Alcohol-related liver disease

Alcohol-related liver disease  Illnesses and conditions Stomach, liver and gastrointestinal tract Alcohol-related liver disease Alcohol-related liver disease About alcohol-related liver disease Symptoms of alcohol-related liver disease Causes of alcohol-related liver disease Diagnosing alcohol-related liver disease Treating alcohol-related liver disease Complications of alcohol-related liver disease About alcohol-related liver disease Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms. ARLDdoesnt 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 anklesand tummy confusionor drowsiness vomiting blood or passing blood in your stools This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage. If youregularly drink alcohol to excess, tell your GP so they can check if your liver is damaged. Read more about: symptoms of ARLD diagnosing ARLD Alcohol and the liver With the exception of the brain, the liver is the most complex organ in the body.Its functions include: filtering toxins from the blood aiding digestion of food regulating blood sugar and cholesterol levels helping fight infection and disease The liver is very resilient and 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 (drinking too much)over many years can reduce its ability to regenerate. This canresult in serious andpermanent damage to your liver. ARLD isvery common in the UKthe number of people with the condition has been increasing over the last few decadesas a result ofincreasing levels of alcohol misuse. Read more about the causes of ARLD . Stages of ARLD There are 3main stages ofARLD, although theres often an overlap between each stage.These stages are explained below. Alcoholic fatty liver disease Drinking a large amountof alcohol, even for just a few days, can lead to a build-up of fats in the liver. This iscalled alcoholic fatty liver disease, and is the first stage of ARLD. Fatty liver disease rarely causes any symptoms, but its an important warning sign that youre drinking at a harmful level. Fatty liver disease is reversible. If you stop drinking alcohol for 2weeks, your liver should return to normal. Alcoholic hepatitis Alcoholichepatitis which is unrelated to infectious hepatitisis a potentially serious condition that can be caused by alcohol misuse over a longer period. When this develops, it may be the first time a person is aware theyre damaging their liver through alcohol. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking) . The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently. Severe alcoholic hepatitis, however, is a seriousand life-threatening illness. Many people die from the condition each year in the UK, and some people only find out they have liver damage when their condition reaches this stage. Cirrhosis Cirrhosis is a stage ofARLD where the liver has become significantly scarred.Even at this stage, there may not be any obvious symptoms. Its generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy. A person who hasalcohol-related cirrhosis and doesnt stop drinking has a less than 50% chance of living for at least 5more years. How ARLD is treated Theres currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk offurther damage to your liver andgivesit the best chance of recovering. Ifa person isdependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol support services . A liver transplant may be required in severe cases where the liver has stopped functioning and doesnt improve when you stop drinking alcohol. Youll only be considered for a liver transplant if youve developed complications of cirrhosis , despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest oftheir life. Read more about treating ARLD . Complications Death rates linked to ARLD haverisen considerably over the lastfew decades. Alcohol is now one of the most common causes of death in the UK, along with smoking and high blood pressure . Life-threatening complications of ARLD include: internal (variceal) bleeding build-up of toxins in the brain (encephalopathy) fluid accumulation in the abdomen (ascites) with associated kidney failure liver cancer Read more about the complications of ARLD . Preventing ARLD The most effective way to preventARLD is to stop drinking alcohol or stick to the low-risk drinking guidelines . Even if youve been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefitsfor your liver and overall health. Read our drinking and alcohol pages for more information and advice. Symptoms of alcohol-related liver disease In many cases, people with alcohol-related liver disease (ARLD) dont have any noticeable symptoms until their liver is badly damaged. Early symptoms If you do experience early symptoms of ARLD, theseare often quite vague, such as: abdominal pain loss of appetite fatigue feeling sick diarrhoea feeling generally unwell Advanced symptoms Asthe liver becomes more severely damaged, more obvious and serious symptoms can develop, such as: yellowing of the skin and whites of the eyes (jaundice) swelling in the legs, ankles and feet, due toa build-up of fluid (oedema) swelling in your abdomen, due toa build-up of fluid known as ascites a high temperature (fever)and shivering attacks very itchy skin hair loss unusually curved fingertips and nails (clubbed fingers) blotchy redpalms significant weight loss weakness and muscle wasting confusion and memory problems, trouble sleeping ( insomnia ) and changes in your personality due to a build-up of toxins in the brain vomiting blood and black, tarry stools due tointernal bleeding a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums increased sensitivity to alcohol and drugs (because the liver cant process them) When to seek medical advice ARLDdoesnt often cause symptoms until its reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of these symptoms. Read about alcohol misuse (drinking too much) . Contact your GP for adviceif you have a history of regular alcohol misuse. A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4questions: Have you ever thought you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about your drinking? Have you ever drunk an eye-opener, which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves? If you answer yes to 1or more of the questions, you may have an alcohol problem and are advised to see your GP. See your GP as soon as possibleif you have symptoms of advanced ARLD. Read more about how ARLD is diagnosed . Causes of alcohol-related liver disease Alcohol-related liver disease (ARLD) is caused by drinking too much alcohol. The more you drink above the recommended limits, the higher your risk of developing ARLD. There are 2ways alcohol misuse (drinking too much)can cause ARLD. These are: drinking a large amount of alcohol in a short amount of time (binge drinking) can cause fatty liver disease and, less commonly, alcoholic hepatitis drinking more than the recommended limits of alcohol over many years can causehepatitis and cirrhosis , the more serious types of ARLD Evidence suggests people whoregularly drink more than the recommended maximum amounts are most at risk of developing ARLD. Read more about alcohol units and how to calculate them. Additional factors As well as drinking excessive amounts of alcohol, other factors can increase your chances of developing ARLD. Theseinclude: being overweight or obese being femalewomen appear to be more vulnerable than men to the harmful effects of alcohol having a pre-existing liver condition, such as hepatitis C geneticsalcohol dependence 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 a damaged liver. This is becausethe conditioncauses few obvious symptoms in the early stages. If a doctor suspects ARLD, theyll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption. Its important to be totally honest about how much and how often you drink alcohol to avoid 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. However, liver function tests can be normalat many stages of liver disease. 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. A low level of serum albumin suggests your liver isnt 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 on liver function tests . Further testing If your symptoms or liver function test suggest an advanced form of ARLD  eitheralcoholic hepatitis or cirrhosis  you may need further tests. Imaging tests Scans may be needed toproduce detailed images of your liver. This may include: an ultrasound scan a computerised tomography (CT) scan a magnetic resonance imaging (MRI) scan 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 ,afine 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. Thebiopsy is usually carried out under local anaesthetic , either as a day case or with an overnight stay in hospital. Specialist doctors will 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 long, thin, flexible tube with a light and a video camera at one end.During an endoscopy,the instrument ispassed 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. Treating alcohol-related liver disease Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle. Stopping drinkingalcohol Treatment forARLD involves stopping drinking alcohol. This is known as abstinence, which can be vital, depending on what stage the condition is at. If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least 2weeks. After this point, its usually safe to start drinking again if you stick to the NHS guidelines on alcohol consumption . If you have a more serious form of ARLD  alcoholic hepatitisor cirrhosis  life-long abstinence is recommended.This is because stopping drinking is the only way to prevent your liver damage getting worse and potentially stop you dying of liver disease. Stopping drinking isnt easy, especially as an estimated 70% of people with ARLD have an alcohol dependency problem. Nevertheless, if you have alcohol-related cirrhosis or alcoholic hepatitis and dont stop drinking, no medical or surgical treatment can prevent liver failure. Withdrawal symptoms If youre abstaining from alcohol, you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes 3to 7days from the time of your last drink. Many people initially experiencedisturbed sleep when abstaining from alcohol, butin most cases their sleep pattern returns to normal within a month. In some cases,you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offereda medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process. Some peopleneed to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases, sotheirprogress can be closely monitored. If yourestaying at home, youll regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service. Preventing relapses Once youve stoppeddrinking, you mayneed furthertreatment to help ensure you dontstart drinking again. The first treatment usually offeredis psychological therapy. This involvesseeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour and wellbeing. If psychological therapy alone isnt effective, you may also need medication to help you abstain from alcohol, such as: acamprosate naltrexone disulfiram Read our page on treating alcohol misuse formore information on the treatments offered. Self-help groups Many people with alcohol dependence find it useful to attend self-help groups to help them stop drinking. One of the most well-known is Alcoholics Anonymous , but there aremany other groups that can help. Read the alcohol support page for more information about the help available. Diet and nutrition Malnutrition is common in people with ARLD, so its 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 reduce your risk of developing swelling in your legs, feet and abdomen (tummy) caused by a build-up of fluid. The damage to your liver can also mean its unable to store glycogen  acarbohydrate 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 3or 4small meals a day, rather than 1or 2large 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 tubeinserted through the nose and into the stomach. Medicationforsymptoms The use of medication to directlytreatARLD is controversial. Many experts have arguedtheres limited evidence for its effectiveness. For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment withcorticosteroidsor pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition. Nutritional support 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) ropylthiouracil (a type of medicine originally designed to treat overactive thyroid glands ) However, theres a lack of good evidence that these help and theyre no longer used for severe alcoholic hepatitis. Liver transplants In the most serious cases of ARLD, the liver loses its ability to function, leading toliver failure. A liver transplant is currently the only way to cure irreversible liver failure. A liver transplant may be considered if: you develop progressive liver failure, despite not drinking alcohol youre otherwise well enough to survive such an operation you commit to not drinking alcohol for the rest of your life Complications of alcohol-related liver disease A number of serious complications can develop if you have alcohol-related liver disease (ARLD). Portal hypertension and varices Portal hypertension is a common complication of cirrhosis and, less commonly, alcoholic hepatitis.It occurs whenthe blood pressure inside your liver has risen to a potentially serious level. When the liver becomes severely scarred, its harder for blood to move through it. This leads to an increase in the pressure of blood around the intestines. The blood must also find a new way to return to your heart. It does this by opening up new blood vessels, usually along the lining of your stomach or oesophagus (the long tube that carries food from the throat to the stomach). These new blood vessels are known as varices. If the blood pressure rises to a certain level, it can become too high for the varices to cope with, causing thewallsof the varicesto split and bleed. This can cause long-term bleeding, which can lead to anaemia . Alternatively, the bleeding can be rapid and massive, causing you to vomit blood and pass stools that are very dark or tar-like. Split varices can be treated by using anendoscope to locate the varices. A tiny band can then be used to seal the base of the varices. Ascites A person with portal hypertension may also develop a build-up of fluid in their abdomen (tummy) and aroundthe intestines. This fluid is known as ascites. Initially, this can be treated with water tablets (diuretics). If the problem progresses, many litres of fluid can build up, which needs to be drained. This is a procedure known as paracentesis and involves a long, thin tube being placed into the fluid through the skin under local anaesthetic . One of the problems associated with the development of ascites is the risk of infection in the fluid (spontaneous bacterial peritonitis). This is a potentially very serious complication and is linked to an increased risk of kidney failure and death. Hepatic encephalopathy One of the most important functions of the liver is to remove toxins from your blood. Ifthe liver is unable to do this due to hepatitis or cirrhosis, the levels of toxins in theblood increase. A high level of toxins in the blood due to liver damage is known as hepatic encephalopathy. Symptoms of hepatic encephalopathy include: agitation confusion disorientation muscle stiffness muscle tremors difficulty speaking in very serious cases, a coma Hepatic encephalopathymay require hospital admission. In hospital, body functions are supported and medication is used to remove toxins from the blood. Liver cancer Liver damage due to heavy drinking over many years can also increase your risk of developing liver cancer . Over the past few decades, rates of liver cancer in the UK have risen sharply due to increased levels of alcohol misuse . Its estimated that, every year, 3-5% of people with cirrhosis will develop liver cancer.