Alcoholic Liver Disease Overview

In the United States, alcoholic liver disease is the major cause of cirrhosis of the liver – a life-threatening disease.

Cirrhosis leads to liver cancer in approximately 10% of all cases. In 2000, cirrhosis was one of the leading causes of death in the United States.

Also referred to as Laennec’s cirrhosis, or alcoholic cirrhosis, alcoholic liver disease usually develops after years of excessive alcohol intake.

The longer the period during which alcohol is excessively consumed and the greater the amount ingested, the higher the likelihood of developing alcoholic liver disease.

Symptoms of Alcoholic Liver Disease

Symptoms are usually worse after an episode of heavy drinking, and tend to vary with the severity and progression of the disease.

Sometimes symptoms do not present themselves until the disease is relatively advanced.

  • Abdominal pain and tenderness
  • Ascites (fluid build up in the abdomen)
  • Confusion, disorientation and memory impairment
  • Dry mouth / excessive thirst
  • Fatigue
  • Gastrointestinal bleeding (red or black stool or vomiting blood)
  • Jaundice
  • Leg swelling
  • Loss of appetite
  • Weight gain due to fluid retention

Additional symptoms associated with the disease:

  • Abnormally dark or light skin
  • Agitation
  • Altered level of consciousness
  • Breast development in males
  • Difficulty concentrating
  • Hallucinations
  • Impaired judgment
  • Impotence
  • Infertility
  • Light-headedness or fainting
  • Rapid heart rate when rising to a standing position
  • Redness on soles of feet or palms of hands
  • Shrinkage of testicles
  • Slow, sluggish, lethargic movement

Alcoholic Liver Disease is Progressive

When you drink too much alcohol over time, your liver will get worse and worse over time through stages. 

1. Fatty Change

A progressive illness, alcoholic liver disease first appears as a fatty change in the liver. Also known as steatosis or fatty liver disease, this accumulation of fat in liver cells can be seen through a microscope as large, fatty globules.

In addition to alcoholism, these large globules can also be caused by diabetes, obesity, high cholesterol, and starvation.

Learn more about in this in-depth Fatty Live Disease Overview.

2. Alcoholic Hepatitis

Some people are more prone to alcoholic hepatitis than others. Alcoholic hepatitis is an inflammatory reaction to the fatty change in liver cells.

Health experts speculate that this inflammatory condition lays the groundwork for the development of fibrosis. In these cases, there has been recent alcohol ingestion and people often develop jaundice.  

3. Liver Fibrosis

While not normally accompanied by symptoms in the early stages, liver fibrosis can develop into cirrhosis as it progresses.

The fibrosis – also known as scar tissue – alters the very fabric of the liver to such an extent that liver functioning is seriously impaired.

4. Cirrhosis

Often referred to as end-stage liver disease, cirrhosis is characterized by replacement of liver tissue with fibrotic scar tissue and regenerative nodules, and permanent, irreversible damage to the liver.

Cirrhosis is a condition whereby the liver is so extensively damaged that it may no longer function, which can result in death. In its advanced stages, the only option for cirrhosis is liver transplantation.

Alcoholic Liver Disease Prognosis

While fatty change and alcoholic hepatitis are considered reversible, the later stages of fibrosis and cirrhosis tend to be irreversible, but can sometimes be managed for long periods of time without progression.  

Your doctor will monitor for signs of decompensation (like a bleeding event, episodes of confusion or disorientation, or development of fluid in the abdomen) and monitor blood work which can assess how well the liver is functioning.  

A MELD-Na score can be calculated and if high enough, may require referral to a liver transplant center for evaluation and monitoring.

Malnutrition contributes to liver disease and is therefore a serious concern. It can develop as a result of empty calorie intake from alcohol, reduced appetite, and inadequate absorption of nutrients. 

Life expectancy is reduced if alcohol consumption is continued.  Liver disease is more likely to progress with ongoing alcohol consumption.

Alcoholic Liver Disease Treatment

Discontinuing alcohol consumption is vital, as is the implementation of a high calorie, high protein diet.  If swelling or ascites are a problem, a low sodium diet (< 2g/day) is also important.

Improvement has been shown through the incorporation of a multivitamin containing both Thiamine (B1) and folic acid which are often deficient in the setting of chronic alcohol consumption.

Counseling and an alcohol rehabilitation program to combat addiction may also be necessary, as well as a health regimen to manage the complications that arise from chronic liver disease.

In case of fluid buildup, diuretics can be started which help reduce the fluid buildup by increasing the urine output. If confusion develops, medications can be used to help manage this.

If cirrhosis is diagnosed, an upper endoscopy is recommended to screen for esophageal varices (large veins in the esophagus) which can be treated during the endoscopy or with medication.

Regular monitoring with imaging and blood work is important to screen for hepatocellular carcinoma, a cancer that can develop in the liver in people with cirrhosis.  If caught early, there are many more treatment options than tumors diagnosed at a later stage.

If the complications of liver disease can no longer adequately be managed with medications, liver transplant is the next step.

This requires evaluation by a multidisciplinary team of liver doctors, surgeons, social workers, dieticians, and even cardiologists, pulmonologists or psychiatrists in some cases to determine if a transplant is medically feasible and appropriate.

Alcoholic Liver Disease Final Thoughts

Now that you have concerns about the health of your liver, and also understand its critical role in your overall health, it’s time to take some action.

One method to improve your liver function and begin your recovery from alcoholic liver disease is to quit drinking alcohol.  

Support services like Alcoholics Anonymous, friends, family, social workers and mental health professionals can all be helpful in maintaining an alcohol free life.

You might be interested in these other articles on the liver and alcohol:

Julie C. Guider MyGoodGut

Medically reviewed by Julie Guider, M.D.

Dr. Julie Guider earned her medical degree from Louisiana State University School of Medicine. She completed residency in internal medicine at the University of Virginia. She completed her general gastroenterology and advanced endoscopy fellowships at University of Texas-Houston. She is a member of several national GI societies including the AGA, ACG, and ASGE as well as state and local medical societies.