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Alcoholic liver disease

Alcoholic liver disease is the result of an overconsumption of alcohol that leads to a buildup of fats and scarring of the liver. It can be fatal.

What is alcoholic liver disease?

Excess amount of alcohol intake for prolonged period may harm liver. Liver disease due to alcohol is known as alcoholic liver disease. This usually manifests in three forms:hepatic steatosis (fatty liver),  alcoholic hepatitis and hepatic cirrhosis.

How does alcohol damage liver?

Alcohol is metabolised in liver. During metabolic process there is generation of free radicals and oxidants which damage liver cells and other intracellular oraganallae. Thus they kill healthy liver cells and produce inflammation. These damaged cells initially become foamy leading to fatty liver, later on fibrosis occurs. Fibrosis might progress to cirrhosis which is irreversible damage to liver. Prolonged cirrhosis is a risk factor for liver cancer. Every patient might not go through every stage.

What amount of alcohol is harmful ?

If a healthy man or woman consumes more than 40 gm/day or 20 gm/day alcohol for more than 10 years, he or she is at risk of developing alcoholic cirrhosis.  Usually beer, wine and whisky contain 8%, 12% and 40% alcohol respectively. Therefore to avoid serious liver disease males should not consume more than 500 ml of beer or 250 ml of wine or 100 ml of whisky in a day. The dose for females is half of this. Fatty liver disease can occur at lower dose.

A conveninent method of calculating the amount of alcohol one consumes is to count the number of “standard drinks” he has. A standard drinks contain approximately 10 gm of alcohol. So males should have less than 4 standard drinks per day while females should have less than 2 standar drinks per day, to avoid injury to the liver.


Why many people never develop liver disease even when they are consuming more alcohol?

Only 15-30 % of all people who consume alcohol in significant amount develop liver disease. This difference may be due to their differing capacity of alcohol metabolism. There is no test to determine who is at risk of developingliver disease. However those who are obese, diabetic, have pre-existing liver disease or are consuming medicines which might be toxic to liver are at high risk. Females are more susceptible to get liver damage due to alcohol.

How is alcoholic liver disease diagnosed?

Fatty liver is usually asymptomatic or may present with right upper abdomen discomfort. Alcoholic hepatitis usually present with jaundice, loss of appetite, malaise and weakness. Cirrhosis may present with abdominal distension due to fluid in tummy (ascites), bleeding or altered behaviour. Ultrasound abdomen, blood tests like liver function tests help in diagnosis of liver disease. Fibroscan, CT scan, Endoscopy etc. may be needed for detailed work up.

A patient with ascites:

How is alcoholic liver disease treated?

Following are the treatment aspects of alcoholic liver disease:

Abstinence: The most important aspect of treatment in ALD is the immediate and total abstinence from alcohol. Drugs may be used to treat the symptoms of withdrawal.

Good nutrition: It is critical that the patient’s nutritional intake is adjusted to maintain a high-calorie, high-protein diet.Proteins and vitamin dietary supplements are prescribed. Vitamin B and K are administered. Potassium, magnesium and zinc are administered to those patients with decompensated liver disease.

Hospitalization: Patients with severe forms of alcoholic liver disease like alcoholic hepatitis or decompensated alcoholic liver cirrhosis with complications may require hospitalization.

Medications: Patients with alcoholic hepatitis may need specific medications. Corticosteroids are prescribed for severely ill alcoholic hepatitis patients. This group of patients, with a high risk of mortality, has been found to have high levels of circulating pro-inflammatory cytokines. These are blocked by steroids, which have an anti-inflammatory effect. Another drug pentoxifylline prevents worsening of renal function in patients with severe alcoholic hepatitis.

Liver transplantation: Patients with advanced cirrhosis due to alcohol may requirebecause liver transplantation improves survival rates in decompensated liver cirrhosis. However, most transplant centers require a documented period of 6-months of abstinence from alcohol before transplantation.

The most important treatment of alcoholic liver disease is complete abstinence from alcohol