What is Alcoholic Liver Disease?

Alcoholic Liver Disease (ALD) is a spectrum of liver conditions caused by excessive alcohol consumption. The liver is the body’s primary organ for metabolizing alcohol, and prolonged, heavy drinking can overwhelm its capacity, leading to damage and dysfunction.

Understanding ALD is crucial, as it’s a significant cause of liver-related illness and mortality worldwide. ALD occurs when liver is exposed to prolonged alcohol abuse.

During the process of metabolism of alcohol in the liver, toxic byproducts are formed which have ability to harm/injure liver cells. The liver is very strong, it has the ability to restore, but repeated exposure to alcohol stops the restoring process and results in progressive injury.

The stages of ALD usually unfold in three phases, but some may overlap, and not every person is a victim of all of the stages:

• Alcoholic Fatty Liver (Steatosis): This takes the form of the first and most widely spread stage when fat builds in the liver cells. It may happen after a couple of days of intense drinking. They may not have any symptoms that can be noticed, or there may be some slight ones, such as tiredness or pains in the upper right abdomen. Fatty liver can be corrected by itself under the condition of stopping alcohol consumption.
• Alcoholic Hepatitis: This phase constitutes the inflammation of the liver and, in most cases, the death of liver cells. This may be mild or severe and life-threatening. Symptoms may include nausea, vomiting, loss of appetite, fever, abdominal pain, and jaundice (yellowing of the skin and eyes). Although mild alcoholic hepatitis may also be reversible via abstinence, severe ones may cause liver failure within a short period of time and may prove fatal.

• Alcoholic Cirrhosis: This is the most severe and generally irreversible stage of ALD. In cirrhosis, healthy liver tissue is replaced by extensive scar tissue (fibrosis), permanently impairing liver function. The liver becomes hard and shrunken, severely compromising its ability to filter toxins, produce essential proteins, and aid digestion.

Symptoms and Complications

ALD is a disease that normally develops silently in its infant stages. Destruction of the liver: The symptoms are normally experienced at the stage when a large portion of the liver is severely affected. The signs and symptoms may be present as the disease progresses and may include:

• Jaundice: The pigmentation of the skin and the eyes with a shade of yellow as a result of the accumulation of bilirubin.
• Abdominal swelling (Ascites): Fluid accumulation in the abdomen.
• Swelling in the legs and ankles (Edema).
• Weakness and fatigue.
• Weight loss and loss of appetite.
• Vomiting and nausea.
• Urine is dark with pale stools.
• Bleeding and easy bruising.

Confusion, memory problems, and personality changes (Hepatic Encephalopathy): Due to the liver’s inability to remove toxins from the blood, which then affects the brain.

Variceal bleeding: Dilated veins of the esophagus or the stomach with the risk of rupturing and bleeding, which can lead to a life-threatening complication.

Conclusion

Alcoholic Liver Disease is a serious and preventable condition that progresses from reversible fatty liver to life-threatening cirrhosis. The most crucial intervention for ALD is complete and permanent abstinence from alcohol.

Early detection and intervention can significantly improve outcomes, allowing the liver to recover in its earlier stages. For individuals with advanced ALD, a liver transplant may be the only viable treatment option, but this also requires sustained abstinence from alcohol.

Awareness of the risks and symptoms associated with alcohol misuse is vital for safeguarding liver health.

Dr. Kailash Mishra
Director & Gastroenterologist Consultant
Prime Gastro Liver Clinic