Alcohol-Associated Liver Disease: Symptoms, Treatment, and Progression

Medically Reviewed By Saurabh Sethi, M.D., MPH
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Alcohol-associated liver disease (ALD) is liver disease from excessive and long-term alcohol use. It includes fatty liver, hepatitis, and cirrhosis. “Alcoholic liver disease” is an older name for ALD that is still in common use. The term “alcohol-associated liver disease” may help reduce the stigma of ALD.

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.

What is alcohol-associated liver disease?

person pouring a beer at an outdoor table with several beer bottles on it
Lightsy/Stocksy United

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.

Read How Your Liver Keeps You Healthy.

What are the stages of alcohol-associated liver disease?

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:

  • fatigue
  • nausea
  • fever
  • yellowing of the skin and whites of the eyes (jaundice)
  • abdominal pain, especially in the upper right quadrant

Learn more about alcoholic hepatitis.

3. Cirrhosis

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:

What are the symptoms of alcohol-associated liver disease?

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:

Gastrointestinal symptoms

Symptoms can include:

Skin symptoms

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:

What causes alcohol-associated liver disease?

Alcohol use for many years is the main cause of ALD. Heavy drinking and binge drinking increase the chance of ALD.

A drink is 14.0 grams (g) or 0.6 ounces of alcohol. The chance of liver disease increases for:

  • 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

Learn about alcohol use disorder.

Heavy drinking does not always lead to ALD. Factors besides alcohol consumption play a role as well.

What are the risk factors for alcohol-associated liver disease?

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
  • obesity
  • hepatitis C
  • hemochromatosis
  • nonalcoholic fatty liver disease

How can you prevent alcohol-associated liver disease?

The main way to prevent ALD is abstaining from or limiting alcohol. Coffee appears to protect the liver. Studies show it reduces the chance of chronic liver disease and liver cancer.

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

How is alcohol-associated liver disease diagnosed?

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.

How is alcohol-associated liver disease treated?

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
  • corticosteroids
  • viral hepatitis treatment, as necessary
  • paracentesis to drain fluid from the abdomen, as necessary

Liver transplant

Liver transplant is a possible treatment option for severe ALD. Learn about liver transplant waiting lists.

Complimentary remedies

Milk thistle and vitamins A and E are not effective for ALD.

What is the outlook?

The outlook depends on the amount of inflammation and scarring of the liver and other factors. About half of people with complications of cirrhosis survive at least 5 years after diagnosis.

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.

Complications

Potential complications of ALD include:

Other frequently asked questions

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.

Summary

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.

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Medical Reviewer: Saurabh Sethi, M.D., MPH
Last Review Date: 2022 Aug 15
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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