Alcohol and Liver

Alcohol is the most widely abused agent in the world and its excessive intake is the leading cause of liver disease. It is consumed as beer, wine or distilled spirit and a blood level of 100 mg/dl is the legal definition for drunk driving in India. A blood concentration of 200 mg/dl causes inebriation while a level of 300-400 mg/dl can lead to coma, respiratory arrest and death.What is alcoholic liver disease?

Alcohol ingestion affects the liver, nervous system, cardiovascular system, gastrointestinal system, muscles and the reproductive system. There is also an increased risk of cancer of the mouth, pharynx, food pipe, and liver associated with prolonged alcohol abuse.

The liver bears the greatest brunt of alcoholic injury leading to 3 distinctive, but overlapping forms of liver disease:

• Fatty change (hepatic steatosis)
• Acute alcoholic hepatitis
• Cirrhosishats the cause?
  

Daily ingestion of 80 gm or more of ethanol poses a significant risk for serious liver damage while a daily intake of 160 gm or more for 10-20 years is consistently associated with severe liver injury. Only 10-15% of chronic alcoholics, however, develop cirrhosis. Women are more prone to hepatic injury and this may be related to reduced breakdown of alcohol and differences in body composition, possibly a genetic susceptibility. No genetic markers are known that can identify susceptible individuals.

The relation between fatty change or alcoholic hepatitis and progression to cirrhosis is not yet clear with cirrhosis developing without preceding evidence of fatty change or hepatitis in some individuals. In the absence of a clear understanding of the different factors responsible for liver injury, no safe upper limit for alcohol intake can be stated.

Fatty change: This is an acute, reversible effect of alcohol ingestion and, in chronic alcoholism, may lead to a massive enlargement of the liver. This occurs because of increased breakdown of fat in the body causing more fatty acids to be delivered to the liver; excess lipid biosynthesis in the liver; reduced fat breakdown by the liver; and decreased transport of fat out of the liver.

Acute alcoholic hepatitis: This liver injury is also potentially reversible. It is caused by the direct toxic effect of alcohol and is due to injury to the liver cell; reduced protective chemicals in the liver cells; increased production of toxic substances within the liver; and stimulation of the immune system. Reduced oxygen supply within the liver also contributes to the injury. If alcohol ingestion is continued, about 10-15% of patients from this stage will develop cirrhosis of liver. This occurs acutely, usually after a bout of heavy drinking. Patient may have minimal symptoms or may come in a fulminant liver failure. The usual symptoms, however, are malaise, loss of appetite, weight loss, fever, liver pain and jaundice. Each bout of hepatitis carries a risk of death of 10%-20% and repeated episodes lead to cirrhosis in 1/3rd of patients in a few years.

Cirrhosis: This stage is characterised by a hard, shrunken liver and is a serious, potentially fatal condition. The patient has weakness, wasting of muscles, fluid in the abdominal cavity (ascites), bleeding in the intestinal tract and coma. Jaundice, ascites, portal hypertension and other features like grossly bloated abdomen and wasting of extremities clinically manifest this state.

End-stage alcoholic: The causes of death include hepatic coma, profuse intestinal bleeding, unremitting infection, involving kidney failure and cancer of the liver.

In case of fatty change the patient is usually asymptomatic with only a mild liver enlargement. Blood tests may be normal or there may be a mild increase in bilirubin and alkaline phosphatase enzyme.

In case of acute alcoholic hepatitis, blood tests reveal elevated bilirubin level, increase in alkaline phosphatase and rise in white cell count.

Blood tests are grossly abnormal and biopsy of liver may be indicated in case of cirrhosis. is the treatment?

Stopping alcohol and a well balanced diet helps reverse the liver injury in case of fatty change.

In case of acute alcoholic hepatitis total abstinence from alcohol and proper nutrition usually allow it to improve slowly. In some cases, however, it progresses to cirrhosis despite stopping alcohol.

There is no treatment for cirrhosis. Liver transplant is the only available option.

The Progression of Liver Disease

There are many different types of liver disease. But no matter what type you have, the damage to your liver is likely to progress in a similar way.

Whether your liver is infected with a virus, injured by chemicals, or under attack from your own immune system, the basic danger is the same – that your liver will become so damaged that it can no longer work to keep you alive.

Anything that keeps your liver from doing its job may put your life in danger.

The Healthy Liver

Your liver helps fight infections and cleans your blood. It also helps digest food and stores energy for when you need it. A healthy liver has the amazing ability to grow back, or regenerate, when it is damaged. Anything that keeps your liver from doing its job – or from growing back after injury – may put your life in danger.

Inflammation

In the early stage of any liver disease, your liver may become inflamed. It may become tender and enlarged. Inflammation shows that your body is trying to fight an infection or heal an injury. But if the inflammation continues over time, it can start to hurt your liver permanently.

When most other parts of your body become inflamed, you can feel it – the area becomes hot and painful. But an inflamed liver may cause you no discomfort at all.

If your liver disease is diagnosed and treated successfully at this stage, the inflammation may go away.

Fibrosis

If left untreated, the inflamed liver will start to scar. As excess scar tissue grows, it replaces healthy liver tissue. This process is called fibrosis. (Scar tissue is a kind of fibrous tissue.)

Scar tissue cannot do the work that healthy liver tissue can. Moreover, scar tissue can keep blood from flowing through your liver. As more scar tissue builds up, your liver may not work as well as it once did. Or, the healthy part of your liver has to work harder to make up for the scarred part.

If your liver disease is diagnosed and treated successfully at this stage, there’s still a chance that your liver can heal itself over time.

Cirrhosis

But if left untreated, your liver may become so seriously scarred that it can no longer heal itself. This stage – when the damage cannot be reversed – is called cirrhosis.

Cirrhosis can lead to a number of complications, including liver cancer. In some people, the symptoms of cirrhosis may be the first signs of liver disease.

Liver Cancer

Cancer that starts in the liver is called primary liver cancer. Cirrhosis and hepatitis B are leading risk factors for primary liver cancer. But cancer can develop in the liver at any stage in the progression of liver disease. Read more.

• You may bleed or bruise easily.
• Water may build up in your legs and/or abdomen.
• Your skin and eyes may take on a yellow color, a condition called jaundice.
• Your skin may itch intensely.
• In blood vessels leading to your liver, the blood may back up because of blockage. These blood vessels may burst.
• You may become more sensitive to medications and their side effects.
• You may develop insulin resistance and type-2 diabetes.
• Toxins may build up in your brain, causing problems with concentration, memory, sleeping, or other mental functions.

Once you’ve been diagnosed with cirrhosis, treatment will focus on keeping your condition from getting worse. It may be possible to stop or slow the liver damage. It is important to protect the healthy liver tissue you have left.

Liver failure

Liver failure means that your liver is losing or has lost all of its function. It is a life-threatening condition that demands urgent medical care.

The first symptoms of liver failure are often nausea, loss of appetite, fatigue, and diarrhea. Because these symptoms can have any number of causes, it may be hard to tell that the liver is failing.

Liver failure is a life-threatening condition that demands urgent medical care.

But as liver failure progresses, the symptoms become more serious. The patient may become confused and disoriented, and extremely sleepy. There is a risk of coma and death. Immediate treatment is needed. The medical team will try to save whatever part of the liver that still works. If this is not possible, the only option may be a liver transplant.

When liver failure occurs as a result of cirrhosis, it usually means that the liver has been failing gradually for some time, possibly for years. This is called chronic liver failure.

Chronic liver failure can also be caused by malnutrition. More rarely, liver failure can occur suddenly, in as little as 48 hours. This is called acute liver failure and is usually a reaction to poisoning or a medication overdose.

Cirrhosis, liver cancer, and liver failure are serious conditions that can threaten your life. Once you have reached these stages of liver disease, your treatment options may be very limited.

That’s why it’s important to catch liver disease early, in the inflammation and fibrosis stages. If you are treated successfully at these stages, your liver may have a chance to heal itself and recover.

Talk to your doctor about liver disease. Find out if you are at risk or if you should undergo any tests or vaccinations.