Alcoholic Cirrhosis
Alcoholic cirrhosis is the most advanced stage of liver damage caused by long-term heavy drinking. While the scarring that defines this condition cannot be reversed, stopping alcohol use can prevent further damage and significantly extend life expectancy.
Table of contents
- What is Alcoholic Cirrhosis?
- Causes and Risk Factors
- Symptoms and Warning Signs
- Stages of Alcohol-Related Liver Disease
- How is Alcoholic Cirrhosis Diagnosed?
- Treatment Options
- Complications
- Outlook and Prognosis
What is Alcoholic Cirrhosis?
Alcoholic cirrhosis is a severe and life-threatening condition that represents the final stage of alcohol-related liver disease. It occurs when healthy liver tissue is replaced by scar tissue due to long-term, heavy alcohol consumption.[1] This scarring, called fibrosis, prevents the liver from working properly and can lead to liver failure, a condition where the liver can no longer perform its essential functions.[2]
The liver is one of the most complex organs in the body. Its functions include filtering toxins from the blood, aiding digestion of food, regulating blood sugar and cholesterol levels, and helping fight infection and disease.[3] When scarring builds up in the liver, it blocks blood and oxygen from flowing through liver tissues. This reduces the liver’s ability to filter toxins, process nutrients, and produce bile and essential proteins.[2]
Alcoholic cirrhosis is the most advanced and irreversible form of liver injury related to alcohol consumption.[4] According to research, about 20% to 25% of people who misuse alcohol by drinking heavily over many years will develop cirrhosis.[5] In 2019, approximately 37,000 deaths in the United States were attributed to alcohol-related liver disease.[8]
Causes and Risk Factors
The primary cause of alcoholic cirrhosis is prolonged, heavy alcohol use. When you drink alcohol, your liver works to break it down. However, if you consume more alcohol than your liver can process, it can seriously damage the organ over time.[12]
The quantity and duration of alcohol intake are the highest risk factors for developing alcoholic cirrhosis.[4] Heavy drinking is defined differently for men and women. For males, heavy drinking is three or more drinks per day or 21 or more drinks per week. For females, heavy drinking is two or more drinks per day or 14 or more drinks per week.[7] The type of alcoholic beverage consumed plays only a minimal role in the development of liver disease.[4]
Several factors increase the risk of developing alcoholic cirrhosis beyond the amount of alcohol consumed. Women are more susceptible than men to alcohol-related liver damage, even when consuming the same amount of alcohol.[4] Obesity and a high-fat diet also increase the risk of alcoholic liver disease.[4]
Having concurrent hepatitis C infection is associated with younger age of onset, more advanced liver damage, and decreased survival in people who drink heavily.[4] Certain genetic factors may also play a role in determining who develops severe liver disease from alcohol use.[4]
Symptoms and Warning Signs
Alcoholic cirrhosis often does not cause symptoms until significant liver damage has occurred.[3] In the early stages, your body can compensate for limited liver function, and you might not notice any symptoms. This is called compensated cirrhosis. As liver function declines, symptoms develop. This is known as decompensated cirrhosis.[2]
Early symptoms may include feeling sick, weight loss, loss of appetite, feeling weak and tired, and upper abdominal pain.[3] Some people notice visible blood vessels that look like spiders on their skin, or redness on the palms of their hands.[2]
As the condition progresses, more noticeable symptoms appear. These include jaundice, which is a yellowing of the whites of the eyes and skin.[3] Other later symptoms include dark-colored urine and light-colored stools, itchy skin without a visible rash, unexplained weight loss and muscle wasting, easy bleeding and bruising, and swelling in the abdomen (called ascites) or ankles.[2]
Some people may experience confusion, drowsiness, or changes in mood and thinking, a condition called hepatic encephalopathy. Vomiting blood or passing blood in stools can also occur and requires immediate medical attention.[3]
Stages of Alcohol-Related Liver Disease
Alcohol-related liver disease progresses through three main stages, although there is often overlap between each stage.[3]
The first stage is alcoholic fatty liver disease (also called steatosis). Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fats in the liver.[3] At this stage, fat accumulates in the liver cells approaching the portal tracts.[4] About 90% of people who regularly consume excessive amounts of alcohol develop fatty liver disease.[8] Fatty liver disease rarely causes any symptoms, but it is an important warning sign that you are drinking at a harmful level. Importantly, fatty liver disease is reversible if you stop drinking alcohol for a period of time, which could be months or years.[3]
The second stage is alcoholic hepatitis, which involves inflammation of the liver. This stage is characterized by marked fat accumulation, liver cell death, and acute inflammation.[4] Alcoholic hepatitis is a potentially serious condition that can be caused by alcohol misuse over a longer period. Less commonly, it can occur if you drink a large amount of alcohol in a short period of time (binge drinking).[3] The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently. However, severe alcoholic hepatitis is a serious and life-threatening illness, and many people die from this condition each year.[3]
The final stage is cirrhosis, where the liver has become significantly scarred. This stage is described by progressive liver fibrosis and the formation of nodules.[4] Even at this stage, there may not be any obvious symptoms initially.[3] Cirrhosis is generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase life expectancy.[3]
How is Alcoholic Cirrhosis Diagnosed?
If you regularly drink alcohol to excess, it is important to tell your doctor so they can check if your liver is damaged.[3] Your doctor will do a complete health history and physical exam. It is important that you share openly with your doctor about your alcohol use in order to receive an accurate diagnosis.[12]
Several tests are used to diagnose alcoholic cirrhosis. Blood tests, including liver function tests, help determine whether your liver is working properly.[12] A liver biopsy involves removing small tissue samples from the liver with a needle, then checking these samples under a microscope to diagnose the type and extent of liver disease.[12]
Imaging tests can also help diagnose cirrhosis. Ultrasound uses high frequency sound waves to create a picture of your liver. CT scans use X-rays to produce detailed images, while MRI uses a magnetic field and radio frequency pulses to produce comprehensive pictures of your liver.[12]
Treatment Options
The most important part of treating alcoholic cirrhosis is to permanently stop all alcohol consumption.[12] Stopping drinking is not easy, especially as an estimated 70% of people with alcohol-related liver disease have an alcohol dependency problem.[11] Nevertheless, if you have alcoholic cirrhosis and do not stop drinking, no medical or surgical treatment can prevent liver failure.[11]
Complete abstinence from alcohol is necessary and will lead to improvements in most patients.[10] The beneficial effects of stopping alcohol start immediately, but the full benefits may take several weeks or longer to achieve. Once you have stopped drinking, you may need further treatment to help ensure you do not start drinking again.[11]
Support for stopping drinking is available through various channels. Alcohol treatment programs should be recommended to all patients with alcoholic liver disease.[10] The first treatment usually offered is psychological therapy, such as cognitive behavioural therapy (CBT), which involves seeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour.[11]
If psychological therapy alone is not effective, medicines may be prescribed to help you abstain from alcohol, such as acamprosate, disulfiram, or naltrexone.[11] Some people may need to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases so their progress can be closely monitored.[11]
Many people with alcohol dependence find it useful to attend self-help groups. One of the most well-known is Alcoholics Anonymous, but there are many other groups that can help.[11]
Proper nutrition is also an important part of treatment. Malnutrition is common in people with alcohol-related liver disease, so it is important to eat a balanced diet to make sure you get all the nutrients you need.[11] Avoiding salty foods and not adding salt to foods you eat can reduce your risk of developing swelling in your legs, feet, and abdomen caused by fluid build-up.[11] Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat three or four small meals a day, rather than one or two large meals.[11]
For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment with corticosteroids may be used to reduce inflammation of the liver in some people with this condition. Nutritional support is also an important part of treatment in these cases.[11]
In the most serious cases of alcohol-related liver disease, the liver stops functioning and does not improve when you stop drinking alcohol. A liver transplant may be required in these severe cases.[3] All liver transplant units require people with alcohol-related liver disease to not drink alcohol while awaiting the transplant, and for the rest of their life.[3]
Complications
Life-threatening complications of alcohol-related liver disease can develop as the condition progresses. These include internal bleeding from enlarged blood vessels (called variceal bleeding), build-up of toxins in the brain causing confusion and altered mental state (hepatic encephalopathy), and fluid accumulation in the abdomen with associated kidney failure.[3]
People with cirrhosis also have an increased vulnerability to infections and a higher risk of developing liver cancer.[3] Scar tissue can compress important blood vessels, including the portal vein, leading to portal hypertension, which is high blood pressure in the vessels that carry blood to the liver.[2]
Outlook and Prognosis
The outlook for people with alcoholic cirrhosis depends largely on whether they stop drinking alcohol. Stopping drinking alcohol immediately can prevent further damage and significantly increase life expectancy.[3] Although cirrhosis itself cannot be reversed, treatment may slow or stop it from getting worse.[2]
Death rates linked to alcohol-related liver disease have risen considerably over the last few decades. Alcohol misuse is now one of the most common causes of death in the UK, along with smoking and high blood pressure.[3] Each year, about 26,000 deaths in the United States are attributed to cirrhosis, and these rates are rising.[2]
The most effective way to prevent alcohol-related liver disease is to stop drinking alcohol or stick to recommended limits for alcohol consumption.[3] If you have been diagnosed with advanced liver disease or cirrhosis, you should stop drinking alcohol completely. Even a small amount of alcohol can increase the risk of the disease getting worse or complications developing.[3]
