Liver damage from alcohol is progressive and goes through several stages. I am board certified in Internal Medicine and have been practicng medicine for the last eight years. As a physician working regularly in the ICU, I admit patients with advanced liver damage from alcohol on a regular basis. By the time they get to that stage, it is too late and there is very little we can do to save them. Most patients are unaware of the liver damage from alcohol at the early stages when we can actually help them. I will describe 4 distinct stages of liver damage from alcohol and hope the knowledge may encourage people to get help before they end up in the ICU.
- Alcoholic fatty liver
- Acute alcoholic hepatitis
- Chronic compensated alcoholic cirrhosis
- End stage cirrhosis and liver failure
Alcoholic fatty liver:
Alcoholic fatty liver is the mildest form of liver damage from alcohol. Most patients with alcoholic fatty liver do not have any specific symptoms of the disease. It is usually discovered incidentally when doing ultrasound of the liver for another unrelated reason. The ultrasound shows deposits of fat in the liver. The diagnosis of alcoholic fatty liver is important as it gives the patient a golden opportunity to easily reverse the liver damage from alcohol at an early stage. The only treatment is to stop drinking but the good news is that it is completely reversible in most patients
Acute alcoholic hepatitis:
Acute alcoholic hepatitis is a short-term complication of liver damage from alcohol and may result from excessive drinking over a short period of time.The severity of acute alcoholic hepatitis may range from a mild abdominal discomfort to severe life threatening liver failure. Most patients have some abdominal pain and low-grade fever. Patents with more severe form of the disease have jaundice or yellow discoloration of their skin and eyes.The most severe form of the disease affects the brain and causes confusion and disorientation. A few patients with severe liver damage develop liver failure and may die from it. But most patients recover from acute alcoholic hepatitis and those who stop drinking usually have a good long-term prognosis.
Chronic compensated alcoholic cirrhosis:
Chronic compensated alcoholic cirrhosis is the result of long-term liver damage from alcohol. These patients usually have years of heavy drinking before any symptoms appear. The onset of symptoms is very slow and is mostly diagnosed at a very advanced stage. Anytime someone drinks too much alcohol, there is some damage to the liver cells. Alcohol is directly toxic to the liver. Liver cells are usually very resilient and repair themselves after the alcohol is gone. With repeated insults without enough time to repair, the repairs become less than perfect and leave behind small scars. These small scars accumulate over many years and the liver becomes scarred and fibrous. This is how cirrhosis develops in alcoholics. Patients develop back flow of fluid into their abdomen and it can swell up and resemble the belly of a pregnant woman. The veins in the chest and abdomen become prominent and pop up everywhere. Toxins build up in blood and impair brain functions. The patients have impaired memory, judgement and thinking. At this stage, the liver damage may still be reversible in some patients if they give up drinking completely. If they continue to drink, they will almost certainly die from liver failure within a few years or even a few months in some cases.
End stage cirrhosis and liver failure:
End stage cirrhosis and liver failure develop when there is further liver damage from alcohol in patients with chronic compensated alcoholic cirrhosis. The toxins in the blood continue to accumulate and patients may lose all ability to think and behave in a normal way and seem totally crazy. The popped up veins in the food pipe may burst and they may bleed to death by vomiting large amounts of blood. They may develop life threatening infections because of impaired immune system. Treatment at this stage is very difficult and only serves to prolong the life by at most a few months in most patients. You can read more about cirrhosis on the national digestive disease information clearinghouse.
In conclusion, the only sure way to protect someone against liver damage from alcohol is to intervene when the disease is still in the early stage. You can help them by sharing this knowledge. They may stop drinking if they know exactly what will happen as the disease progresses.
