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Stages of Alcohol-Related Liver Disease
Stages of Alcohol-Related Liver Disease
Alcohol-related liver disease (ARLD) refers to liver damage caused by alcohol misuse. It
covers a range of conditions and associated symptoms.
ARLD does not usually cause any symptoms until the liver has been severely damaged.
When this happens, symptoms can include:
feeling sick
weight loss
loss of appetite
yellowing of the eyes and skin (jaundice)
swelling in the ankles and tummy
confusion or drowsiness
vomiting blood or passing blood in your stools
This means that alcohol-related liver disease is frequently diagnosed during tests for other
conditions.
If you consistently or intermittently drink alcohol to excess you should tell your GP so they
can check if your liver is damaged.
Alcohol and the liver
With the exception of the brain, the liver is the most complex organ in the body. It's functions
include:
filtering toxins from the blood
aiding digestion of food
regulating blood sugar and cholesterol levels
helping to fight infection and disease
The liver is very resilient and is capable of regenerating itself. Each time your liver filters
alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol
misuse over many years can reduce your liver’s ability to regenerate, resulting in serious
damage to the liver.
ARLD is widespread in the UK, and the number of people with the condition has been
increasing over the last few decades because of increasing levels of alcohol misuse.
Complications
Death rates linked to ARLD have risen considerably over the last few decades and alcohol is
now one of the most common causes of death in the UK, along with smokingand high blood
pressure.
Life-threatening complications of ARLD can develop. These include internal (variceal)
bleeding, a build-up of toxins in the brain (encephalopathy), fluid accumulation in the
abdomen (ascites) with associated kidney failure and also liver cancer.
As well as drinking excessive amounts of alcohol, there are other factors that can increase
your chances of developing ARLD, including:
being overweight or obese
being female (women appear to be more vulnerable than men to the harmful
effects of alcohol)
having a pre-existing liver condition, such as hepatitis C (a chronic viral
infection of the liver)
genetics - dependence on alcohol and problems processing alcohol often run in
families
Diagnosing alcohol-related liver disease
Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical
conditions show that the liver has been damaged.
This is because the condition causes few obvious symptoms in the early stages.
If a doctor suspects you may have ARLD, they will usually arrange a blood test to check how
well your liver is working. They may also ask you about your alcohol consumption.
It is important to be totally honest about how much and how often you drink alcohol. If you
say you drink less alcohol than you do or deny drinking any alcohol, you may be referred for
further unnecessary testing. This could lead to a delay in the treatment you need.
Blood tests
Blood tests used to assess the liver are known as liver function tests. They can detect
enzymes in your blood that are normally only present if your liver has been damaged.
Blood tests can also detect if you have low levels of certain substances, such as a protein
called serum albumin, which is made by the liver. Low levels of serum albumin suggest that
your liver is not functioning properly.
A blood test may also look for signs of abnormal blood clotting, which can indicate
significant liver damage.
Lab Tests Online has more information about liver function tests.
Further testing
If your symptoms or liver function test suggest that you may have an advanced form of
alcohol-related liver disease, either alcoholichepatitis or cirrhosis, you may need further tests
to assess the state of your liver. These are described below.
Imaging tests
An ultrasound scan, computerised tomography (CT) scan or a magnetic resonance imaging
(MRI) scan may also be carried. These scans can produce detailed images of your liver. Some
scans may also measure the stiffness of the liver, which is a good indication of whether your
liver is scarred.
Liver biopsy
During a liver biopsy, a fine needle is inserted into your body (usually between your ribs). A
small sample of liver cells is taken and sent to a laboratory to be examined under a
microscope. The biopsy is usually carried out under local anaesthetic, as a day case or with an
overnight stay in hospital.
Specialist doctors are able to examine the liver biopsy tissue under the microscope to
determine the degree of scarring in the liver and the cause of the damage.
Endoscopy
An endoscope is a thin, long, flexible tube with a light and a video camera at one end. During
an endoscopy, the instrument is passed down your oesophagus (the long tube that carries food
from the throat to the stomach) and into your stomach.
Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor
will be looking for swollen veins (varices), which are a sign of cirrhosis.
Preventing relapses
Once you have stopped drinking, you may need further treatment to help ensure you
don't start drinking again.
The first treatment usually offered is psychological therapy. This involves seeing a therapist
to talk about your feelings and thoughts and how these affect your behaviour and wellbeing.
If psychological therapy alone is ineffective, you may also need medication to help you
abstain from alcohol, such as acamprosate, naltrexone or disulfiram.
See treating alcohol misuse for more information about treatments offered.
Self-help groups
Many people with a dependence on alcohol find it useful to attend self-help groups to help
them stop drinking. One of the most well-known is Alcoholics Anonymous, but there
are many other groups that can help.
See alcohol support for more information about the help available.
Diet and nutrition
Malnutrition is common in people with ARLD, so it's important to eat a balanced diet to help
ensure you get all the nutrients you need.
Avoiding salty foods and not adding salt to foods you eat can help reduce your risk of
developing swelling in your legs, feet and abdomen (tummy) caused by a build-up of fluid.
See tips for a lower salt diet for more information.
The damage to your liver can also mean it is unable to store glycogen, a carbohydrate that
provides short-term energy. When this happens, the body uses its own muscle tissue to
provide energy between meals, which leads to muscle wasting and weakness. Therefore, you
may need extra energy and protein in your diet.
Healthy snacking between meals can top up your calories and protein. It may also be helpful
to eat three or four small meals a day, rather than one or two large meals.
Your GP can advise you on a suitable diet or, in some cases, refer you to a dietitian.
In the most serious cases of malnutrition, nutrients may need to be provided through a
feeding tube inserted through the nose and into the stomach.
Medication for symptoms
The use of medication to directly treat ARLD is controversial. Many experts have
argued there is limited evidence for its effectiveness.
For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific
treatment with corticosteroids or pentoxifylline medication may be used to reduce
inflammation of the liver in some people with this condition. Nutritional support (see above)
is also an important part of treatment in these cases.
Other medications that have been used to treat liver damage include anabolic steroids (a more
powerful type of steroid medication) and propylthiouracil (a type of medicine originally
designed to treat overactive thyroid glands), but there is a lack of good evidence these help
and they are no longer used for severe alcoholic hepatitis.
Liver transplants
In the most serious cases of alcohol-related liver disease, the liver loses its ability to function,
leading to liver failure. A liver transplant is currently the only way to cure irreversible liver
failure.
If you develop progressive liver failure despite abstinence from alcohol, you are otherwise
well enough to survive such an operation, and you commit to not drinking alcohol for the rest
of your life, liver transplantation can be considered.