Alcoholic liver disease

Alcoholic liver disease is one of the most common hepatic disorders associated with the alcohol abuse. The risk of the alcoholic liver disease depends largely on the dose, duration and frequency of alcohol consumption. It is established that the risk of liver injury increases significantly when more than 40-80 grams of pure ethanol (ethyl alcohol) is used per day per day for at least 5 years.

This amount of ethanol is contained in 100-200 ml of vodka (40% of alcohol), 400-800 ml of dry wine (10% of alcohol) 800-1600 ml of beer (5% of alcohol). These doses of alcohol are considered to be critical for the adult persons. Women and adolescents are more sensitive to alcohol, and critical daily doses of ethanol are much lower for them. For the women the use of more than 20 g of ethanol per day is harmful.

Development of the alcoholic liver disease is independent of the type of the used alcoholic beverages. Only the amount of the used pure ethanol is important. Thus, use of beer only for over 5 years, the daily dose of which is 40-80 grams of pure ethanol, can lead to liver injury.

There are a few forms or stages of the alcoholic liver disease: fatty liver (hepatosis), acute and chronic alcoholic hepatitis, cirrhosis and/or liver cancer.

Alcohol and liver 

Stages of alcoholic liver disease

The first stage of the alcoholic liver disease is the fatty degeneration of liver or fatty hepatosis. Chronic alcoholic hepatitis (steatohepatitis) differs from steatosis with the changes in biochemical liver function tests specific to the inflammation and cell death - increased levels of the AST and ALT. Chronic alcoholic hepatitis may be occult or have clinically marked exacerbations, so called attacks of acute alcoholic hepatitis. It leads to the development of alcoholic cirrhosis.

Acute alcoholic hepatitis can develop at any stage of alcoholic liver disease. It occurs after the excessive intake of alcohol and is characterized by the development of abdominal pain, nausea, fever and jaundice. Common symptoms include the enlargement of the abdomen due to accumulation of fluid in it (ascites), bleeding from the nose, gums, and gastrointestinal tract. The increase of the white blood count in the complete blood count is very characteristic. The severity of the attack of acute alcoholic hepatitis varies from the mild anicteric form to the severe form with the pronounced jaundice (20-fold increase in bilirubin levels), in which the mortality is 50-60%.

Alcoholic cirrhosis develops in about 10-20% of alcohol abusers. The hepatic injuries at this stage are manifested with the jaundice, enlarged liver, cirrhosis complications including liver failure, portal hypertension, ascites, bleeding from esophageal veins. Alcoholic cirrhosis is a predisposition to the development of liver cancer.

Excessive consumption of alcohol leads to the disorders of many organs, in addition to liver:

  • gastrointestinal tract (heartburn due to inflammation of the esophagus, esophageal ruptures with bleeding, gastritis, gastric ulcer and duodenal ulcer),
  • pancreas (frequent diarrhea, abdominal pain, and severe acute pancreatitis requiring surgical treatment),
  • brain (nervous system degeneration),
  • peripheral nervous system (numbness, extremity sensation disorders),
  • heart (increased blood pressure, heart failure and others),
  • skeletal muscles, blood cells, skin, kidney.

These disorders create some "alcoholic pattern", which allows the doctor to correctly diagnose the chronic alcoholic disease with the liver injury despite of latent liver involvement and often observed the patient denial of the alcohol abuse.

The main and most effective method of treatment of alcoholic liver disease is the complete cessation of alcohol intake. Abstinence from alcohol at the stage of fatty degeneration of liver results in the complete restoration of the size and structure of the liver. Prescription of the hormonal products may be required in the severe acute alcoholic hepatitis. An important component of the treatment is adequate and balanced diet and restoration of the deficiency of the vitamins and micronutrient elements. Prognosis for patients with the alcoholic liver cirrhosis in total abstinence from alcohol is in general favorable.