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May 2010
Alcohol and Your Liver
Dr. Shravan Bohra
Most people mistakenly think that alcohol is fairly harmless and just something to be enjoyed. Other than a few illeffects the next day, and maybe putting on a bit of extra weight, it will not have any long lasting effects.
It is a mistake to think that you have to be a heavy drinker to run into problems. Although it can take as long as 10 to 15 years, drinking just a bit more than you should, over time, can seriously harm your liver. Not feeling any side effects from drinking does not mean that you are not risking chronic ill-health or lasting liver damage from alcohol-related liver disease.

What happens to the liver if you drink too much?
Your liver can only handle a certain amount of alcohol at any given time (one unit an hour). When the liver is processing alcohol it produces a substance called acetaldehyde. This has a toxic effect on the liver itself, as well as the brain and stomach lining. This is what causes your hangover.

Fatty liver
When the liver breaks down alcohol, it stores the fat in your liver. There should be little or no fat in a healthy liver. Too much of this fat can build up if you drink more than the liver can cope with, leading to fatty liver disease.

Alcoholic hepatitis
If you have a fatty liver and continue to drink, you have up to a one in three chance of getting alcoholic hepatitis. This is a condition where your liver becomes puffy, swollen and tender. It can affect you suddenly – after a weekend of binge drinking, for example – and if your liver fails, it can kill you. Alcoholic hepatitis can happen to you at an early stage or after many years of excessive drinking.

The final stage of alcoholic liver disease is cirrhosis. This is usually the result of long-term, continuous damage to the liver. Irregular bumps, known as nodules, replace the smooth liver tissue and the liver becomes harder. By the time you discover you have cirrhosis your quality of life may be severely damaged, as your liver will have stopped working efficiently. If you carry on drinking at this stage you will speed up the damage to your liver and rapidly increase your chances of dying. The odds are two in ten that you will develop cirrhosis if you drink too much over a long period of time. People with cirrhosis also have a much higher chance of getting liver cancer.

By the time you discover you have cirrhosis your quality of life may be severely damaged, as your liver will have stopped working efficiently

The symptoms and signs
Your liver can withstand years of damage by repairing itself and protecting the rest of your body. However, the liver is unable to signal real distress until it is in the end stages of liver failure, so that by the time you feel any symptoms of liver problems, the damage may be done.

If you have alcoholic liver damage you may have symptoms such as:
  • Feeling some pain in the liver area, that is the right side of your upper abdomen
  • Having a general feeling of poor health and fatigue
  • Loss of appetite
  • A sick, nauseous feeling, especially in the mornings and often accompanied by diarrhoea
If you have any of the following specific symptoms, it is likely that your liver is already quite badly damaged and you should talk to your doctor at once.
  • Yellow eyes or, in more severe cases, yellow skin (jaundice)
  • Vomiting blood
  • Dark black, tarry, stools
  • Significant weight loss
  • Periods of confusion or poor memory
  • Swelling of the abdomen or the ‘tummy’ area and legs
  • Itching

Stop drinking: The most effective way to treat alcoholic liver disease is to stop drinking.

Diet: Drinking alcohol can lead to malnutrition. For this reason, eating well is important in helping your liver recover. If you have alcoholic liver damage it is likely that you lack vitamins, in particular thiamine (a B vitamin that helps the body convert carbohydrates into energy).

Other treatments: If you have severe alcoholic hepatitis you may have to be admitted to hospital. You may also need to be admitted to a critical care unit. For people with alcoholic cirrhosis there is no specific treatment other than to stop drinking or, if available, undergo a liver transplant.
Dr Shravan Bohra is Chief Liver Disease Specialist at Apollo Hospitals, Ahmedabad

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