What are the early signs of liver damage?

What are the early signs of liver damage? header graphic

The first stage of liver damage is inflammation, but most people that experience liver damage from drinking do not show any early signs. In fact, liver damage can progress through several stages before they or their doctor notices anything is wrong. Most people do not realize they have a problem until they reach the point where built-up scar tissue is impeding proper liver function. When the symptoms do become noticeable, they usually include:

  • A general sense of being unwell
  • Having a lower tolerance for alcohol
  • Nausea and vomiting
  • Experiencing severe hangovers
  • A lack of appetite
  • Diarrhea
  • Abdominal pain in the upper right quadrant
  • Abdominal protrusion

Healthy Smooth Liver, Damaged Discolored Textured Liver

What are the stages of liver damage?

Liver disease from alcoholism can be divided into the following stages:

  • Inflammation
  • Fibrosis
  • Cirrhosis
  • Liver cancer
  • Liver failure (End-stage liver disease)

As the liver progresses through these stages, the prognosis becomes more serious and it’s less likely that the cells of the liver can recover from the damage they have sustained. Treatment and management of liver damage also becomes more complicated. Liver problems from drinking usually progress from fatty liver to alcoholic hepatitis, and finally to cirrhosis. Once an individual develops cirrhosis of the liver, the damage cannot be reversed. However, abstaining from alcohol and adhering to treatment protocol can prevent the disease and its symptoms from getting worse.  

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. Any pain or abnormalities in this area could signal liver problems.

What is Alcoholic Fatty Liver Disease?

Alcoholic fatty liver disease is a condition of the liver caused by heavy alcohol consumption, seen in 20 percent of chronic drinkers. With this disease, fat deposits build up in the liver (also known as steatosis). This causes inflammation that reduces hepatic function. This inflammation can cause liver pain on the right side of the body, but not always. If left untreated, it will progress into more serious forms of liver damage. I have treated many patients who delayed care at this stage and ended up with permanent liver damage down the road. For treatment to work, the patient has to stop drinking immediately.
Alcoholic Fatty Liver Disease graphic

What is Alcoholic Hepatitis (Liver Fibrosis)?

Alcoholic hepatitis is a condition where the liver becomes inflamed, resulting in damage to the cells of the organ. Roughly 35% of long-term heavy drinkers develop this condition. For many people with fibrosis, there either are no symptoms or they are so minor that patients fail to realize something is wrong. At this stage, liver damage can still be treated, and much of the damage will heal. However, if left untreated or the individual starts drinking again, alcoholic hepatitis is likely to progress into cirrhosis, which is chronic.

Symptoms: Potentially none at first, then:

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Fever
  • Pain or tenderness in the right upper abdomen

In severe cases, there’s a 50% mortality rate. If drinking continues, 40% will develop into cirrhosis.
Alcoholic Hepatitis graphic

What is Alcoholic Cirrhosis?

Alcoholic cirrhosis develops when the scar tissue from alcoholic hepatitis builds up to the point that it overwhelmingly replaces healthy liver tissue. This impairs blood flow and other critical components of healthy liver function. For many people suffering from alcoholic liver damage, this is the stage where symptoms become clearer. Signs that cirrhosis has developed include:

Early Symptoms

  • Feeling tired or weak
  • Poor appetite
  • Losing weight without trying
  • Nausea and vomiting
  • Mild pain or discomfort in the upper right side of your abdomen

Distinct Symptoms

  • Red palms
  • Shortening of muscles in the fingers
  • White nails or thickening and widening of the fingers and nails

Late-Stage Symptoms

  • Bruising and bleeding easily
  • Confusion, difficulty thinking, memory loss, personality changes, or sleep disorders
  • Swelling in your lower legs, ankles or feet
  • Bloating from the buildup of fluid in your abdomen
  • Severe itchy skin
  • Darkening of the color of your urine
  • Jaundice
  • Gastrointestinal bleeding
  • Liver failure

If left untreated, alcoholic cirrhosis is deadly. However, with the right treatment and a commitment to sobriety, upwards of 90 percent of see positive outcomes.

Alcoholic Cirrhosis graphic

How do you know if your liver is failing when there are no early symptoms?

Despite there not being many early symptoms of liver disease and failure, there is a clear indicator that you are likely incurring damage: heavy and/or frequent drinking. If you have a problematic relationship with alcohol, there is a strong chance that your liver has sustained damage.

Long before your body begins displaying symptoms, liver damage can be detected in bloodwork. This is due to liver cells dying at a higher rate than they naturally would. 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. When someone is displaying these symptoms, I order bloodwork checking for these enzymes at the beginning of treatment, and then subsequently follow up as the levels stabilize.

Why do alcoholics get yellow skin?

Yellowing of the skin and eyes is a condition known as jaundice. This occurs when the liver is unable to properly process waste material which is normally excreted in the feces. If the liver is unable to remove it, the material builds up and starts to alter the color of the skin and eyes.

How much drinking causes liver damage?

Because everyone’s biology and genetics are different, there is no way to determine how much alcohol a person can drink before they get liver damage. Most people develop liver damage after years of heavy drinking, but new data suggests that binge drinking can also cause liver issues. The CDC recommends that men should drink no more than 2 drinks per day (1 for women). Exceeding these amounts will put you at a greater risk of developing liver problems.

Can the liver repair itself after years of drinking?

In most cases, the answer is yes. While it is possible for liver damage to be too significant to reverse, most of my patients are able to partially or wholly restore their liver function by stopping drinking and getting the right treatment. Because liver cells can regenerate easier than those of other organs, treatment usually leads to a positive outcome.

  1. The best treatment is early detection.
  2. Stopping your drinking will always improve your outcome.
  3. Addiction treatment centers (like JourneyPure) can help you stop drinking for good.

Sources

National Institute on Alcohol Abuse and Alcoholism: “The Epidemiology of Alcoholic Liver Disease.”
World Journal of Hepatology: Symptoms and Signs of Acute Alcoholic Hepatitis.”
National Institute of Diabetes and Digestive and Kidney Diseases: “Symptoms & Causes of Cirrhosis.”

Responses

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  1. 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.

  2. 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.

  3. 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.

    1. 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!

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