In the United States alone, two million people have alcohol induced liver disease. Because it is the primary site where alcohol and other potential toxins, including drugs, are metabolized (processed and broken down) the liver is susceptible to damage from these agents. Eighty percent of alcohol passes through the liver to be processed. There are many factors that determine to what extent alcohol will affect the liver of each individual. Genetics, malnutrition and poor diet, as well as the presence of other underlying liver disease such as chronic viral hepatitis B or C can each play a role in how alcohol affects this important organ. While the reason is not clear, it is believed that women are more susceptible than men to the effects of alcohol on the liver. In general, damage to the liver increases with increased quantity and duration of alcohol intake. As damage progresses, the liver goes through three recognizable pathologic and clinical stages.
Fatty Liver Disease
During this first stage of alcohol induced liver disease extra fat builds up inside the liver cells. Most heavy drinkers will have fatty liver disease. There may be no symptoms and this condition is generally reversible if alcohol intake ceases.
Alcoholic Hepatitis
In the second stage in the progression of alcohol induced liver disease the liver swells and is damaged. Between 10 and 35% of heavy drinkers will progress to alcoholic hepatitis. Signs and symptoms may include loss of appetite, nausea, vomiting, abdominal pain and jaundice. Mild cases can be reversed by abstinence from alcohol.
Alcoholic Cirrhosis
Approximately 10 to 20% of individuals who drink heavily for eight to ten years will develop cirrhosis of the liver. In this last stage in the progression of alcohol induced liver disease, normal liver tissue is destroyed and replaced with fibrous scar tissue. While cirrhosis is generally not reversible, abstinence from alcohol can prevent further damage. Some patients with cirrhosis will progress to liver failure. In addition to a decline in the liver’s ability to perform its many important functions, complications of cirrhosis can include accumulation of fluid in the abdominal cavity, kidney failure, encephalopathy (confusion), and catastrophic bleeding from the veins in the esophagus. Treatment is generally supportive and some patients may be candidates for liver transplantation.
Drug Induced Liver Disease
There are a number of other agents that can be toxic to the liver cells, including both mainstream and alternative medications and, of course, certain species of mushrooms. The most common cause of acute liver injury in the United States is ingestion of acetaminophen (Tylenol). While the toxic affect of acetaminophen is dose dependent, individuals with malnutrition or who use alcohol may be susceptible to liver injury at lower doses. Treatment of drug induced liver disease consists of supportive therapy and withholding the offending agent. In the case of acetaminophen toxicity, patients may benefit from treatment with the antidote N-acetylcysteine.