Laennec’s cirrhosis

Alternative names
Liver disease due to alcohol; Cirrhosis or hepatitis - alcoholic; Alcoholic liver disease

Definition
Alcoholic liver disease involves an acute or chronic inflammation of the liver induced by alcohol abuse. See also cirrhosis.

Causes, incidence, and risk factors

Alcoholic liver disease usually occurs after years of excessive drinking. The longer the duration of alcohol use and the greater the consumption of alcohol, the greater the probability of developing liver disease. Acute alcoholic hepatitis can result from binge drinking, and may be life-threatening if severe.

Malnutrition develops as a result of empty calories from alcohol, reduced appetite, and malabsorption (inadequate absorption of nutrients from the intestinal tract). Malnutrition contributes to liver disease.

The toxicity of ethanol to the liver, individual susceptibility to alcohol-induced liver disease, and genetic factors also contribute to the development of alcoholic liver disease.

Alcoholic liver disease does not affect all heavy drinkers, and women may be more susceptible than men. Drunkenness is not essential for the development of the disease.

Changes start within the liver as inflammation (hepatitis) and progress to fatty liver and cirrhosis. Cirrhosis is the final phase of alcoholic liver disease. Symptoms may not be present until the disease is relatively advanced.

Serious complications are associated with advanced disease such as alcoholic encephalopathy (damage to brain tissue) and portal hypertension (high blood pressure within the liver).

Symptoms

     
  • Loss of appetite  
  • Nausea  
  • Jaundice  
  • Abdominal pain and tenderness  
  • Fever  
  • Ascites (fluid collection in the abdomen)  
  • Unintentional weight gain (because of fluid collection)  
  • Mental confusion  
  • Excessive thirst  
  • Dry mouth  
  • Fatigue

Additional symptoms that may be associated with this disease:

     
  • Vomiting blood or material that looks like coffee grounds  
  • Bloody or dark black or tarry bowel movements (melena)  
  • Abnormally dark or light skin  
  • Redness on feet or hands  
  • Paleness  
  • Light-headedness or fainting, especially with upright posture  
  • Rapid heart rate (tachycardia) when rising to standing position  
  • Slow, sluggish, lethargic movement  
  • Breast development in males  
  • Impaired ability to concentrate  
  • Agitation  
  • Fluctuating mood  
  • Difficulty paying attention (attention deficit)  
  • Impaired judgment  
  • Confusion (encephalopathy)       o Altered level of consciousness       o Impaired short- or long-term memory       o Hallucinations

Symptoms vary with the severity of the disease and are usually worse after a recent period of heavy drinking.

Signs and tests

     
  • A CBC may show anemia and other abnormalities.  
  • Liver function tests such as ALP are abnormal.  
  • Liver biopsy shows alcoholic liver disease.

Tests to rule out other diseases include:

     
  • Ultrasound of the abdomen  
  • CT scan - abdominal  
  • Blood tests for other causes of liver disease

This disease may also alter the results of the following tests:

     
  • Reticulocyte count  
  • Ferritin  
  • Alpha fetoprotein

Treatment

The objective of treatment is to discontinue alcohol, and to provide a high-carbohydrates, high-calorie diet to reduce protein breakdown in the body. Vitamins, especially B1 and folic acid, are associated with improvement. An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Management of the complications of chronic liver disease may be needed. If cirrhosis develops, liver transplant may be necessary.

Support Groups
The stress of illness can often be eased by joining a support group whose members share common experiences and problems. See alcoholism - support group and liver disease - support group.

Expectations (prognosis)

Continued excessive drinking is associated with a shorter life expectancy. The probable outcome is poor if drinking continues.

Complications

     
  • Bleeding esophageal varices  
  • Portal hypertension  
  • Hepatic encephalopathy

Calling your health care provider

     
  • Call your health care provider if symptoms of alcoholic liver disease develop.  
  • Call your provider if symptoms develop after prolonged or heavy drinking, or if you are concerned that drinking may be damaging your health.

Prevention

If you drink alcohol, limit consumption to moderate levels.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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