Liver Disease of Alcoholism - symptoms and treatment

Liver Disease of Alcoholism - symptoms and treatment

Liver Disease of Alcoholism - permanent damage to the LIVER that results from long-term, excessive ALCOHOL consumption. Alcohol is one of the most toxic substances ingested into the body. It enters the bloodstream unchanged, about 20 percent absorbed from the STOMACH and 80 percent from the SMALL INTESTINE. The liver must filter alcohol from the blood, a process that certain enzymes in the liver regulate. The enzymes limit the amount of alcohol the liver can extract, allowing alcohol to accumulate in the bloodstream.

The first of these enzymes, alcohol dehydrogenase (ADH), converts the alcohol into acetaldehyde. Acetaldehyde gives the breath of a person who has been drinking alcohol its characteristic odor. It is also a toxin, available as an industrial chemical for numerous manufacturing uses such as a solvent, hardener, and preservative. The second of these enzymes, aldehyde dehydrogenase, facilitates acetaldehyde’s break down into acetic acid (the same acid found in vinegar) and acetylcoenzyme A. These substances are less toxic than acetaldehyde. Though aldehyde dehydrogenase works rapidly, it cannot convert all of the aldehyde before this toxic chemical causes the deaths of hepatocytes. Other enzymes in the liver further metabolize the acetic acid and acetate into GLUCOSE (energy) and carbon dioxide (waste).

Liver Disorders

With repeated exposure to acetaldehyde, structural changes take place in the liver. The first of these is the accumulation of fat in the liver. The liver must direct nearly its full efforts to metabolize alcohol, in the effort to protect itself from the alcohol’s toxic effects. As a consequence other metabolic functions in the liver slow, altering carbohydrate and lipid (fat) METABOLISM. The liver can metabolize alcohol at the rate of about 15 grams per hour, a pace that results in minimal hepatocytic damage. Alcohol consumption that exceeds this rate (equivalent to 1 ounce of 100-proof distilled spirits, one 12-ounce beer, or 4 ounces of wine) maintains alcohol circulation in the bloodstream until the liver can accommodate its metabolism. Repeated excessive alcohol consumption characteristically results in three liver disorders, which may exist singly or collectively.

Alcoholic hepatitis

The HEPATITIS of ALCOHOLISM, also called Laennec’s hepatitis, occurs when the repeated irritation of alcohol results in INFLAMMATION of the liver. When the flow of alcohol through the liver stops, symptoms abate and hepatocytes (the primary working cells of the liver) regenerate. Within a few months of alcohol cessation, the liver can restore itself to a normal level of function.

Alcoholic steatohepatitis

Acetylcoenzyme A, one of the products of alcohol metabolism, interferes with the liver’s synthesis and storage of fatty acids such that fatty tissue accumulates in the liver. Alcoholic STEATOHEPATITIS improves when the liver’s metabolism of alcohol stops, and liver structure can return to normal with alcohol cessation.

Alcoholic cirrhosis

Alcoholic CIRRHOSIS is a condition in which repeated INFLAMMATION (hepatitis) causes SCAR tissue to form and replace hepatocytes. As is the case with cirrhosis resulting from any cause, damage that has already occurred to the liver is not reversible. However, alcohol cessation halts the progression of cirrhosis to limit further damage.

Symptoms of Liver Disease of Alcoholism and Diagnostic Path

The symptoms of alcoholic liver disease are much the same as those of nonalcoholic liver disease and include JAUNDICE (yellowish discoloration of the SKIN), right upper ABDOMINAL PAIN, ASCITES (fluid accumulation in the abdominal cavity), NAUSEA, loss of APPETITE, and FATIGUE. The diagnostic path begins with LIVER FUNCTION TESTS and a thorough assessment of drinking habits. Additional diagnostic procedures might include abdominal ULTRASOUND, COMPUTED TOMOGRAPHY (CT) SCAN, or PERCUTANEOUS LIVER BIOPSY.

Liver Disease of Alcoholism Treatment Options and Outlook

Treatment is alcohol cessation and support for symptoms. The doctor may recommend an alcohol and SUBSTANCE ABUSE TREATMENT PROGRAM, counseling, 12-step program such as Alcoholics Anonymous, and other efforts to help maintain SOBRIETY. When liver disease of alcoholism reaches endstage LIVER FAILURE, LIVER TRANSPLANTATION may be an option for a person who has maintained sobriety for at least six months and has a reasonable expectation of doing so following the liver transplantation. Though liver disease of alcoholism continues if alcohol consumption resumes, with alcohol abstinence the manifestations of liver disease are generally reversible (except cirrhosis).

Risk Factors and Preventive Measures

Chronic alcohol use is the only cause of liver disease of alcoholism. Though most often the use is excessive, alcohol-related damage can occur to the liver with moderate alcohol consumption that extends over a long period of time. Alcoholic steatohepatitis can develop in a person who consumes as few as four alcoholic drinks a week. The only, and absolute, preventive measure is abstinence from alcohol.

See also ENCEPHALOPATHY; HEPATOTOXINS.

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