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Alcohol-Related Liver Disease: Symptoms, Treatment and More

Central to hepatitis development is the activation of KCs, the resident liver macrophages. Drinking history is an essential component, which includes the number of drinks per day and the duration of drinking. Given the lack of a unique diagnostic test, the exclusion of other causes of liver injury is mandatory.

In general, the risk of liver disease increases with the quantity and duration of alcohol intake. The quantity of alcohol in alcoholic beverages varies by volume base on the type of beverage (Table 2). Drinking cessation is considered the most effective therapy in patients with ALD. Abstinence from alcohol not only resolves alcoholic steatosis but also improves survival in cirrhotic patients (Sofair et al. 2010). The education component also concerns the need to convince the patient to follow a screening program (to detect hepatocellular carcinoma) in case of severe liver damage.

What are the different types of alcohol-related liver disease?

Alcoholic liver disease is treatable if it is caught before it causes severe damage. However, continued excessive drinking can shorten your lifespan. Alcoholic liver disease is damage to the liver and its function due to alcohol abuse. In addition to our comprehensive treatment options, we also do research on the next generation of treatments. You can be confident your personalized care plan will include the most advanced and innovative options available. If you have complications due to NASH, such as cirrhosis or liver failure, you may need to have a liver transplant.

Scoring systems can be used to assess the severity of alcoholic hepatitis and to guide treatment. A Maddrey discriminant function (DF) score greater than 32 or a model for end-stage liver disease (MELD) score greater than 21 indicates severe alcoholic hepatitis and pharmacologic treatment should be considered. Hepatic encephalopathy and ascites are seen more often in patients who succumb to alcoholic hepatitis than in patients who survive. Long-term survival in patients with alcoholic hepatitis who discontinue alcohol use is significantly longer than in patients who continue to drink. Three-year survival approaches 90% in abstainers, whereas it is less than 70% in active drinkers.

Alcohol Related Liver Disease

Several histopathologic studies have shown that as many as 50% of patients with alcoholic liver disease have increased hepatic iron content compared with healthy controls. This excess deposition of iron may play a significant role in the progression of the alcoholic liver damage. Portosystemic shunts, especially the side-to-side variety, enormously increase the deposition of iron in the liver. Occasionally, this excessive iron deposition leads to a clinical and pathologic entity that is analogous to primary hemochromatosis.

Alcohol dehydrogenase and acetaldehyde dehydrogenase cause the reduction of nicotinamide adenine dinucleotide (NAD) to NADH (reduced form of NAD). The altered ratio of NAD/NADH promotes fatty liver through the inhibition of gluconeogenesis and fatty acid oxidation. CYP 2E1, which is upregulated in chronic alcohol use, generates free radicals through the oxidation of nicotinamide adenine dinucleotide phosphate (NADPH) to NADP.


Once the alcoholic liver disease progresses, its symptoms become easier to recognize. If a person continues to drink alcohol it will lead to ongoing liver inflammation. The early signs of alcoholic liver disease are vague and affect a range of systems in the body. Patients with DF ≥ 32 or MELD score ≥ 21 should be considered for clinical trial enrollment if available. If a clinical trial is not available, a trial of glucocorticoid treatment is reasonable. The Lille score is designed to determine whether patients treated with corticosteroids should stop treatment after 1 week of treatment due to lack of treatment response.

What are 4 warning signs of a damaged liver?

  • Jaundice or yellowing of the eyes or skin.
  • Pain and distention of the abdomen due to the release of fluid from the liver.
  • Swelling of the lower legs due to fluid retention.
  • Confusion or forgetfulness.
  • Dark-colored urine.
  • Pale-colored stool.

With alcohol abstinence, morphologic changes of the fatty liver usually revert to normal. Although the short-term prognosis in patients with alcoholic steatosis is excellent, with longer follow-up it has been found that cirrhosis develops more commonly in alcohol abusers with fatty liver changes than in those with normal liver histology. In contrast, patients with severe acute alcoholic hepatitis are at a high risk of early death, at a rate of 50% or greater within 30 days. Patients with severe alcoholic hepatitis may benefit over the short term from specific therapies directed toward reducing liver injury, enhancing hepatic regeneration, and suppressing inflammation.

Antirejection medications after transplant can increase the risk of serious infections and certain cancers. As the liver no longer processes toxins properly, a person will be more sensitive to medications and alcohol. Alcohol use speeds up the liver’s destruction, reducing the liver’s ability to compensate for the current damage. Abdominal paracentesis should be performed in all patients with newly identified ascites.

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Alcohol related 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. The overall 30-day mortality rate in patients hospitalized with alcoholic hepatitis is approximately 15%; however, in patients with severe liver disease, the rate approaches or exceeds 50%.

Risk factors for alcohol-related liver disease

In its severe, acute form the disease may occur suddenly – after binge drinking for instance – and can quickly lead to life-threatening complications. The classic histologic features of alcoholic hepatitis include inflammation and necrosis, which are most prominent in the centrilobular region of the hepatic acinus(Figure 2). Hepatocytes are classically ballooned, which causes compression of the sinusoid and reversible portal hypertension. The inflammatory cell infiltrate, located primarily in the sinusoids and close to necrotic hepatocytes, consists of polymorphonuclear cells and mononuclear cells. In addition to inflammation and necrosis, many patients with alcoholic hepatitis have fatty infiltration and Mallory bodies, which are intracellular perinuclear aggregations of intermediate filaments that are eosinophilic on hematoxylin-eosin staining. Neither fatty infiltration nor Mallory bodies are specific for alcoholic hepatitis or necessary for the diagnosis.

alcoholic liver disease

Activated HSCs also contribute to the inflammatory response by coordinating the recruitment and stimulation of white blood cells (WBCs) by releasing chemokines and proinflammatory cytokines, as well as expressing adhesion molecules. VLDL assembly is regulated by the availability of triglycerides (which make up more than 50 percent of the VLDL lipids) stored in cytoplasmic lipid droplets. Up to 70 percent of the triglycerides in VLDLs are derived from the pool of triglycerides stored in lipid droplets that first undergo lipolysis and then are re-esterified to constitute VLDL triglycerides. Ethanol (i.e., ethyl alcohol) is oxidized principally in hepatocytes of the liver. (Left panel) Peroxisomal catalase is a minor hepatic pathway of ethanol oxidation that uses hydrogen peroxide (H2O2) to oxidize ethanol to acetaldehyde and water.

The prevalence of alcoholic liver disease is highest in European countries. Daily consumption of 30 to 50 grams of alcohol for over five years can cause alcoholic liver disease. Steatosis can occur in 90% of patients who drink over 60 g/day, and cirrhosis occurs in 30% of individuals with long-standing consumption of more than 40 g/day. Prognosis is determined by the degree of hepatic fibrosis and inflammation.

What are the three stages of alcoholic liver disease?

Alcoholic liver disease is defined by three stages of liver damage following chronic heavy alcohol consumption: fatty liver, alcoholic hepatitis, and fibrosis/cirrhosis (Figure 5).