Alcoholic Liver Disease

Alcoholic liver disease (ALD) is the result of drinking more alcohol than the liver can process, which damages the organ. The liver, responsible for performing many functions in the body, processes what the body needs, discarding what it doesn’t. As the liver breaks down the alcohol, the chemical reaction releases a toxin, which damages liver cells. If too much alcohol is ingested repeatedly over time, even without getting drunk, liver damage begins. When too much liver damage occurs, it impacts the whole body. ALD is both preventable and can be fatal.

More than 21,000 people die annually in the United States from ALD. Nearly 70 percent of those deaths are men, yet women develop the disease after less exposure to alcohol than men.

Types of Alcoholic Liver Disease

  • Alcoholic fatty liver disease (also called steatosis): Fat accumulates inside liver cells, making it hard for the liver to work properly. This early stage of liver disease occurs fairly soon after repeated heavy drinking. Usually it is symptom free but upper abdominal pain on the right side from an enlarged liver may occur. Steatosis goes away with alcohol abstinence.
  • Alcoholic hepatitis: This condition is marked by inflammation, swelling and the killing of liver cells. This scars the liver, which is known as fibrosis. Symptoms may occur over time or suddenly after binge drinking. They include fever, jaundice, nausea, vomiting, abdominal pain and tenderness. Up to 35 percent of heavy drinkers develop alcoholic hepatitis, which can be mild or severe. If it is a mild case, stopping the drinking can reverse it.
  • Cirrhosis: The most serious form of ALD, it occurs when the entire liver is scarred, causing the liver to shrink and harden. This can lead to liver failure. Usually the damage cannot be reversed. Between 10 to 20 percent of heavy drinkers develop cirrhosis typically after 10 or more years of drinking.

Alcoholic hepatitis and alcoholic cirrhosis previously were called alcoholic steatohepatitis (ASH), a term that still arises among some circles.

Risk Factors for Alcoholic Liver Disease

Not everyone who drinks heavily develops ALD. While the amount of alcohol and the length of time as a heavy drinker are the key risk factors, additional forces impact the outcome. They are:

  • Obesity/Overweight: Carrying extra weight increases the risk of liver disease because fat builds up in the liver. The fat cells secrete acids which cause a reaction that destroys healthy cells in the liver, leading to scarring. Add alcohol to the mix and the combined effect adds additional liver damage.
  • Malnutrition: Often people who drink heavily, eat poorly. They also may have trouble absorbing nutrients because alcohol’s toxic byproducts make it difficult to break down food. The lack of nutrients contributes to liver cell damage.
  • Genetic component: How a body metabolizes alcohol is influenced by genetics. If certain enzymes are missing, that can affect the risk of developing ALD.
  • Demographic influencers: Rates of alcoholic cirrhosis are higher in African-American and Hispanic males than they are in Caucasian males. Women are more susceptible than men to the impact of alcohol because they become more impaired than men after drinking equal amounts.
  • Having viral hepatitis, especially hepatitis C: Adding alcohol to a liver already taxed by hepatitis increases the risk of developing liver disease, as well as liver cancer.

Symptoms of ALD

Early ALD may not have any symptoms at all, which is why it is important to take action if you are drinking heavily. By the time symptoms develop, ALD is usually very advanced. 

As the disease progresses, the symptoms include:

  • Jaundice (a yellow tint to the skin and the whites of the eyes)
  • Swelling of the lower limbs (edema)
  • Fluid buildup in the abdomen (ascites)
  • Itchy skin
  • Fever and shivering
  • Fingernails that curve excessively
  • Muscular weakness
  • Blood in vomit or stools
  • Bleeding and bruising more easily
  • More sensitive reactions to alcohol or drugs
  • High blood pressure in the liver (portal hypertension)
  • Bleeding from veins in the esophagus (esophageal varices)
  • Confusion and behavior changes
  • Enlarged spleen
  • Kidney failure

ALD Diagnosis

A hepatologist, a liver specialist, may suspect ALD after a physical examination and a conversation about a patient’s history of alcohol use. If further testing is needed, the doctor may order:

  • Blood test
  • Imaging tests: CT scan, MRI or ultrasound of the liver
  • Endoscopy: To look for abnormal veins in the esophagus, stomach, and intestines
  • Liver function test: Used to check for liver inflammation and liver damage.
  • Liver biopsy: This is most commonly done using a percutaneous approach, where the area is numbed and a needle is inserted into the liver to obtain a small piece of tissue for analysis.

ALD Treatment

Stop drinking alcohol: Abstinence is the most critical step to take following an ALD diagnosis. Even one drink is too many. Alcohol avoidance is the only way to possibly reverse the damage or prevent the disease from worsening. Those who find stopping alcohol use difficult should discuss treatment options with a doctor. Getting help improves long-term abstinence and because a rapid reduction of alcohol in the body can lead to dangerous withdrawal symptoms including hallucinations and seizures, for which medicine may be prescribed.

Nutrition and diet: Because nutritional deficiencies are common in patients with ALD, a special diet, vitamins and supplements may help. A nutritionist will educate patients on meal planning to combat malnutrition and help keep fluid buildup at bay through low-sodium suggestions. Similarly, a lifestyle change that includes eating right and losing weight may help decrease the toxic fat deposits in the liver.

Medications: A doctor may prescribe medicine depending on the severity of the ALD.  Viral treatment is not a common part of ALD treatment, though it may be needed if someone has comorbid viral liver disease.     

Liver transplantation: This surgery removes the diseased cirrhotic liver and replaces it with a healthy liver from a donor. Qualifying for one requires approval from a transplant center, as well as abstaining from alcohol both before and after surgery.

Other Information About Digestive and Liver Health

To see related medical services we offer, visit our Digestive and Liver Health overview page.

Make an Appointment

To make an appointment with the University of Michigan Hepatology Program, call 844-233-0433.