Alcoholic liver disease

[Sommer]

Alcoholic liver disease is liver damage caused by drinking too much alcohol for a long time.

In general, the amount of alcohol consumed (how much, how often, and for how long) determines the risk and severity of liver damage.
Symptoms range from none at first to fever, jaundice, fatigue, and a tender, painful, and enlarged liver, then to more serious problems such as bleeding in the digestive tract and deterioration of brain function.
To help identify whether drinking is a problem, doctors may give the person a questionnaire and ask family members how much the person drinks.
If people who have been drinking in excess have symptoms of liver disease, doctors do blood tests to evaluate the liver and occasionally do a liver biopsy.
The best treatment is to stop drinking alcohol, but doing so is very difficult and requires help, often in rehabilitation programs.

About 8.5% of adults in the United States are estimated to have alcohol use disorder in any given year. About twice as many men as women abuse alcohol. (See also Alcohol.)
Most alcohol, after being absorbed in the digestive tract, is processed (metabolized) in the liver. As alcohol is processed, substances that can damage the liver are produced. The more alcohol a person drinks, the greater the damage to the liver. When alcohol damages the liver, the liver can continue to function for a while because the liver can sometimes recover from mild damage. Also, the liver can function normally even when about 80% of it is damaged. However, if people continue to drink alcohol, liver damage progresses and may eventually result in death. If people stop drinking, some damage may be reversed. Such people are likely to live longer.
Abuse of alcohol may cause three types of liver damage, which often develop in the following order:

Accumulation of fat (fatty liver, or hepatic steatosis): This type is the least serious and can sometimes be reversed. It occurs in more than 90% of people who drink too much alcohol.
Inflammation (alcoholic hepatitis): The liver becomes inflamed in about 10 to 35% of people.
Cirrhosis: About 10 to 20% of people develop cirrhosis. In cirrhosis, a large amount of normal liver tissue is permanently replaced with scar tissue (called fibrosis), which performs no function. As a result, the internal structure of the liver is disrupted, and the liver can no longer function normally. Eventually, the liver usually shrinks. People may have a few symptoms or the same symptoms as those due to alcoholic hepatitis. Cirrhosis cannot be reversed.

Cirrhosis can cause the following serious complications:

Ascites: Fluid may accumulate in the abdomen, causing swelling.
Hepatic (portosystemic) encephalopathy: Brain function may deteriorate because the damaged liver is less able to remove toxic waste products from the blood. People may become drowsy and confused.
Portal hypertension: The vein that brings blood to the liver may be narrowed or blocked, increasing blood pressure in that vein. Portal hypertension causes or contributes to ascites, bleeding in the digestive tract, an enlarged spleen (splenomegaly), and sometimes portosystemic encephalopathy.
Bleeding in the digestive tract: Veins in the esophagus and stomach may enlarge and begin to bleed because of portal hypertension. People may vomit blood or have bloody or dark, tarry stools.
Liver failure: The liver becomes less and less able to function, resulting in many complications and generally failing health. Liver failure can eventually lead to kidney failure.
Coagulopathy: People tend to bleed and bruise more easily because the damaged liver does not produce enough of the substances that make blood clot (coagulate). Also, alcohol can reduce the number or activity of platelets, which also help blood clot. Portal hypertension leads to an enlarged spleen, which also decreases the number of platelets.
Splenomegaly: Portal hypertension causes the spleen to enlarge (a condition called splenomegaly). The enlarged spleen traps and destroys more white blood cells and platelets than it normally does. As a result, the risk of infections and bleeding is increased.