Alcohol Related Liver Disease

Excess alcohol consumption can lead to a gradual scarring of the liver and eventually may lead to cirrhosis and abnormalities of liver function. It is a very common cause of liver disease in the UK and it usually progresses gradually over many years. The risk of developing alcohol-related liver damage is directly proportional to the amount of alcohol consumed but can also be exacerbated by other factors such as obesity and diabetes. Susceptibility to alcohol-related liver disease can also run in families.

Prevention of further damage, if possible, is the first step and we will encourage lifestyle changes if your liver disease is related to alcohol consumption to try to reduce the pressure on the liver. Most patients will be unaware that their liver is at risk as symptoms are usually only apparent at the advanced stages of liver damage. Symptoms at this time may include loss of muscle mass and body weight, lack of energy, mild confusion or the development of a swollen abdomen or legs. The onset of jaundice in someone who drinks alcohol to excess is a very worrying feature and necessitates urgent medical attention. We can provide patients with a tailored set of investigations to assess for liver damage and can support patients in their efforts to reduce their alcohol consumption.

The chronic alcohol-related liver disease can be divided into 4 stages:

  • Most heavy drinkers will develop a fatty liver as a result of the breakdown of alcohol. This stage usually produces no symptoms and gets better if alcohol consumption is reduced.
  • The liver becomes inflamed. This is called steatohepatitis. In severe cases, jaundice may develop. A diagnosis of acute alcoholic hepatitis is made at this point.
  • Fibrosis – the laying down of scar tissue – begins. This cannot be picked up by routine blood tests or scans, and requires specific tests, such as a Fibroscan, to detect.
  • Liver cirrhosis is advanced fibrosis. The normally soft liver tissue is divided into thousands of pea-sized pockets, called nodules, and wrapped in extensive scar tissue. Blood supply through the liver can become impeded and normal liver function can be drastically reduced.

The cornerstone of the treatment of alcohol-related liver disease is a sustained reduction in alcohol consumption. Dependent on the situation, a complete abstinence from alcohol may be required. Damage to the liver is often reversible in this situation, but recovery of normal liver function is harder to achieve the more advanced the stage of scarring. Once liver cirrhosis develops, the prognosis very much hinges on whether or not someone continues to drink.

We can assist patients to identify ways to reduce their alcohol consumption and if necessary make recommendations and onward referrals to allied specialists in this field to help. Patients who drink alcohol to excess may have a poor overall diet or specific nutritional deficiencies, and this is an area we will focus on. Patients with advanced liver disease can be at risk of future complications and an aspect of the care we provide here will involve intermittent screening tests to manage complications pre-emptively. Alcohol hepatitis requires urgent medical therapy to prevent acute deterioration in liver function.