Gastroenterology - Alcohol Related Liver Disease (ARLD)

What is Alcohol related Liver disease?

Most people think that alcohol is fairly harmless and just something to be enjoyed, that it does not have any long lasting ill effects. But alcohol can cause harm.

You don’t have to be a heavy drinker to run into problems. Drinking a little bit more than you should, over time can seriously damage your liver. You may not have any of the obvious side effects but this does not mean you are not risking chronic ill- health or lasting liver damage. Vast numbers of us now fall into this category.

How can alcohol damage the liver?

The liver is your largest internal organ. It has approximately 500 tasks to perform to keep your body working, one of which is dealing with the alcohol you drink. The liver has so few nerve endings that you will not know when it is complaining. You may not feel anything is happening, until your liver begins to fail. By this time the damage will be severe – and could be fatal.

Your liver can only handle a certain amount of alcohol. Drinking quickly results in your liver cells having to work overtime to process the alcohol. If you drink more than the liver can deal with, then the excess is transported to the rest of your organs.

The liver needs water to do its job. Alcohol acts as a diuretic (makes you pass urine), it dehydrates you and forces the liver to divert water from elsewhere. A substance called acetaldehyde is produced as the liver processes the alcohol. This is not just toxic to the liver, but also to the brain and the stomach lining. This is what causes a hangover.

Regular and/or heavy drinking can strain or disrupt this process leading to alcoholic liver disease.

What is binge drinking?

People think that binge drinking is getting drunk and staying drunk over a period of time.

In actual fact, binge drinking is drinking twice the amount of alcohol recommended in one day, or more than 8 units in one session.

Men: More than 4 units in one day e.g. 1 pint of beer.

Women: Drinking more than 3 units in a single day e.g. 1 large glass of wine.

Drinking heavily over a short period leads to a rapid rise in blood alcohol and consequently to drunkenness. The effect varies from person to person. It ranges from relaxation, to violence, to recklessness, to being accident prone.

High blood alcohol levels can cause your brains control over the respiratory system to paralyse, leading to heart irregularities, strokes and other fatal occurrences.

Can my liver recover?

Possibly - this will depend on how badly your liver has been damaged and also your general health.

If the alcohol related liver disease is so severe that you need to be admitted, then you have a 1 in 3 chance of dying in the first month after admission.

Symptoms of alcohol related liver damage

The liver is tough. It can withstand years of damage by repairing itself and protecting the rest of your body. It only signals any distress at the end stages of liver disease, by which time the damage is done.

You may experience vague symptoms for example:

• Pain in the liver (the lower area of your ribs on the right side)
• General feeling of ill health and fatigue
• Loss of appetite
• Sickness or nausea especially in the mornings, often accompanied by diarrhoea

Red flag symptoms

If you have any of the following problems you need to contact your doctor immediately:

• Yellow eyes or skin (Jaundice)
• Vomiting blood (Haematemesis)
• Dark black, tarry stools (Melaena)
• Confusion or memory loss (Hepatic encephalopathy)
• Swelling of the abdomen and legs
• Fever – with possibly shivering attacks
• Itching (Pruritus)

Tests for alcohol related liver damage

• Blood tests to measure your liver function and damage (LFT)
• Scanning your liver either by ultrasound, CT or MRI scans
• A liver biopsy
• Endoscopy, in which a thin tube containing a tiny camera is passed down your gullet into the stomach. This is to look for any veins in the oesophagus or stomach that may rupture and bleed spontaneously

Treatment

Stop drinking!

For most people with fatty liver or alcoholic hepatitis, the liver will recover and heal itself if you stop drinking.

If you have alcohol related liver damage, cutting down will only reduce the rate of damage. The symptoms may disappear but this does not mean that damage is not still taking place.

Cirrhosis can develop even after drinking just a little too much over the years, there may never have been any warning signs. Cirrhosis cannot be reversed but there are treatments available that will alleviate the symptoms.

Stopping alcohol may increase survival chances.

Diet

Drinking alcohol can lead to malnutrition, so eating well is important in helping your liver to recover.

If you have alcohol related liver disease, it is likely that you lack vitamins, especially thiamine and vitamin B12. Your doctor may have to prescribe vitamin supplements. If you are unsure what constitutes a good diet ask for a referral to a dietician. Reduce your salt intake.

Steroids

Steroids may be used to control the inflammation of your liver and can improve the chances of survival from 60 to 70%, to between 90 and 95% if you are free from infection and have no internal bleeding from your gut. In some cases, the body does not react positively to this treatment, it will be withdrawn after 7 days. A positive reaction will result in reducing steroid treatment over several weeks.

Liver transplant

For some, this may be the only option. Alcohol related cirrhosis is the most common reason that people in the UK need a transplant. Only patients whose liver fails to improve after a period of 6 months alcohol free will be considered.

Gastroenterology Nurse Specialist
The Royal Oldham Hospital: 0161 656 1538
 

Who else can help?

Alcoholics Anonymous Telephone: 01904 0644026
General Service office Helpline: 0845 07697555
PO Box 1
19 Toft Gree York, YO1 7NJ

Drinkline (The National Alcohol Helpline)

Freephone: 0800 917 8282 Mon to Friday 9.00am to 11pm

Addiction Dependency Solutions

135 – 141 Oldham Street Manchester
M4 1LN
www.ADSolutions.org.uk

British Liver Trust

Freephone: 0800 652 7330
Email: info@britishlivertrust.org.uk Web: www.britishlivertrust.org.uk