The types of changes that can occur in alcoholic liver disease are summarised below. These can occur in combination with each other or may progress from one to the other. These changes are;
1. Fatty Liver
Part or all of the liver may be affected. Liver cells accumulate fat as a result of alcohol intake being high. Usually, fatty liver is reversible and soon resolves if individuals stop drinking alcohol. There are usually no symptoms and most people will be unaware of any changes unless they undergo a routine inspection of their liver, usually for other reasons, with for example, an ultrasound scan. Liver function tests (LFT) which test for liver enzymes by taking a blood sample, are usually normal, suggesting that no damage of liver cells has taken place.
If however, alcohol abuse continues, there is a higher risk of progression of liver changes from fatty liver to the more serious stage of alcoholic hepatitis.
2. Alcoholic Hepatitis
Hepatitis means “inflammation of the liver”. LFT’s can be abnormal with elevated liver enzymes. The higher these levels, the more damage has taken place. This therefore represents a more serious stage than simple fatty change. The degree of inflammation can vary from mild to severe.
Mild hepatitis: this may cause no symptoms and may simply be diagnosed by a routine blood test, perhaps taken for other reasons. Liver damage may be reversible at this stage providing alcohol consumption is stopped. However, in some people, the hepatitis becomes chronic (longer standing), if alcohol intake continues unabated. These people risk development of liver cirrhosis.
Moderate hepatitis: this occurs as liver enzymes levels continue to climb as more liver damage occurs. Patients often have symptoms at this stage with complaints such as nausea, lethargy, a feeling of being unwell, upper abdominal discomfort and jaundice. This is when individuals develop a yellowish skin and eye colour due to raised levels of bilirubin.
Severe hepatitis: this is a serious condition causing several worrying symptoms and may result in death. Symptoms are caused by liver failure. Patients may become deeply jaundiced, have bleeding from almost any site such as gums, wounds, rectum or vagina, may be confused, fall into a coma and sometimes this condition may be fatal. Rapid assessment is required in hospital. The only solution for many may be a liver transplant if other treatments don’t work.
3. Alcoholic Cirrhosis
Cirrhosis means “scarring of the liver”. Normal liver cells are replaced with scar tissue and nodules by a process called fibrosis. Although this process occurs gradually, it is a serious condition as liver cells die. The scarring of the liver affects the normal structure of the liver, its function and its ability to regrow and regenerate. Slowly, the liver starts to fail and its ability to carry out its several hundred functions wanes until eventually, other body organs and systems begin to succumb to the build up of toxins that the liver can no longer process. The scar tissue also affects the normal blood flow through the liver. This creates a back pressure effect on the hepatic portal vein. In turn, this can cause other serious complications such as severe and sometimes fatal bleeding from varicose veins (varices) which develop in the foodpipe (oesophagus).
Cirrhosis may occur for many other reasons. These are summarised on the page entitled “Cirrhosis of the Liver”. Cirrhosis is not reversible. Once scarring has taken place, those liver cells which die and are replaced by fibrous scar tissue cannot regenerate. But, the advancement of scar tissue formation may be slowed or even halted if alcohol intake is stopped.