One in five heavy alcohol drinkers have liver issues, but most don’t know it. The first stage of alcohol-induced liver disease is inflammation, which often has no obvious symptoms.
If warning signs are noticed, it usually indicates the second stage of alcoholic liver disease where scar tissue has already built up enough to impede proper liver function.
Early Symptoms of Liver Issues
- A general sense of being unwell
- Lower tolerance for alcohol
- Nausea and vomiting
- Severe hangovers
- A lack of appetite
- Losing weight without trying
- Diarrhea
- Abdominal pain or discomfort in the upper right quadrant
- Abdominal protrusion
Page contents: Stages of Liver Disease | When to See a Doctor | Liver Repair
Where is your liver?
The liver is located in the upper right quadrant of your abdomen. It sits above the stomach but beneath the diaphragm. The size is similar to a football.
Any pain or abnormalities in this area could signal liver problems.
What are the stages of liver damage?
Liver issues from alcoholism progress through three distinct diseases:
- Alcoholic Fatty Liver Disease: Fat build-up, inflammation
- Alcoholic Hepatitis/Liver Fibrosis: Inflammation, scarring
- Alcoholic Cirrhosis: Severe scarring
As the liver goes through the stages, it’s less likely the liver cells can recover and treatment becomes more complicated.
Once diagnosed with cirrhosis of the liver, the damage cannot be reversed. However, abstaining from alcohol and adhering to treatment protocol prevents the disease and its symptoms from getting worse.
What is Alcoholic Fatty Liver Disease?
Alcoholic fatty liver disease is a reversible condition where heavy drinking causes fat to build up in the liver (hepatic steatosis). The build-up of fat deposits leads to inflammation that reduces liver function.
Alcoholic fatty liver disease impacts 20% of heavy drinkers.
- Symptoms: Usually no symptoms.
- Prognosis: Reversible if drinking is stopped. If drinking is continued, issues progress into more serious liver diseases.
What is Alcoholic Hepatitis (Liver Fibrosis)?
Alcoholic hepatitis is a condition where the liver becomes so inflamed that liver cells become damaged.
Symptoms of Alcoholic Hepatitis
Usually, no symptoms or symptoms so minor most people fail to realize something is wrong. Most diagnoses come from a liver biopsy, after warning signs from a lab test or abdominal scan (ultrasound, CT, MRI).
As the disease gets worse, clinical symptoms in this stage may include:
- Swollen liver
- Nausea
- Vomiting
- Abdominal pain in the upper right quadrant
- Fever
- Yellowing of the skin and whites of the eyes
Why do alcoholics get yellow skin?
Yellowing of the skin and eyes is a symptom of liver disease known as jaundice. Jaundice occurs when the liver is unable to process waste material that is normally excreted in the feces.
If the liver is unable to remove waste material, it builds up and starts to alter the color of the skin and eyes.
Prognosis for Alcoholic Hepatitis
Alcoholic Hepatitis can usually be treated, and some of the damage will heal. If drinking continues, 40% will develop into cirrhosis. Death can also occur at the hepatitis stage without developing full cirrhosis.
What is Alcoholic Cirrhosis?
Alcoholic cirrhosis is the most serious alcohol-induced liver disease where scar tissue overwhelmingly replaces healthy liver tissue. Blood flow and other critical components of healthy liver function are impaired.
According to the National Institute on Alcohol Abuse and Alcoholism, alcoholic cirrhosis impacts 10-15% of people with alcoholism.
Symptoms of Alcoholic Cirrhosis
Many people still do not realize they have liver issues, even though cirrhosis has distinguishable symptoms and can show on lab tests and radiographic scans.
All of the symptoms of alcoholic hepatitis often occur since the diseases happen in progression.
Distinct Symptoms of Alcoholic Cirrhosis
- Redness of the palms (palmar erythema)
- Shorting of the muscles in the fingers (contractures)
- White nails
- Thickening and widening of the fingers and nails (clubbing)
- Liver enlargement
Note: 30-40% of cirrhosis cases are discovered at autopsy never noticing symptoms.
Late-Stage Alcoholic Cirrhosis Symptoms
- Jaundice
- Bloating from the buildup of fluid in your abdomen (ascites)
- Gastrointestinal bleeding
- Bruising and bleeding easily
- Confusion, difficulty thinking, memory loss, personality changes, or sleep disorders
- Swelling in your lower legs, ankles or feet
- Severe itchy skin
- Darkening of the color of your urine
- Liver failure
- Death
Prognosis for Alcoholic Cirrhosis
The 5–year survival rate for people with cirrhosis who stop drinking is ~90%. However, for late-stage cirrhosis, the rate drops to only 60% for those who stop drinking and 35% for those who do not.
Cirrhosis is the most serious consequence of alcoholism for the liver, but other organs will also start to suffer damage from this level of drinking. (See What is Wet Brain?).
How do you know if your liver is failing when there are no early symptoms?
There is one clear indicator that you are incurring liver damage: heavy or frequent drinking. If you have a problematic relationship with alcohol, you are damaging your liver even if you don’t feel any symptoms.
Are there tests for liver disease?
Liver damage can be detected in bloodwork early because liver cells are dying at a higher rate than normal.
- Ask a doctor for a liver panel and CBC with platelets.
- Liver enzymes, including SGPT, SGOT, and GGTP, will show up on the tests as being elevated.
- The higher their levels, the worse the condition of the liver.
An abdominal ultrasound with a doppler, an MRI or a CT scan can show abnormalities like enlargement that also indicate an issue.
If lab work or scans come back showing issues, a liver biopsy can confirm a diagnosis and identify the severity.
Liver biopsies are an outpatient procedure that takes five minutes. The area is numbed and a small incision is made to collect the liver tissue.
When should I see a doctor to get my liver tested?
You should have your liver checked if you meet any of the following criteria:
- You have a problem with drugs or alcohol
- You are showing symptoms of liver problems (pain, jaundice, tiredness, etc.)
- Your family has a history of liver problems
- You take medications that are known to cause liver damage
How much drinking causes liver damage?
Most people develop liver damage after years of daily drinking. However, research from the Neurology Department at UCSF suggests sporadic binge drinking over just seven weeks causes liver issues.
Pending you’re not pregnant, on medications or have any health concerns, I suggest sticking with the CDC recommendations.
- No more than 2 drinks per day for men
- No more than 1 drink per day for women
Everyone’s biology and genetics are different, but exceeding these amounts puts you at greater risk of damage to your liver, brain or other organs.
The damage from chronic alcohol use is reversible until it’s not. There isn’t an amount or even many warning signs before permeant damage sets in.
Note: over 30% of adults in the U.S. don’t drink alcohol. That’s always the healthiest option.
Can the liver repair itself after years of drinking?
In most cases, yes. Liver cells regenerate easier than other organs. Patients can partially or wholly restore liver function by:
- Stopping drinking
- Following all treatment guidelines (like medications and high protein diets that avoid fatty or fried foods)
A liver transplant is only required if the organ has already become mostly scar tissue. Drinking will need to be permanently stopped to qualify for the transplant list.
Liver Reparability By Stage
| Stage | Reversible | Treatment |
|---|---|---|
| Fatty Liver | Stop Drinking | |
| Hepatitis | Somewhat | Stop Drinking + Medications |
| Cirrhosis | Stop Drinking + Medications + Transplant |
As you can see, treatment for alcoholic liver disease centers around treatment for alcohol dependency.
- Stopping your drinking will always improve your outcome.
- Addiction treatment centers help you stop drinking for good.
- People fly from all over the country to JourneyPure’s alcohol treatment programs in Tennessee, which also serves the local liver transplant hospitals.
- The JourneyPure inpatient alcohol rehab in Kentucky serves patients across the stages of liver disease as well.
- Even if it’s not JourneyPure, call a treatment center today to get help!
- (If you’re concerned about a loved one’s drinking, see family of alcoholics).
JourneyPure.com doctors follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, count records, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the fields and their own personal recovery.
-
Wegner, S.A., Pollard, K.A., Kharazia, V., Darevsky, D., Perez, L., Roychowdhury, S., Xu, A., Ron, D., Nagy, L.E. and Hopf, F.W. (2017). Limited Excessive Voluntary Alcohol Drinking Leads to Liver Dysfunction in Mice. Alcohol Clin Exp Res, 41: 345-358. https://doi.org/10.1111/acer.13303
Mann, R. E., Smart, R. G., & Govoni, R. (2003). The Epidemiology of Alcoholic Liver Disease. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/arh27-3/209-219.htm.
Basra, G., Basra, S., & Parupudi, S. (2011). Symptoms and signs of acute alcoholic hepatitis. World journal of hepatology, 3(5), 118–120. https://doi.org/10.4254/wjh.v3.i5.118
Khatri, M. (2019, September 4). Fatty Liver Disease: Nonalcoholic & Alcoholic Steatohepatitis (NAFLD/AFLD). WebMD. https://www.webmd.com/hepatitis/fatty-liver-disease.
Mayo Foundation for Medical Education and Research. (2021, February 6). Cirrhosis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487.
NHS. (2021, March 12). NHS Choices. https://www.nhs.uk/conditions/jaundice/.
The abnormal hepatic morphology: not always cirrhosis – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Nodular-hepatic-margins_fig4_296936036 [accessed 10 Jun, 2021]
Disclaimer
All content is for informational purposes only. No material on this site, whether from our doctors or the community, is a substitute for seeking personalized professional medical advice, diagnosis or treatment. Never disregard advice from a qualified healthcare professional or delay seeking advice because of something you read on this website.
Do you have more questions?
Leave a Reply
-
Chimom says: I have fatty liver disease which progressed to stage 1 NASH during fertility treatments. I did a core restore liver detox to reverse it (recommended by integrative/holistic Dr.) It would be helpful to know what to do if you are in a stage where reversing the disease is possible.
I think some diet guidelines would be helpful such as coffee (hepatologist told me about a study on its positive effects for the liver, after I reversed NASH with a detox) and apple cider vinegar in removing fat and cleaning the liver.
-
Dr. Stephen Loyd M.D. says: Thanks for your question!
The number one thing you can do to reverse NASH (besides avoiding alcohol) is to maintain a healthy diet and exercise regularly. Reducing your cholesterol level and losing weight are proven to help restore liver function.
-
-
Lucy says:
Hello doctor, my uncle is been drinking alcohol since he was 13 years and now he is 53 years. He drinks what ever he gets but mostly whiskey, which he consumes half a bottle every night but sometimes keeps 2 days of no alcohol day. But luckily he never gets sick not even a flu and hasn’t shown any symptoms of liver or any disease. I am worried about him, what are the chances of him developing liver problem.??!!
-
Dr. Stephen Loyd M.D. says:
Hi Lucy, thank you for your question.
Because your uncle is a heavy drinker and has been for a long time (3-6 shots a day for 10+ years), he has a high chance of developing liver problems unless he stops drinking immediately.– Fatty liver, the first stage of liver damage from alcohol, affects about 20% of heavy drinkers.
– Alcoholic hepatitis, the next stage, affects 10 – 35% of heavy drinkers.
– Cirrhosis, the most severe form of liver damage from alcohol, affects 10-15% of heavy drinkers.If your uncle addresses his drinking problem now, there is a good chance his liver can fully recover without permanent damage. Stay strong – your uncle is lucky to have someone like you looking out for him!
-
-
Mary McGarvey says:
Hi Doctor! I found your info here because a friend is in dire trouble from drinking, now in ICU. It’s well written and clear, but I have a suggestion: that cartoon of a lady with jaundice just looks unprofessional or fake. Why not put a photo of a healthy man and a man with jaundice, and better yet, the same man after treatment. That is what people need to see: the real thing! I had never seen anyone with jaundice so I was looking for a real photo. It would also give fortitude to those in despair, that they have ruined their health if they have jaundice. You could show how it can be cured with before/after photos. Please use a man (young and good looking of course) as the men are often the heavy drinkers. Thanks!
-
Dr. Stephen Loyd M.D. says:
Hi Mary, great suggestion! I worked with our design team to incorporate real photos of jaundice skin and eyes instead of the illustration. Thank you for helping us make this blog a better resource. I’m glad you found the information helpful, and I wish you and your friend all the best!
-
-
José R Diaz says:
Hi DR i was drinking for24 Years and i stop IT but i drink wine 4 glass a day can that be a problemas or danger
-
Dr. Stephen Loyd M.D. says:
Hi José,
Yes, drinking that much wine can be dangerous. The type of alcohol doesn’t matter. All forms of alcohol, including wine, can cause health problems.
If you’re worried about how much you’re drinking, try taking an online assessment. If you answer Yes to any of the questions, I recommend getting an official assessment from your healthcare provider or a treatment center that specializes in alcohol use disorder.
Best of luck to you!
-
-
Shannon smith says:
Can you have liver failure if you never drink alcohol ? My doctor told me my liver test was high. I never have drink alcohol. He want me to a ultrasound of my liver.
-
Dr. Stephen Loyd M.D. says:
Hi Shannon! Liver failure can happen even if you never drink, but it’s rare. When it does happen, it is usually caused by hepatitis or taking too much of certain medications, like acetaminophen.
Continue to work with your doctor to investigate the results of your liver test, including having an ultrasound. Whatever is causing the elevated results needs to be addressed as soon as possible. Best of luck to you!
-
-
Matthew says:
Thank you for this informative information. I have been struggling with alcoholism for some time, and I have started feeling abdominal pain. I am 36 and have been drinking heavily for at least ten years. I've been to rehab a couple times, but haven't been able to maintain sobriety. Now I'm scared I might have damaged my liver.
-
Dr. Stephen Loyd M.D. says:
Hi Matthew, you’re welcome! I know it can get discouraging when you're struggling to stay sober, but don’t give up! Many people don’t get sober on their first try – it doesn’t mean that you can’t do it this time around.
If I could offer you any advice, I would look for an inpatient program with a strong medical team. This way, you’ll have the medical and clinical staff to treat your physical symptoms while you address the root causes of your drinking. The sooner you address both the drinking and the pain, the better. Minor liver damage is reversible, but only if you treat it early.
-
-
Valerie Isley says:
Thank you. This article explains what I have been telling my stepdaughter, who was informed she had early signs of liver disease one week after my husband passed from encephalopathy.
Thankfully after our last go round, she is disabled and lives with me. She has started AA.
This article will be of great help in her understanding of this disease.-
Dr. Stephen Loyd M.D. says:
Hi Valerie, I’m so sorry to hear about your husband’s passing. Losing a loved one is never easy, but I’m overjoyed to hear that it inspired your stepdaughter to start attending meetings. It is so crucial to stay connected to others who are in recovery, especially in those first few months of sobriety. Best of luck to her and you as well!
-
Dr. Stephen Loyd M.D. 
Mary McGarvey 
José R Diaz 
Sean 
Shannon smith 
Matthew 
Valerie Isley
Can you have liver failure if you never drink alcohol ? My doctor told me my liver test was high. I never have drink alcohol. He want me to a ultrasound of my liver.
Hi Shannon! Liver failure can happen even if you never drink, but it’s rare. When it does happen, it is usually caused by hepatitis or taking too much of certain medications, like acetaminophen.
Continue to work with your doctor to investigate the results of your liver test, including having an ultrasound. Whatever is causing the elevated results needs to be addressed as soon as possible. Best of luck to you!
Thank you. This article explains what I have been telling my stepdaughter, who was informed she had early signs of liver disease one week after my husband passed from encephalopathy.
Thankfully after our last go round, she is disabled and lives with me. She has started AA.
This article will be of great help in her understanding of this disease.
Hi Valerie, I’m so sorry to hear about your husband’s passing. Losing a loved one is never easy, but I’m overjoyed to hear that it inspired your stepdaughter to start attending meetings. It is so crucial to stay connected to others who are in recovery, especially in those first few months of sobriety. Best of luck to her and you as well!
Hello doctor, my uncle is been drinking alcohol since he was 13 years and now he is 53 years. He drinks what ever he gets but mostly whiskey, which he consumes half a bottle every night but sometimes keeps 2 days of no alcohol day. But luckily he never gets sick not even a flu and hasn’t shown any symptoms of liver or any disease. I am worried about him, what are the chances of him developing liver problem.??!!
Hi Lucy, thank you for your question.
Because your uncle is a heavy drinker and has been for a long time (3-6 shots a day for 10+ years), he has a high chance of developing liver problems unless he stops drinking immediately.
– Fatty liver, the first stage of liver damage from alcohol, affects about 20% of heavy drinkers.
– Alcoholic hepatitis, the next stage, affects 10 – 35% of heavy drinkers.
– Cirrhosis, the most severe form of liver damage from alcohol, affects 10-15% of heavy drinkers.
If your uncle addresses his drinking problem now, there is a good chance his liver can fully recover without permanent damage. Stay strong – your uncle is lucky to have someone like you looking out for him!
Hi Doctor! I found your info here because a friend is in dire trouble from drinking, now in ICU. It’s well written and clear, but I have a suggestion: that cartoon of a lady with jaundice just looks unprofessional or fake. Why not put a photo of a healthy man and a man with jaundice, and better yet, the same man after treatment. That is what people need to see: the real thing! I had never seen anyone with jaundice so I was looking for a real photo. It would also give fortitude to those in despair, that they have ruined their health if they have jaundice. You could show how it can be cured with before/after photos. Please use a man (young and good looking of course) as the men are often the heavy drinkers. Thanks!
Hi Mary, great suggestion! I worked with our design team to incorporate real photos of jaundice skin and eyes instead of the illustration. Thank you for helping us make this blog a better resource. I’m glad you found the information helpful, and I wish you and your friend all the best!
Thank you for this informative information. I have been struggling with alcoholism for some time, and I have started feeling abdominal pain. I am 36 and have been drinking heavily for at least ten years. I've been to rehab a couple times, but haven't been able to maintain sobriety. Now I'm scared I might have damaged my liver.
Hi Matthew, you’re welcome! I know it can get discouraging when you're struggling to stay sober, but don’t give up! Many people don’t get sober on their first try – it doesn’t mean that you can’t do it this time around.
If I could offer you any advice, I would look for an inpatient program with a strong medical team. This way, you’ll have the medical and clinical staff to treat your physical symptoms while you address the root causes of your drinking. The sooner you address both the drinking and the pain, the better. Minor liver damage is reversible, but only if you treat it early.
I have a Fatty liver what can I do to get the fat out of my liver
I have fatty liver disease which progressed to stage 1 NASH during fertility treatments. I did a core restore liver detox to reverse it (recommended by integrative/holistic Dr.) It would be helpful to know what to do if you are in a stage where reversing the disease is possible.
I think some diet guidelines would be helpful such as coffee (hepatologist told me about a study on its positive effects for the liver, after I reversed NASH with a detox) and apple cider vinegar in removing fat and cleaning the liver.
Thanks for your question!
The number one thing you can do to reverse NASH (besides avoiding alcohol) is to maintain a healthy diet and exercise regularly. Reducing your cholesterol level and losing weight are proven to help restore liver function.
test
What causes liver to go bad if not alcohol related?
Hi DR i was drinking for24 Years and i stop IT but i drink wine 4 glass a day can that be a problemas or danger
4 drinks is 4 drinks, regardless of what kind of alcohol it is.
Hi José,
Yes, drinking that much wine can be dangerous. The type of alcohol doesn’t matter. All forms of alcohol, including wine, can cause health problems.
If you’re worried about how much you’re drinking, try taking an online assessment. If you answer Yes to any of the questions, I recommend getting an official assessment from your healthcare provider or a treatment center that specializes in alcohol use disorder.
Best of luck to you!