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
- Abdominal pain or discomfort in the upper right quadrant
- Abdominal protrusion
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
- Abdominal pain in the upper right quadrant
- 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
- 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
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 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
|Fatty Liver||check||Stop Drinking|
|Hepatitis||Somewhat||Stop Drinking + Medications|
|Cirrhosis||remove||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 rehab in Tennesse, which also serves the local liver transplant hospitals.
- The JourneyPure 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!
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.
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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]
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