Liver problems from alcohol

Dear AGOA, 

Learning more about your grandmother’s liver problems is a thoughtful way to support her. The liver is one of the largest organs in the body and is responsible for several different functions including processing nutrients from food, producing bile, and removing waste products from the body including toxins such as alcohol. Because the liver fulfills so many responsibilities within the body, liver damage (either due to alcohol use or not) can have a wide range of effects. Additionally, some people may be at a higher risk for alcohol-related liver damage (more on that in a bit). Fortunately, there are several options for your grandmother, even after a diagnosis, to improve her health. 

Signs and symptoms of liver damage (both those with alcohol-related diseases and non-alcohol-related diseases) can include: 

• Loss of appetite 
• Nausea and vomiting 
• Fever 
• Mental confusion 
• Fatigue 
• Yellowing of the skin and whites of the eyes (also known as jaundice) 
• Abdominal pain/tenderness (because the liver will become enlarged and feel sensitive) 
• Abdominal swelling due to fluid accumulation (also known as ascites) 
• Kidney or liver failure 

While there are many different conditions related to the liver (you can learn more about these at the American Liver Foundation website), there are several that are related to alcohol use: 

• Fatty liver is a condition where a build-up of fat occurs in the liver cells, which makes it harder for the liver to function properly. There are rarely any symptoms other than fatigue, weakness, and weight-loss. In many cases, if you have fatty liver disease and stop drinking alcohol, the disease will reverse course. 
• Alcoholic hepatitis is characterized by inflammation of the liver and destruction of liver cells caused by excessive alcohol use. It typically occurs in those who drink alcohol (in large amounts) over many years. However, not all people who drink heavily will get alcoholic hepatitis and sometimes those who drink more moderately will develop the disease. If you stop drinking early enough, the body can sometimes reverse the damage. However, if the disease is more advanced, stopping alcohol use will only help to prevent possible complications. 
• Cirrhosis is an irreversible condition where scar tissue replaces normal liver tissue. This scar tissue cannot perform liver functions and the more scar tissue there is, the more difficulty the liver will have performing its normal functions. 

In order to be diagnosed with a liver condition, a health care provider will perform a physical exam and ask about family history, specifically to see if there is any history of alcohol abuse. Additionally, they may also perform a blood test, a liver biopsy, an imaging test, an ultrasound, a magnetic resonance imaging (MRI), or computerized tomography (CT) scans. 

Not everyone who drinks alcohol excessively will get an alcohol-related liver disease. However, a pattern of increased alcohol use over time can increase the chances of getting an alcohol-related liver disease. Additionally, excessive alcohol use and having cirrhosis can also lead to liver cancer. For someone who drinks alcohol in excess, the following factors may increase the chances of developing liver damage: 

• Sex assigned at birth plays a role as females develop alcoholic hepatitis more often than males. 
• Race and ethnicity may also play a role as research has shown that Black and Hispanic men have higher rates of alcoholic cirrhosis than White men. However, this is more complex than just race and ethnicity, as these higher rates of alcohol-induced liver damage may be the result of environmental and socioeconomic factors that contribute to the health disparities faced by minority racial and ethnic groups in the United States today. 
• Genetic factors can impact how alcohol is processed in the body and increase the risk of alcoholic liver disease and some alcohol-associated cancers. 
• Obesity may contribute additional fat deposits to the liver, increasing the damage that may have occurred from fatty liver disease due to alcohol use. 
• Malnutrition, either from a poor diet because of nausea and lack of appetite or from an inability of the body to absorb nutrients due to the byproducts of alcohol, can lead to cell damage in the liver. 
• Other types of hepatitis, which are inflammatory liver diseases, can cause further liver damage. 

There are a few recommendations that health care providers typically make when a person has been diagnosed with a liver condition. First and foremost, it’s recommended that they stop consuming alcohol especially for an alcohol-related condition (those with liver conditions not related to alcohol use are also strongly advised to limit or avoid alcohol). A balanced diet that will help their liver to recover from damage and medications prescribed to manage the complications caused by liver damage may also be in order. With some advanced cases of cirrhosis, a liver transplant is sometimes necessary. 

In light of this information, you can support your grandmother by encouraging any efforts she takes to improve her liver and her health. It may also be helpful for you to know that though you can support her, only your grandmother can make health-related decisions for herself. She is ultimately the one in control of her own body and her behaviors.