Alcohol-Associated Liver Disease: Symptoms, Treatment, and Progression
Not everyone who drinks a lot of alcohol develops liver disease. Other factors play a role. However, the greater the quantity and years of alcohol use, the greater the chance of developing ALD.
Read on to learn about ALD symptoms at each stage and treatment options. Find out the quantity of alcohol tied to liver disease and other factors that increase the chance of ALD.
Sex and gender exist on a spectrum. This article uses the terms “female” and “male” to refer to sex that was assigned at birth.
Learn more about the difference between sex and gender.
ALD is a series of liver diseases related to alcohol use, specifically alcohol use disorder.
One job of the liver is to break down toxins in the blood. This includes medications and recreational drugs, including alcohol.
As your liver filters alcohol from the blood, liver cells die. The liver has some ability to regenerate but chronic alcohol use reduces this function. The disease gets more severe as alcohol consumption continues. Damage builds up and becomes permanent.
ALD progresses through three clinical stages.
1. Alcoholic fatty liver disease
This first stage of ALD is also known as hepatic steatosis, or “fatty liver.” Alcohol metabolism produces fatty deposits that accumulate in liver cells. The liver may be larger than usual. There are usually no symptoms at this stage.
Learn how alcohol affects triglyceride levels.
2. Alcoholic hepatitis
This stage is marked by fat deposits, liver inflammation and swelling, and liver necrosis, which means liver cells are dying. The liver is enlarged and may be tender. Hepatitis severity varies greatly. People can have mild disease or quickly become very sick and need hospital care.
Symptoms may include:
- yellowing of the skin and whites of the eyes (jaundice)
- abdominal pain, especially in the upper right quadrant
Learn more about alcoholic hepatitis.
Liver damage continues and scar tissue replaces healthy tissue. Fibrosis is the medical term for scarring. Cirrhosis is when there is a lot of scar tissue and liver function declines. Symptoms may include those of hepatitis, fluid buildup, and neurological complications. Symptoms include, but are not limited to:
- abdominal distention from ascites
- swelling of the lower legs from fluid buildup (edema)
- mental changes, including confusion and trouble with memory
- symptoms of low blood oxygen levels:
- pale complexion
- nail clubbing
- difficulty breathing
Seek immediate medical care by calling 911
Alcohol-associated liver disease can progress rapidly and hospital care is usually necessary. Call 911 for these serious symptoms:
Symptoms vary by the severity of ALD. They usually persist; they do not come and go. ALD affects multiple body systems.
Common general symptoms
Symptoms can include:
- abdominal pain
- abdominal swelling, distention, or bloating
- excessive thirst
- nosebleeds or bleeding from the gums
- unexplained weight loss
Symptoms can include:
Symptoms can include:
- hands and feet looking flushed
- spidery blood vessels
- skin discoloration
- yellowing of the skin and whites of the eyes
Brain and nervous system symptoms
These symptoms can include:
- difficulty walking
- difficulty with memory, thinking, talking, comprehension, writing, or reading
- tingling or other unusual sensations in the hands or feet
Alcohol use for many years is the main cause of ALD. Heavy drinking and binge drinking increase the chance of ALD.
- females who drink 20–40 g a day for more than 10 years
- males who drink more than 40 g a day for more than 10 years
Heavy drinking does not always lead to ALD. Factors besides alcohol consumption play a role as well.
Other factors that may increase the chance of ALD include:
- drinking alcohol and fasting or not eating
- cigarette smoking
- female sex, assigned at birth
- variations in certain genes
- hepatitis C
- nonalcoholic fatty liver disease
Based on known risk factors, other prevention strategies that may help include:
- following a healthy eating plan
- not smoking, if you smoke
- treating hepatitis C
- maintaining a moderate weight
Physicians base a diagnosis of ALD on a history of chronic or heavy alcohol use, symptoms, and the results of tests, which may include:
- liver function and bilirubin tests
- kidney function tests
- blood clotting tests
- complete blood count
- abdominal ultrasound
- liver biopsy (sometimes)
Learn about the ALT blood test for liver function.
Checking liver function at home
At-home liver tests are available for purchase online. Keep in mind that the Food and Drug Administration (FDA) does not list the following two tests in its database of FDA-approved diagnostic kits:
If you use an at-home test, discuss the results with a doctor.
The first step in treating ALD is to discontinue alcohol consumption. This can reverse fatty liver and hepatitis. Steatosis may resolve in 6 weeks without drinking. It also prevents further injury and helps heal the liver. Fibrosis and cirrhosis are usually not reversible.
Learn about measures to help you stop drinking.
Additional ALD treatments may include:
- nutritional support, including:
- vitamin B supplements
- building a nutritious eating plan
- tube feeding
- viral hepatitis treatment, as necessary
- paracentesis to drain fluid from the abdomen, as necessary
Milk thistle and vitamins A and E are not effective for ALD.
People with cirrhosis who stop drinking alcohol live longer than those who continue drinking. Primary liver cancer and chronic hepatitis C lower survival.
Doctors use the Model for End-Stage Liver Disease (MELD) score to help determine ALD severity and prognosis. The MELD score is a function of liver and kidney function.
Potential complications of ALD include:
- bleeding esophageal varices, which are swollen veins
- hepatic encephalopathy
- portal hypertension, which is high pressure in the veins around the liver, stomach, and esophagus
- liver cancer
Saurabh Sethi, M.D., MPH, has reviewed the following frequently asked questions.
What are the first signs of liver damage from alcohol?
Early signs and symptoms of liver damage include:
What part of the body itches with liver problems?
Itching with liver disease primarily affects the limbs, especially the palms of the hands and soles of the feet, but it can be general. Itching is possible with ALD when there is a problem with bile secretion from the liver.
Chronic and heavy alcohol use injures the liver and can cause ALD. The disease often progresses through overlapping stages that include alcoholic fatty liver disease, hepatitis, and cirrhosis.
Abstaining from all alcohol use can cure ALD in the early stages. Nutrition guidance, corticosteroids, and other supportive treatments can help people with severe ALD to live longer.