A B C D E F G H I J K L M N O P R S T U V W

LIVER DISEASE - ALCOHOLIC

What is Liver Disease ?

Alcoholic liver disease is unfortunately very common. It carries with it all the other social and medical problems which result from abuse of alcohol. The liver is in the abdominal cavity, beneath the lower right ribs and in the upper right abdomen. It has many functions, including the breakdown of unwanted substances absorbed from the gut, and the production of proteins such as albumin and vitamin K (which prevents bruising). It is also an essential organ for excreting unwanted substances. In alcoholic liver disease, the liver swells at first and there may be pain in the right upper abdomen. Tiredness, loss of appetite, nausea and vomiting may occur.

On the other hand, liver damage can be gradual and quite unnoticed by the patient until it is too late. As the liver is damaged, increased pressure in the veins in the liver may cause other nearby veins to swell. Bulging veins in the gullet are called oesophageal varices. These can rupture and bleed, causing vomiting of blood, shock and anaemia. Fluid may accumulate in the abdomen (ascites), due to increased liver vein pressure and reduced levels of albumin in the blood. Yellow jaundice may occur due to blockage of liver ducts which normally drain away the bile. Once the liver fails, toxic substances can no longer be got rid of. They circulate to the brain causing confusion, and later coma.

How does Liver Disease occur ?

Excessive consumption over a long period of time damages liver cells. The first consequence is that the liver becomes swollen with fat. If the damage is more severe, inflammation occurs, a condition called alcoholic hepatitis . Both these problems may be completely reversed if alcohol abuse stops. If heavy drinking continues, the liver becomes irreversibly damaged with ‘scarring’. This is called cirrhosis.

Why does Liver Disease occur ?

People drink too much alcohol for different reasons. In some it is just a habit drinking with friends, which gets out of hand. In others it stems from a need to boost confidence or escape from an unpleasant home or work situation. It is easy to get addicted. Alcohol is measured in units. One unit is a half-pint of standard strength beer, a single measure of spirits or a standard glass of wine. Under 21 units a week in men (14 in women) is thought to be safe. Over 45 units in men (30 in women) is almost certain to cause some liver disturbance eventually. These figures are for guidance only and the risk of liver damage increases according to the level of intake. It is probable that binge drinking is more harmful than the same amount of alcohol drunk over a period of days. Eating poorly is often a problem in alcohol abuse. This raises the risk of liver damage. Apart from this, some people's livers seem to be more easily damaged than others. Unfortunately there is no way of finding this out in advance!

Treatment Involved for Liver Disease

Treatment will involve an initial assessment of the amount of liver damage that has been sustained, as well as any damage to other organs. This will typically include blood tests and an ultrasound (sound wave) scan. These tests are very straightforward. Further tests may include an endoscopy (telescope test via the mouth) to examine the gullet and stomach. On occasions a sample of liver may be taken by using a needle inserted through the skin into the liver. This test, called a liver biopsy, is the most accurate method of assessing the degree of damage to the liver. Because there is a rare but serious risk of bleeding associated with this test it is not always appropriate.

The most important part of treatment is stopping drinking. This allows any possible recovery to occur but it may be many months or longer before maximum recovery has occurred. Support from a variety of agencies, such as Alcoholics Anonymous, Other treatments are directed to the specific complications of liver disease. This will typically include water tablets (diuretics), vitamin tablets and dietary restriction of salt. Bleeding into the stomach may occur and can be life-threatening. This is usually treated using an endoscope (see above). Infections, such as pneumonia, are more common and antibiotics may be required. On occasions, a liver transplant may be considered but there is a shortage of donor organs and therefore limited availability.

During Treatment for Liver Disease

If all alcohol is stopped, the outlook is much improved. The earlier stages of liver damage may recover completely and even with established cirrhosis the disease may stabilise. Any of the problems indicated above may occur and need treatment. Cessation of alcohol should be for life unless this has been discussed and agreed with the doctor. Over-the-counter drugs from a chemist should not be taken without consulting the pharmacist or doctor as to their safety in liver disease. Things to watch out for include sudden abdominal swelling, bruising, jaundice, vomiting of blood and black stools. You will need to contact your doctor if any of these happen.

If Liver Disease is Left Untreated

Continued drinking will cause further liver damage. Eventually the liver disease will progress and one or more of the problems indicated above will occur. Response to treatment is less likely in those who continue to drink and will only lead to a short-term improvement. Ultimately treatment will fail and the patient will usually die from one or more of the possible complications.

Effects on Family of Liver Disease

The excessive intake of alcohol associated with the development of liver disease can often have a devastating affect upon the family. There are the immediate problems associated with looking after an ill member of the family but this will be greatly increased if the patient does not wish to change their behaviour and alcohol intake. In addition, other problems relating to alcohol excess will often occur. These may include driving and related offences, family conflicts and poor performance at work.