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What is liver disease?

As the liver is such as complex organ, performing over 500 functions, it is not suprising that liver function can be damaged in a number of ways, through viral infection - Acute viral hepatitis A and Chronic viral hepatitis B and C in particular, through illegal drug use, legal drug overuse especially paracetamol or acetaminophen. What many do not realise is that there are many types of cirrhosis including autoimmune, biliary, cryptogenic and post hepatic. There are also congenital liver diseases. The majority of liver cancer can be linked to cirrhosis of the liver. Many liver diseases eventually cause cirrhosis, most notably hepatitis B and C. 

There is no doubt that if you drink heavily you increase your risk, not only of alcoholic liver disease, but for many cancers and all cause mortality. If you combine heavy drinking with obesity, poor diet and a sedentary lifestyle, the risks increase further. The message, as ever, is to enjoy drinking in moderation, and if you believe you are drinking too heavily, cut back, and with care, your liver can recover

When is alcohol implicated?

 Scientists are not sure exactly why drinking too much alcohol can damage your liver but the reasons include:

  • Oxidative stress. When our liver tries to break down alcohol, the resulting chemical reaction can damage its cells. This damage can lead to inflammation and scarring as the liver tries to repair itself.
  • Toxins in gut bacteria. Alcohol can damage our intestine which lets toxins from our gut bacteria get into the liver. These toxins can also lead to inflammation and scarring.

Evidence suggests that other factors that increase your risk of developing liver disease include:

  • being dependent on alcohol – around seven in 10 of people with alcoholic liver disease have an alcohol dependency problem
  • being overweight – excess weight can exacerbate many of the mechanisms of liver damage caused by excessive drinking
  • genetics – certain genetic factors, including those affecting the liver’s handling of fat, influence the risk of a heavy drinker developing liver disease.

Eating well

A healthy meal before you start drinking or while you drink slows down the absorption of alcohol into the blood stream, helps to support your liver function and plays a crucial role in your health

Fatty Liver

Fatty liver is a condition in which too much fat builds up in the liver.The liver turns glucose into fat which it sends round the body to store for use when we need it. Alcohol affects the way the liver handles fat so your liver cells retain it. ">You are more at risk of this if you tend to put on weight around your middle. Fatty liver is also associated with high blood fat hyperlipidemia and diabetes irrespective of any alcohol use. You can get a fatty liver without drinking. This is called ‘non-alcoholic fatty liver disease’ (NAFLD).

There should be little or no fat in a healthy liver. Too much of this fat can build up if you drink more than the liver can cope with, leading to fatty liver disease. It is thought that if you are overweight and drinking too much, you increase the chances of damaging your liver more. Alcoholic Fatty livers should return to normal if you limit your  drinking to  within responsible drinking guidelines of 2 drinks for women and 3 for men. If you carry on drinking above that limit you are running the risk of more serious damage.

Symptoms You may feel a vague discomfort in your abdomen because your liver is swollen. You might also feel sick and lose your appetite. A blood test may be able to show if you have fatty liver. 90-100% of heavy drinkers have alcoholic fatty liver disease  and one in five drinkers with fatty liver disease will go on to develop cirrhosis.

Alcoholic hepatitis

If you have a fatty liver and continue to drink, you have up to a one in four chance of getting alcoholic hepatitis. This is a condition where your liver becomes puffy, swollen and tender. Alcoholic hepatitis can happen to you at an early stage or after many years of excessive drinking. Up to 35% of heavy drinkers develop alcoholic hepatitis. Symptoms may include loss of appetite, nausea, vomiting, abdominal pain and tenderness, fever and jaundice. The damage maybe reversible if you stop drinking. In its severe form, the disease may occur suddenly and it can quickly lead to life-threatening complications. One in four drinkers with fatty liver disease will develop alcoholic hepatitis.

Alcoholic Cirrhosis

The final stage of alcoholic liver disease is cirrhosis. This is usually the result of long-term, continuous damage to the liver. Irregular bumps, known as nodules, replace the smooth liver tissue and the liver becomes harder. The effect of this, together with continued scarring from fibrosis, means that the liver will run out of healthy cells to support normal functions. This can lead to complete liver failure.

Between 10 and 20% of heavy drinkers develop cirrhosis, usually after 10 or more years of high levels of drinking, but may be much less. Symptoms of cirrhosis are completely silent. The damage from cirrhosis is not reversible, but patients who stop drinking can live near normal lives. Many heavy drinkers will progress from fatty liver to alcoholic hepatitis and finally to alcoholic cirrhosis, though the progression may vary from patient to patient.

The risk of developing cirrhosis is particularly high for people who drink heavily and have another chronic liver disease such as viral hepatitis C.

Those with cirrhosis of the liver of any cause are also at higher risk of development of liver cancer, nearly always fatal. In addition to causing liver damage by excess, alcohol, at least when abused, inhibits liver regeneration (healing) from any damage, by viral hepatitis, toxin, medication overdose (acetaminophen), hemochromatosis (hereditary iron overload), or alcohol itself.

Symptoms of liver disease can include: fatigue, nausea,vomiting, diarrhoea and abdominal pains.

Later stage liver damage symptoms  include:

  • jaundice (yellow skin)
  • vomiting blood
  • fatigue
  • weakness, loss of appetite
  • itching
  • easy bruising
  • swelling of the legs ankles, or abdomen
  • liver cancer
  • bleeding in the gut
  • increased sensitivity to alcohol and drugs, both medical and recreational (because the liver cannot process them)
When you develop cirrhosis, cutting out alcohol is essential to prevent you from dying from liver failure which is when your liver stops working completely. People who have had no previous symptoms who stop drinking when they have cirrhosis, have an 80% chance of being alive after 10 years.

Deaths from alcoholic liver disease

In Canada, there are an estimated 5,000 deaths per year due to liver disease. 95% of deaths from liver disease are due to chronic hepatitis B and C, non-alcoholic fatty liver disease, liver cancer and alcoholic liver disease.

The Canadian liver foundation: www.liver.ca

The Canadian Association for the study of the liver www.hepatology.ca

Please visit the gateway to sensible drinking and health, alcoholinmoderation.com for specific studies and summary papers.
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