Alcohol-related liver disease

Alcohol-related liver disease (ARLD) is the name for liver damage caused by excess alcohol intake. Over time, regular heavy drinking can cause liver disease, with serious and permanent damage to your liver. Drinking within recommended limits avoids damage to the liver, or stopping drinking can usually stop or reverse damage.

Symptoms of alcohol-related liver disease

In many cases, people with alcohol-related liver disease (ARLD) don't have any noticeable symptoms until their liver is badly damaged.

Early symptoms

If you do experience early symptoms of ARLD, these are often quite vague, such as:

Advanced symptoms

As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as:

  • yellowing of the skin and whites of the eyes (jaundice)
  • swelling in the legs, ankles and feet, due to a build-up of fluid (oedema)
  • swelling in your abdomen, due to a build-up of fluid known as ascites
  • a high temperature (fever) and shivering attacks
  • very itchy skin
  • hair loss
  • unusually curved fingertips and nails (clubbed fingers)
  • blotchy red palms
  • significant weight loss
  • weakness and muscle wasting
  • confusion and memory problems, trouble sleeping (insomnia) and changes in your personality due to a build-up of toxins in the brain
  • vomiting blood and black, tarry stools due to internal bleeding
  • a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums
  • increased sensitivity to alcohol and drugs (because the liver can't process them)

Alcohol and the liver

With the exception of the brain, the liver is the most complex organ in the body. Its functions include:

  • filtering toxins from the blood
  • aiding digestion of food
  • regulating blood sugar and cholesterol levels
  • helping fight infection and disease

Each time your liver filters alcohol, some of the liver cells die.

The liver can develop new cells, but long periods of alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver.

The number of people with the condition has been increasing in Northern Ireland over the last few decades as a result of increasing levels of alcohol misuse.

Stages of ARLD

There are three main stages of ARLD, although there's often an overlap between each stage. These stages are explained below.

Alcoholic fatty liver disease

Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver. This is called alcoholic fatty liver disease, and is the first stage of ARLD.

Fatty liver disease is reversible. If you stop drinking alcohol for two weeks, your liver should return to normal.

Alcoholic hepatitis

Alcoholic hepatitis is a potentially serious condition that can be caused by alcohol misuse over a longer period. It is unrelated to infectious hepatitis.

When this develops, it may be the first time a person is aware they're damaging their liver through alcohol.

Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).

The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently.

Severe alcoholic hepatitis, however, is a serious and life-threatening illness.

Cirrhosis

Cirrhosis is a stage of ARLD where the liver has become significantly scarred. Even at this stage, there may not be any obvious symptoms.

It's generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy.

A person who has alcohol-related cirrhosis and doesn't stop drinking has a less than 50 per cent chance of living for at least five more years.

How ARLD is treated

There's no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. A liver transplant may be required in severe cases where the liver has stopped functioning and doesn't improve when you stop drinking alcohol.

You'll only be considered for a liver transplant if you've developed complications of cirrhosis, despite having stopped drinking.

All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest of their life.

If a person is dependent on alcohol, stopping drinking can be very difficult. Support, advice and medical treatment may be available through local alcohol support services.

Preventing ARLD

The most effective way to help prevent ARLD is to stop drinking alcohol or stick to the recommended limits:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits.

Even if you've been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short and long-term benefits for your liver and overall health.

The information on this page has been adapted from original content from the NHS website.

For further information see terms and conditions.

This page was reviewed August 2018

This page is due for review August 2019

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