The liver is an important organ that processes toxins out of the body, cleans the blood, and produces nutrients that body cells need from digested food. It is responsible for breaking down saturated fats into cholesterol, storing glucose in the form of glycogen, and storing excess nutrients for slower release into the body. At three pounds, the liver is the largest solid organ.
Scarring of the liver, called fibrosis, can lead to long-term damage to the liver’s functionality. This condition is called cirrhosis, and there are many diseases that can cause this type of damage. One of them is alcohol use disorder. Long-term abuse of alcohol causes scarring in the liver, as the organ is not able to keep up with the ingestion of the intoxicating substance. Women are more likely than men to develop cirrhosis when they struggle with alcohol use disorder, and people who have hepatitis B or C are more likely to develop cirrhosis due to problem drinking.
While many people in the United States drink socially or to relax, drinking more than two drinks per day for women, and more than three drinks per day for men, over the course of a decade can lead to enough liver damage for the individual to develop cirrhosis. The American Liver Foundation notes that between 10 and 20 percent of heavy drinkers develop cirrhosis.
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How Cirrhosis Develops from Long-Term Alcohol Abuse
There are three basic stages of alcohol-related cirrhosis. Although not all people go through these when they develop cirrhosis, most people follow this course.
Stage 1: Fatty Liver Disease
For many people, this first stage of cirrhosis does not have noticeable symptoms. Even if a person has some symptoms that lead them to seek medical help, liver function tests typically show normal liver activity, although enzymes may be elevated. However, fat begins to build up in liver cells, which die and decompose, accumulating in the organ. The buildup of fat in the liver is called steatosis. The liver becomes inflamed, so immune cells cause some destruction of liver tissue, which appears to have an infection. The organ may also produce abnormal connective tissue – usually near the large hepatic artery, vein, and bile duct – which can later get in the way of normal liver function. The condition can be reversed at this point if the person stops drinking.
Symptoms that may occur during the development of fatty liver disease include:
- Fatigue or exhaustion
- Discomfort in the upper abdomen
Stage 2: Alcoholic Hepatitis
As damage to the liver becomes worse, more noticeable symptoms appear. These include:
- Loss of appetite
- Nausea and vomiting
- Abdominal pain
- Early stages of jaundice
Fibrosis, or the replacement of normal liver tissue with scar tissue, gets worse, and the organ’s function begins to decrease. As abnormal tissue begins to replace normal liver tissue, the organ cannot filter toxins very well, which leads to a yellowing of the skin and the whites of the eyes, known as jaundice. Sometimes, toxins in the blood can affect brain function, and the individual may become confused or disoriented. Blood pressure increases due to abnormal blood flow into and out of the liver; this is called hepatic hypertension.
About 35 percent of heavy drinkers develop alcoholic hepatitis, and up to 70 percent of people who develop alcoholic hepatitis ultimately develop cirrhosis. However, people who quit drinking and seek help may be able to overcome the worst symptoms of alcoholic hepatitis and avoid cirrhosis.
Stage 3: Cirrhosis
About 55 percent of people who develop alcoholic hepatitis already have cirrhosis, and most of those who do not will go on to develop cirrhosis. This condition is the most advanced form of liver disease, and it cannot be overcome, although the symptoms can be moderated.
Scar tissue “bridges,” called bridging fibrosis, outnumber healthy or normal liver tissue, and liver function is irreversibly impaired. The fibroids are hard, and they can be very uncomfortable, tender, or painful. Symptoms of cirrhosis include:
- Unusual sleepiness
- Slurred speech
- Edema, or fluid retention in the body
- Unexplained and intense itching on the skin
- Bleeding into the digestive tract
Stage 4: End-Stage Cirrhosis
Permanent damage to the liver is not reversible with abstinence, although overcoming alcohol use disorder can moderate symptoms and extend life. As the liver is no longer able to clean toxins out of the blood and release vital nutrients into the body, symptoms get worse and other organ systems begin to fail. Symptoms of end-of-life cirrhosis include:
- Fluid Imbalance: Also called ascites, the buildup of fluid in all parts of the body can make breathing difficult. Pressure on the blood vessels in the abdomen can lead to high blood pressure and bleeding problems. Edema in the legs can make walking difficult.
- Bleeding: The ability of the blood to form clots relies on the liver’s ability to remove toxins. When that is compromised, the body can no longer form clots, so bleeding doesn’t stop. People in end-stage cirrhosis often vomit blood and have black stool.
- Kidney failure: Changes in blood pressure due to liver failure result in less blood flowing to the kidneys and more toxins in the blood that do make it to the renal system. The kidneys begin to fail, leading to dark urine, nausea, vomiting, and jerking movements. The person also experiences delirium.
- Neurologic changes: Chemicals like ammonia begin to build up in the brain, inducing hepatic encephalopathy. This is indicated by confusion, difficulty concentrating, and forgetfulness. The person’s personality may change, they may experience agitation, and they will have difficulty speaking. Encephalopathy can lead to coma and death.
- Infection: Since the blood is not being filtered by the liver, the body’s immune system is not able to respond well to infections. Fever, chills, and joint pain could be caused by an opportunistic infection.
Treatment for Alcohol Use Disorder
Anyone who struggles with alcohol use disorder should get help before long-term physical damage takes hold. Consuming large quantities of alcohol, whether due to chronic alcohol use disorder or binge drinking, is very damaging to the body and can lead to death. Cirrhosis is only one of the many problems associated with problem drinking.
Fortunately, it is possible to become sober, overcome alcohol use disorder, and live a healthy life. Working with medical professionals to detox safely from alcohol dependence, then entering a rehabilitation program, is the best course of action for most people. Rehabilitation programs, both inpatient and outpatient, offer individual, group, and family therapy to help the person understand their addiction, and work on better coping mechanisms for stress or triggers that may have led to the illness. Therapy helps the person rebuild relationships that may have been hurt by the disease and form new social structures to support sobriety.