Alcoholic Liver Disease

What is Alcoholic Liver Disease (ALD)?

Harmful use of alcohol is associated with approximately 3.3 million deaths every year and 5.9% of all deaths worldwide (7.6% in men, 4.0% in women), which includes approximately 139 million disability-adjusted life years. Alcohol accounts for 5.1% of the global burden of disease and injury. ALD spans a spectrum including alcohol associated fatty liver disease, alcohol related steatohepatitis, alcoholic hepatitis and alcohol related liver fibrosis and cirrhosis.

SYMPTOMS

Symptoms of ALD can arise from a range of conditions. Some of these conditions are alcohol withdrawal, acute alcoholic hepatitis or advanced liver disease or cirrhosis.

Symptoms of alcohol withdrawal (AWS) may include:

  • Increased blood pressure and pulse rate
  • Tremors
  • Hyperreflexia
  • Irritability
  • Anxiety
  • Headache
  • Nausea and vomiting

Symptoms may progress to more severe forms of AWS

  • Characterised by delirium tremens, seizures, coma, cardiac arrest, and death


Symptoms associated with alcoholic hepatitis or advanced liver disease may include:

  • Jaundice
  • Confusion or encephalopathy
  • Vomiting blood or black stool
  • Abdominal distension due to water retention or ascites
  • Weight loss or cachexia
WHEN to See a Doctor

Excessive drinking is associated with an increased risk of serious health conditions such as:

  • Cancers, including liver, mouth, throat, oesophagus and breast cancer
  • Acute and Chronic Pancreatitis
  • Cardiovascular disease including alcoholic cardiomyopathy
  • Stroke
  • Hypertension
  • Liver disease
  • Mental health problems
  • Accidental physical injury
  • Adverse outcomes to the unborn child (alcohol foetal syndrome)
  • Alcohol withdrawal syndrome
CAUSES

Chronic use of alcohol is a risk factor for progressive liver disease and cirrhosis.

Current recommendations for alcohol intake are no more than  

  • 2 standard drinks a day for men,  
  • 1 standard drink a day for women.

A standard alcoholic drink is defined as  

  • 1 can (330ml) of regular beer (2 units),  
  • 1/2 a glass (175ml) of wine (2 units) 
  • 1 shot (35ml) of spirit (1.5units).
RISK FACTORS

ALD is associated with a problematic pattern of alcohol use and alcohol dependence. Patients with

ALD cirrhosis may also have other risks factors associated with liver disease progressions such as type II diabetes,  metabolic syndrome, hepatitis B and hepatitis C.

DIAGNOSIS

GPs are to screen individuals that are considered harmful drinkers. High-risk patients admitted to emergency facilities should also be screened for ALD.

Suggested screening methods include:

  • Screening questionnaires
  • Blood tests
  • Ultrasound of the liver
  • Fibroscan (Transient elastography)
TREATMENT

Early recognition and intervention are required. The goal of abstinence or decreased alcohol consumption should be implemented to reduce the risk of liver disease in harmful drinkers. Limit daily intake to ≤2 standard drinks for women and ≤3 for men. This amount is not associated with a significant increase in cirrhosis mortality. After screening, the patient must have an intervention plan with a multidisciplinary team. Specialist alcohol care teams are required to care for patients. Cessation of drinking at any point reduces the risk of disease progression and occurrence of complications.