being

#ithout alcohol. %his usually ta"es bet#een three and seven days from the time of your last

drin".

1any people initially e'perience disturbed sleep #hen abstaining from alcohol but in most

cases their sleep pattern returns to normal #ithin a month.

In some cases you may be advised to reduce your alcohol inta"e in a gradual and planned

#ay to help avoid #ithdra#al problems. 7ou may also be offered a medication called a

 ben?odia?epine and psychological therapy such as cognitive behavioural therapy (2>%) to

help you through the #ithdra#al process.

0ome people need to stay in hospital or a specialist rehabilitation clinic during the initial

#ithdra#al phases so their progress can be closely monitored.

If you are staying at home you #ill regularly see a nurse or other health professional. 7ou

might see them at home at your surgery or at a specialist

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Avoiding salty foods and not adding salt to foods you eat can help reduce your ris" of 

developing s#elling in your legs feet and abdomen (tummy) caused by a build-up of fluid.

0ee tips for a lo#er salt diet for more information.

%he damage to your liver can also mean it is unable to store glycogen a carbohydrate that

 provides short-term energy. When this happens the body uses its o#n muscle tissue to

 provide energy bet#een meals #hich leads to muscle #asting and #ea"ness. %herefore you

may need e'tra energy and protein in your diet.

6ealthy snac"ing bet#een meals can top up your calories and protein. It may also be helpful

to eat three or four small meals a day rather than one or t#o large meals.

7our can advise you on a suitable diet or in some cases refer you to a dietitian.

In the most serious cases of malnutrition nutrients may need to be provided through a

feeding tube inserted through the nose and into the stomach.

edication for symptoms

%he use of medication to directly treat ARLD is controversial. 1any e'perts have

argued there is limited evidence for its effectiveness.

/or people #ith severe alcoholic hepatitis treatment in hospital may be necessary. 0pecific

treatment #ith corticosteroids or pento'ifylline medication may be used to reduce

inflammation of the liver in some people #ith this condition.

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%here are a number of serious complications that can develop if you have alcohol-related

liver disease (ARLD).

0ome of the main complications associated #ith the condition are described belo#.

Portal hypertension and varicesortal hypertension is a common complication of cirrhosis and less commonly

alcoholic hepatitis. It occurs #hen the blood pressure inside your liver has risen to a

 potentially serious level.

When the liver becomes severely scarred it is harder for blood to move through it. %his leads

to an increase in blood pressure.

%he blood must also find a ne# #ay to return to your heart. It does this by opening up ne#

 blood vessels usually along the lining of your stomach or oesophagus (the long tube that

carries food from the throat to the stomach). %hese ne# blood vessels are "no#n as varices.

If the blood pressure rises to a certain level it can become too high for the varices to cope

#ith causing the #alls of the varices to split and bleed.

%his can cause long-term bleeding #hich can lead to anaemia (a condition #here the body

does not have enough o'ygen-carrying red blood cells).

Alternatively the bleeding can be rapid and massive causing you to vomit blood and pass

stools that are very dar" or tar-li"e.

0plit varices can be treated using an endoscope (a narro# tube #ith a camera at the end that

is passed do#n into the stomach) to locate the varices. A tiny band can then be used to seal

the base of the varices.

Ascites

If you have portal hypertension you may also develop a build-up of fluid in your abdomen

(tummy) and around your intestines. %his fluid is "no#n an ascites.

Initially this can be treated #ith #ater tablets (diuretics). If the problem progresses many

litres of fluid can build-up and this #ill need to be drained. %his is a procedure "no#n as

 paracentesis and involves a long thin tube being placed into the fluid through the s"in

under  local anaesthetic.

@ne of the problems associated #ith the development of ascites is the ris" of infection in the

fluid (spontaneous bacterial peritonitis). %his is a potentially very serious complication and is

lin"ed to an increased ris" of "idney failure and death.

Hepatic encephalopathy

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@ne of the most important functions of the liver is to remove to'ins from your blood. If your 

liver is unable to do this due to hepatitis or cirrhosis the levels of to'ins in your blood

increase. A high level of to'ins in the blood due to liver damage is "no#n as hepatic

encephalopathy.

0ymptoms of hepatic encephalopathy include!

• agitation

• confusion

• disorientation

• muscle stiffness

• muscle tremors

• difficulty spea"ing

• in very serious cases coma

6epatic encephalopathy may re&uire admission to hospital. In hospital body functions are

supported #hile medication is given to remove to'ins from the blood.

"iver cancer

Damage to the liver due to heavy drin"ing over many years can also increase your ris" of 

developing liver cancer .

@ver the past fe# decades rates of liver cancer in the have risen sharply as a result

of increased levels of  alcohol misuse and it*s estimated that 8-35 of people #ith cirrhosis #ill

develop liver cancer every year.

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