Stages of the disease
When alcohol is processed in the liver, toxic acetaldehyde is formed, fat metabolism is disrupted and oxidative stress occurs. Liver cells accumulate fat, become damaged and die, and in their place connective tissue gradually forms.
- Alcoholic steatosis (fatty liver) - almost everyone who regularly abuses alcohol has it; reversible
- Alcoholic hepatitis is an inflammation that can be severe with jaundice and fever
- Fibrosis - formation of scar tissue
- Cirrhosis - restructuring of the liver structure, disruption of its functions and blood flow
- Hepatocellular cancer - increased risk in the setting of cirrhosis
Risk factors
There is no safe dose of alcohol for the liver, but the risk of the disease increases sharply with daily consumption of large doses over many years. It is not the type of drink that matters, but the amount of pure ethanol. Women are more sensitive to the damaging effects of alcohol.
- Long-term regular use of alcohol
- Female gender
- Obesity and diabetes
- Viral hepatitis B and C
- Smoking
- Genetic predisposition
Symptoms
At the stage of steatosis, there are usually no complaints or there is only heaviness in the right hypochondrium. Alcoholic hepatitis can manifest suddenly - jaundice, fever, abdominal pain, severe weakness. With cirrhosis, signs of liver dysfunction and portal hypertension appear.
- Weakness, loss of appetite, weight loss
- Heaviness and pain in the right hypochondrium
- Jaundice
- Spider veins on the skin, redness of the palms
- Enlarged abdomen (ascites), swelling of the legs
- Bleeding, bruising
- Sleep disturbances, forgetfulness, confusion
Diagnostics
Diagnosis is based on history of alcohol consumption, physical examination, and test results. Characterized by an increase in AST more than ALT, and an increase in GGT. The doctor must rule out other causes of liver damage, including viral hepatitis. The degree of fibrosis is assessed using elastography. In case of cirrhosis, gastroscopy is performed to look for varicose veins of the esophagus and regular ultrasound for early detection of the tumor.
- ALT, AST, GGT, bilirubin, albumin, INR
- Complete blood count (platelets, mean erythrocyte volume)
- Markers of hepatitis B and C
- Ultrasound of the liver
- Liver elastography
- Gastroscopy for suspected cirrhosis
Treatment
The main and irreplaceable treatment is complete abstinence from alcohol. No hepatoprotectors or “cleansing” protect the liver with continued use. To overcome addiction, the help of a narcologist and psychotherapist is useful, and, if necessary, medications that reduce cravings for alcohol. A nutritious diet with sufficient protein is important, as these patients often have nutritional and vitamin deficiencies. Severe alcoholic hepatitis is treated in a hospital. Complications of cirrhosis require special treatment, and in the terminal stage, liver transplantation is considered after confirmed cessation of alcohol.
- Quit alcohol completely
- Do not suddenly stop using in case of severe addiction without a doctor - a dangerous withdrawal syndrome is possible
- A nutritious diet with sufficient protein
- Vaccinations against hepatitis A and B
- Regular monitoring by a gastroenterologist