The commonest cause of long drawn Chronic Liver Disease in India is Alcoholic liver disease which can be silent in its initial phases lasting for 1-2 decades. The disease evolves in three patterns – to begin with, fat accumulates in the liver (alcoholic fatty liver), swelling or inflammation of liver cells (Alcoholic hepatitis).
And after many years of inflammation, scar tissue (Fibrosis) forms inside the liver and when these accumulate silently, it ultimately results in cirrhosis of the liver.
Alcoholic liver disease is largely silent and only at an advanced stage of alcoholic cirrhosis patient develops symptoms. Cirrhosis generally occurs due to heavy alcohol consumption (20-40 grams of absolute alcohol per day), but this quantification of alcohol needed to develop cirrhosis is highly variable and depends on other factors like genetic makeup of the individual and lifestyle. Those who have lifestyle disorders like diabetes, high blood pressure, elevated cholesterol levels have more risk of fatty liver and alcoholism in them may accelerate liver damage resulting in cirrhosis at a younger age.
Alcoholic Liver Disease occurs in three stages:
Alcoholic Fatty Liver:
The first stage of ALD. Protracted – a decade or more, but essentially asymptomatic. Abstinence from alcohol can reverse this stage of fat accumulation.
The second stage where liver inflammation occurs. This can be extremely dangerous with a high death rate. Symptomatic alcoholic hepatitis necessitating critical care occurs in heavy drinkers and may present with the following symptoms.
- Loss of appetite
- Abdominal tenderness
- Fatigue and weakness
- Weight loss
- Bleeding tendency
- Brain dysfunction
Alcoholic Liver Cirrhosis:
As the phase of liver cell swelling progresses, in due course scar tissue accumulates in the liver, distorts the structure and causing a rise in liver pressure (Portal hypertension). This eventually results in water logging- accumulation of water inside the abdomen and swelling of legs. Bleeding from veins in the food pipe and stomach, brain dysfunction (Hepatic encephalopathy), loss of muscle mass. Raised liver pressure can cause changes in heart, lung, and kidney. The formation of liver cancer is yet another risk.
Once cirrhosis sets in, the most important step to improve survival is total abstinence from alcohol. Medical management in advanced stages of cirrhosis is mostly palliative, managing complications of end-stage liver disease. Liver transplant is the only curative option once liver cirrhosis reaches a complicated phase known as End-Stage Liver Disease (ESLD).
Due to long-standing alcohol consumption, scar tissue forms in the liver. Accumulation of this scar tissue beyond a level is termed as liver cirrhosis. Anybody with liver cirrhosis runs the additional risk of liver cancer. Each ml of alcohol is harmful to the liver and other organ systems. Whatever be the source/type of alcohol, whether it is beer, whiskey, brandy or wine, damage to the liver depends on the amount of Absolute alcohol (100 % alcohol) which reaches the liver added.
Dr. Harikumar R Nair is a Senior Consultant Hepatologist & Liver Transplant Physician at Gleneagles Global Health City, Chennai