What is alcoholic liver disease?

Over consumption of alcohol can cause liver disease, as well as harming many other body organs. The prevalence of alcoholic liver disease (ALD) in a population is usually determined by measuring death rates from alcoholic cirrhosis (in which healthy liver tissue becomes increasingly replaced by scar tissue). These rates have increased alarmingly in recent years. Death rates in the UK have risen by up to 88 percent between 1974 and 1994 with the highest increase in young men aged 35-44 (7.6 deaths per year per 100,000 people). The average adult consumption of alcohol has also increased over this period.

The amount of alcohol that can cause liver damage seems to vary widely between individuals. But it is certain that:

Some genetically inherited susceptibility to the harmful effects of alcohol.
Women are also believed to be more sensitive to the harmful effects of alcohol than men.

Daily drinking, and drinking outside meal times is more harmful than only drinking at weekends.

The more you drink the greater your risk of developing alcoholic liver disease (ALD).

Three main stages of alcoholic liver disease (ALD), although the progression through these stages is variable. which are determined by examining a sample of the liver under the microscope from a biopsy.
Minimal change, or fatty liver: heavy drinkers often develop fatty change in the liver. This is not linked to deterioration in liver function, but abnormalities may be seen in some of the liver blood tests. Fatty liver is reversible with avoiding alcohol and some herbal medicine, but it is the first stage in the progression to cirrhosis.
Alcoholic hepatitis: the effects of this condition can be mild but may also be life threatening. The blood test will almost always be abnormal, and the patient may develop jaundice. As with fatty liver, avoiding alcohol and some herbal medicine can reverse the effects, but those who continue to drink heavily have a high risk of developing cirrhosis. Cirrhosis: this is the final, irreversible stage of alcoholic liver disease (ALD) and is characterized by scarring of the liver and development of liver nodules. It severely affects liver function and reduces life expectancy. The blood test is usually abnormal, there may be jaundice (yellow colouring of the eyes and skin) and sometimes bruising or bleeding caused by abnormalities of the blood clotting system. Complications of so-called 'decompensated' cirrhosis may develop.

Symptoms of alcoholic liver disease (ALD) are usually non-specific, and do not necessarily indicate the severity of the underlying liver damage. Many people will have vague symptoms such as fatigue, nausea and vomiting (typically in the morning), diarrhea or abdominal pains. Many patients, even with advanced alcoholic liver disease (ALD) will have no symptoms and are detected by the finding of liver blood tests performed as part of routine health screening, or during the investigation of other conditions. Only in the more advanced stages of decompensated alcoholic liver disease (ALD) (severe alcoholic hepatitis or cirrhosis) will the sufferer present with more specific liver-related symptoms such as jaundice, ascites (fluid collecting in the abdomen, causing distension), haematemesis (vomiting of blood) or encephalopathy (confusion, reduced level of awareness causing coma). These are signs of severe liver damage and require urgent medical treatment.

Blood tests can give an idea of the degree of liver damage but these are not accurate predictors. Ultrasound scans create an image of the liver and surrounding organs, which helps in taking a liver biopsy. The ultrasound scan can help to assess the severity of disease and exclude other common causes of abnormal LFT's such as gallstones.

Liver biopsy is the most accurate test to determine the stage of alcoholic liver disease (ALD) present and to ensure alcohol is the cause of the liver disease. Research has shown that in up to 20 percent of heavy drinkers with abnormal LFTs an alternate cause of liver disease is found on investigation. Liver biopsies are performed under local anaesthetic, and provide a tiny sample of the liver for analysis under the microscope.
The above investigations will rule out whether the symptoms are caused by any of the following: viral hepatitis, including hepatitis B and C. haemochromatosis (an inherited disorder of iron metabolism). Wilson's disease (an inherited disorder of copper metabolism).
autoimmune hepatitis (a liver disorder caused by the immune system attacking the liver).