Acute Pancreatitis
October 23, 2017
Autoimmune Hepatitis
October 23, 2017
Show all

Alcohol and Liver Disease

 

Functions of the liver
The liver is in the upper right part of the tummy (abdomen). It performs various functions:

  1. It makes proteins that are essential for blood to clot(clotting factors).
  2. It helps to process fats and proteins from digested food.
  3. It stores glycogen, a chemical made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.
  4. It makes bile which passes from the liver to the gut and helps to digest fats.
  5. It helps to remove or process alcohol, poisons and toxins from the body.
  6. It processes many medicines which one may take.

Results of alcohol consumption
When alcohol is consumed, it is absorbed into the bloodstream from the stomach and intestines. All blood from the stomach and intestines first goes through the liver before circulating around the whole body. So, the highest concentration of alcohol happens in the blood flowing through the liver.

Liver cells contain chemicals (enzymes) which process or metabolise alcohol. The enzymes help in breaking down alcohol into other chemicals and these chemicals then break down into water and carbon dioxide. These are then passed out in the urine and from the lungs.

Only a certain amount of alcohol can be processed by the liver cells per hour. So, if one drinks alcohol faster than one’s liver can deal with it, then the level of alcohol in one’s bloodstream rises.

Problems of over-drinking
One’s liver and body are actually compatible with drinking a small amount of alcohol. Indeed, drinking a small amount of alcohol (1-2 units per day) may help to prevent heart disease and stroke.

Drinking over the recommended limits (detailed below) however can be harmful. If one drinks heavily one has an increased risk of developing:

  1. Severe inflammation of the pancreas (pancreatitis).
  2. Serious liver problems (alcoholic liver disease).
  3. Mental health problems, including depression and anxiety.
  4. Some stomach disorders.
  5. Sexual difficulties such as impotence.
  6. Damage to nervous tissue.
  7. Muscle and heart muscle disease.
  8. Accidents – drinking alcohol is associated with a much increased risk of accidents. In particular, injury and death from fire and car crashes. About 1 in 7 road deaths are caused by drinking alcohol.
  9. High blood pressure.
  10. Damage to an unborn baby in pregnant women.
  11. Some cancers (mouth, gullet, liver, colon and breast).
  12. Obesity (alcohol has many calories).
  13. Alcohol dependence (addiction).

Deaths due to alcohol-related diseases (particularly liver disease) have risen considerably over the last 20 years.

Understanding alcoholic liver disease
Too much alcohol consumption can lead to three types of liver conditions – fatty liver, hepatitis and liver ‘scarring’ (cirrhosis). One, or all, of these conditions can occur at the same time in the same person.

Fatty liver
Most people who drink heavily, regularly drink are prone to building up of fat occurring within liver cells. In itself, fatty liver is not usually serious and does not cause symptoms. Fatty liver will usually reverse if heavy drinking is stopped. The fatty liver however progresses and develops into hepatitis in some people.

 

Alcoholic hepatitis
Inflammation of the liver is known as hepatitis. The forms of inflammation may range from mild to severe.

No symptoms may be caused by mild hepatitis. The only indication of inflammation may be an abnormal level of liver chemicals (enzymes) in the blood, which can be detected by a blood test. In some cases however the hepatitis becomes persistent (chronic), which can gradually damage the liver and eventually cause cirrhosis.

A more severe hepatitis generally causes symptoms such as:

  1. Yellowing of the skin and the whites of the eyes (jaundice), caused by a high level of bilirubin – a chemical normally metabolised in the liver.
  2. Genera feeling of being unwell.
  3. Feeling of pain over the liver at times.
  4. Feeling sick (nausea).

A quick liver failure may be caused by a severe bout of alcoholic hepatitis. Lever failure may lead to deep jaundice, blood clotting problems, confusion, coma and bleeding into the guts. It often causes death.

Providing adequate nutrition which may involve passing liquid feeds through a tube in the stomach and steroids, is the main treatment for alcoholic hepatitis.

Cirrhosis caused by alcoholism
A condition where normal liver tissue is replaced by scar tissue or fibrosis is termed as cirrhosis. The scarring generally is a gradual process. The normal structure and re-growth of liver cells is affected by scar tissue. Liver cells become damaged and die as scar tissue gradually develops. So, the liver gradually loses its ability to function well. The blood flow through the liver is also affected by scar tissue. This can cause back pressure in the blood vessels which bring blood to the liver.

About 1 in 10 heavy drinkers will eventually develop cirrhosis. It tends to occur after 10 or more years of heavy drinking.

It is important to note that cirrhosis can develop in people who have never had alcoholic hepatitis.

There can be many causes for cirrhosis other than alcohol – for example, persistent viral hepatitis and some hereditary and metabolic diseases. If one has another persistent liver disease and drinks heavily, one is likely to increase one’s risk of developing cirrhosis.

Cirrhosis can lead to end-stage liver disease. However, in the early stages of the condition, often there are no symptoms. One can get by with a reduced number of working liver cells. But, as more and more liver cells die and more and more scar tissue builds up, symptoms start to appear. The eventual symptoms and complications are similar to a severe episode of hepatitis (listed above). However, unlike a bout of severe hepatitis, the symptoms and complications tend to develop slowly.

Reasons why some people are more prone for their liver cells to be damaged by alcohol and to develop hepatitis and/or cirrhosis, are still obscure. But, as a rule, the heavier you drink and the more regularly that you drink, the more your risk of developing hepatitis and/or cirrhosis.

The scarring and damage of cirrhosis is usually permanent and cannot be reversed. However, recent research have brought to light a greater understanding of cirrhosis. Studies suggest that it may be possible to develop medicines in the future which can reverse the scarring process of cirrhosis.

Diagnosis of liver disease caused by alcohol
A doctor may suspect that one has liver problems from one’s symptoms and from a physical examination. For example, they may detect that one’s liver is enlarged, or that one is retaining fluid. They may especially guess liver problems as a cause of one’s symptoms if one has a history of being a heavy alcohol drinker.
Some investigations may be done towards the same:

  1. An Ulatrsound scan usuall able to detect liver damage
  2. Blood tests (LFT) may prove liver damage
  3. To confirm the diagnosis, a small sample (biopsy) of the liver may be taken to be looked at under the microscope.

The biopsy sample may reflect ‘scarring’ of the liver caused by liver damage (cirrhosis), or the typical features of liver cells with alcoholic hepatitis .

Cure for liver disease caused by alcohol
For all types of liver disease caused by alcohol, one must stop alcohol completely. One may be also be referred to a dietician to review one’s diet. This is because many people who drink heavily do not eat properly and need advice on getting back into eating a healthy diet. Besides, vitamin supplements may be prescribed for a while. Over and above-

  1. If one has fatty liver, or alcoholic hepatitis which is not severe, one would fully recover from these conditions if one stops drinking alcohol.
  2. If one has severe hepatitis and requires hospital admission, one may require intensive care treatment. Some people with severe hepatitis die.
  3. If one has ‘scarring’ of the liver (cirrhosis), stopping drinking alcohol can improve one’s outlook. It depends on how severe the cirrhosis has become. If cirrhosis is diagnosed when it is not too advanced and one stops drinking alcohol, the cirrhosis is unlikely to progress. However, the cirrhosis and symptoms will usually get worse if one continues to drink alcohol.

In severe cases where the scarring is extensive and the liver can barely function, a liver transplant may be the only option.

Obviating alcoholic liver disease
One is very unlikely to develop liver problems caused by alcohol if one drinks within the recommended safe limits. That is:

Men should drink no more than 21 units of alcohol per week, no more than four units in any one dayand have at least two alcohol-free days a week.

Women should drink no more than 14 units of alcohol per week, no more than three units in any oneday and have at least two alcohol-free days a week.

Pregnant women. Advice is “pregnant women or womentrying to conceive should not drink alcohol at all. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk”

The latest studies guidelines suggest that a pregnant woman should not drink at all for the first three months of pregnancy. Then, she should drink no more than one or two standard units once or twice a week subsequently as a maximum amount. Drinking more than 7.5 units of alcohol on a single occasion may be harmful to the developing baby.

In general, the more one drinks above the safe limits, the more harmful alcohol is likely to be.

Here it is important to mark that, binge drinking can be harmful even though the weekly total may not seem too high.

For example, if one only drinks alcohol once or twice a week but when one does, one drinks 4-5 pints of beer each time, or a bottle of wine each time, this is a risk to one’s health.

One unit of alcohol is 10 ml (1 cl) by volume, or 8 g by weight, of pure alcohol. For example:
One unit of alcohol is about equal to:

Half a pint of ordinary strength beer or cider (3-4% alcohol by volume); or

A small pub measure (25 ml) of spirits (40% alcohol by volume); or

A standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume).There are one and a half units of alcohol in:

A small glass (125 ml) of ordinary strength wine (12% alcohol by volume); or A standard pub measure (35 ml) of spirits (40% alcohol by volume).

But one need to remember, many wines and beers are stronger than the more traditional ordinary strengths. A more accurate way of calculating units is as follows. The percentage alcohol by volume (%) of a drink equals the number of units in one litre of that drink. For example:

Strong beer at 6% alcohol by volume has six units in one litre. If one drinks half a litre (500 ml) – just under a pint – then one has had three units.

Wine at 14% has 14 units in one litre. If you drink a quarter of a litre (250 ml) – two small glasses – then one has had three and a half units.

Some other examples
Three pints of beer, three times per week, is at least 18-20 units per week. That is nearly the upper weekly safe limit for a man. However, each drinking session of three pints is at least six units, which is more than the safe limit advised for any one day.

Another example: a 750 ml bottle of 12% wine contains nine units. If you drink two bottles of 12% wine over a week, that is 18 units. This is above the upper safe limit for a woman.

However, one should not drink alcohol at all if:
1. One has already developed early ‘scarring’ of the liver (cirrhosis).
2. One has chronic hepatitis or certain other liver problems.
Doctor’s advice for each specific condition needs to be sought.

CONCLUSION
Consumption of too much alcohol can lead to three types of liver conditions – fatty liver, hepatitis and ‘scarring’ of the liver (cirrhosis). One is unlikely to develop these problems if one drinks within the recommended safe limits.