alcoholic liver Alcoholic liver disease (ALD), also known as alcohol-related liver disease, refers to liver damage caused by long-term excessive alcohol consumption. Initially, it is characterized by significant hepatocellular fat accumulation, which can progress to alcoholic steatohepatitis, liver fibrosis, and cirrhosis. Acute severe alcohol abuse in the short term can also lead to acute alcoholic hepatitis, subacute liver failure, and even death.

Patients meeting the clinical diagnostic criteria for alcoholic liver disease can be categorized into several types based on the extent of liver damage:

Mild alcoholic liver disease: Mild abnormalities in one or more tests (liver biochemical markers, imaging, and histology).

Alcoholic fatty liver: Imaging shows fatty liver, with mild abnormalities in liver biochemical markers.

Alcoholic hepatitis: Can occur at any stage of alcoholic liver disease, characterized by elevated serum transaminases, elevated gamma-glutamyl transferase levels, usually accompanied by increased serum bilirubin, and may be associated with fever and increased peripheral neutrophil count. Severe cases with jaundice, coagulopathy, and hepatic encephalopathy constitute severe alcoholic hepatitis.

Alcoholic liver fibrosis: Patients may not exhibit characteristic symptoms, signs, or routine laboratory and ultrasound findings. Serum liver fibrosis markers and liver transient elastography values may be elevated, and further confirmation may require liver biopsy.

Alcoholic cirrhosis: Symptoms and signs of cirrhosis are present, and liver transient elastography values are significantly elevated. Imaging findings such as ultrasound and CT align with the manifestations of cirrhosis.

Amount and duration of alcohol consumption: Alcoholic liver disease results from long-term excessive alcohol consumption, therefore, the greater the amount and duration of alcohol intake, the greater the damage to the liver. Short-term excessive alcohol consumption can also cause severe liver damage or liver failure.

According to epidemiological data, alcohol-induced liver damage exhibits a threshold effect, meaning that reaching a certain amount of alcohol consumption or duration significantly increases the risk of liver damage.

The amount of alcohol that leads to alcoholic liver disease varies among individuals, but generally, an average daily intake of excessive alcohol over five years (≥40g for males, ≥20g for females), or heavy drinking over two weeks (daily alcohol intake ≥80g) can lead to the disease.

Alcohol intake (g) = alcohol volume (ml) × alcohol content (%) × 0.8 (specific gravity of alcohol)

Alcoholic fatty liver: Patients often have no clinical symptoms; a few may experience nonspecific symptoms such as decreased appetite, fatigue, diarrhea, abdominal distension, and discomfort in the liver area.

Alcoholic hepatitis: Typically presents with liver area pain shortly after alcohol consumption, with manifestations varying based on the extent of liver tissue damage. As liver damage progresses, patients may experience abdominal pain, loss of appetite, jaundice, itching, low-grade or high-grade fever, and chills.

Alcoholic cirrhosis: Similar to cirrhosis caused by other factors, it primarily presents with portal hypertension and liver dysfunction, with manifestations such as ascites, portal-systemic collateral circulation (esophageal varices, abdominal wall varices, internal hemorrhoids, etc.), splenomegaly, malabsorption (decreased appetite, nausea, bloating, diarrhea after consuming meat), jaundice, spider nevi, palmar erythema, gastrointestinal bleeding, easy bruising, and petechiae.

Abstinence from alcohol

Abstinence from alcohol is a key measure in treating alcoholic liver disease; all patients must abstain from alcohol. This can help improve the prognosis, decrease the extent of liver damage, reduce portal vein pressure, slow the progression of liver fibrosis, and increase patient survival rate. Patients who find it difficult to abstain from alcohol can gradually reduce alcohol consumption and may take oral chlordiazepoxide. Alcohol-dependent individuals should be mindful of preventing and managing alcohol withdrawal syndrome, which can be treated with sedatives. Withdrawal symptoms are most severe in the initial 48 hours after the last drink and typically resolve within 3-7 days; some patients may experience sleep disturbances after abstinence, which often resolve on their own within a month. To prevent alcohol withdrawal syndrome, patients can gradually reduce alcohol intake.

Nutritional support

Long-term alcohol abusers often develop malnutrition. Patients with alcoholic liver disease require good nutritional support, including a high-protein, low-fat diet in addition to supplementation with vitamins B, C, K, and folic acid. In cases of severe alcoholic hepatitis, nocturnal meals should also be considered to prevent muscle wasting. However, if patients with alcoholic liver disease are overweight or have abdominal obesity, controlling total calorie intake and appropriate weight loss are necessary for complete recovery from liver disease.

Due to significant individual differences, there is no absolute "best," "fastest," or "most effective" medication. Apart from commonly used over-the-counter drugs, the most appropriate medication should be selected in consultation with a doctor, taking into account individual circumstances.

Glucocorticoids: Used only in patients with severe alcoholic hepatitis to improve survival rates.

Hepatoprotective and anti-inflammatory drugs: In patients with elevated liver enzymes, especially those with alcoholic hepatitis, drugs such as polyene phosphatidylcholine, metadoxine, reduced glutathione, S-adenosylmethionine, glycyrrhizin preparations, silymarin, and N-acetylcysteine can be used to enhance the antioxidant capacity of liver cells and expedite liver cell repair. Under a doctor's guidance, 1-2 hepatoprotective and anti-inflammatory drugs should be selected and taken for at least one year.

Vitamins: Patients with alcoholic liver disease often have deficiencies in vitamins and trace elements. They can take a daily dose of a multivitamin preparation for six months to a year.

When a patient with alcoholic liver disease suffers severe liver damage, it can lead to liver failure. Liver transplantation is currently the only effective treatment for irreversible liver failure. After rigorous medical evaluation, the patient needs to meet the following conditions to be considered for a liver transplant:

The patient has quit drinking and received active treatment, but severe hepatitis and liver failure show no improvement.

The patient is in good physical condition and can undergo liver transplantation surgery.

Before surgery, the patient is required to have quit drinking, and the patient must commit to permanent abstinence from alcohol.

The patient has no severe alcohol-related damage to other organs.

If patients with alcoholic liver disease continue to drink and do not receive timely and effective treatment, they may experience a series of severe complications, including esophageal varices rupture, hepatic encephalopathy, infection, primary liver cancer, electrolyte and acid-base imbalance, hepatorenal syndrome, hepatopulmonary syndrome, and portal vein thrombosis.

Esophageal varices rupture

Portal hypertension is the most common complication of cirrhosis and is sometimes seen in patients with alcoholic hepatitis. If portal vein pressure rises to a certain level, the blood vessel walls of esophageal varices may rupture, leading to hematemesis or melena. Emergency gastroscopy can confirm the diagnosis and provide hemostatic treatment.

Complications related to ascites

When portal hypertension is combined with a decrease in plasma albumin levels, fluid may accumulate in the abdomen and around the intestines, known as ascites. Ascites is a manifestation of severe alcoholic hepatitis and decompensated cirrhosis, requiring a low-salt diet, increased nutrition and rest, and the use of diuretics for treatment. Ascites increases the risk of infection, such as spontaneous bacterial peritonitis, and can lead to electrolyte and acid-base imbalance, acute kidney injury, and hepatorenal syndrome (renal failure).

Hepatic encephalopathy

One of the liver's main functions is to remove toxins from the intestines that enter the bloodstream. If the liver is damaged, it can lead to an increase in toxins in the blood, affecting normal brain function, known as hepatic encephalopathy. Patients may exhibit restlessness, confusion, orientation disorders, muscle rigidity, muscle tremors, speech difficulties, and even coma. Patients with hepatic encephalopathy require timely hospitalization.

Infection

Liver damage weakens the immune system, reducing the patient's immunity and increasing the risk of infection, mainly spontaneous bacterial peritonitis, as well as urinary and respiratory system infections, requiring targeted antibiotic treatment.

Primary liver cancer

Long-term excessive drinking leading to alcoholic liver disease increases the incidence of liver cancer, with approximately 3% to 5% of cirrhosis patients developing liver cancer each year.

Family members should provide psychological support and supervision to help patients reduce alcohol consumption and quit drinking early, and prevent them from drinking again after quitting. Patients may experience alcohol withdrawal symptoms in the early stages of abstinence (such as tremors, restlessness, sweating, nausea, vomiting, delirium, hallucinations, and seizures; severe cases may have convulsions or epileptic-like spasms), and family members should provide special care, using sedatives for calming treatment as needed, and even seek medical treatment. Monitor the patient's condition closely and seek medical attention if any abnormalities arise. Supervise the patient to go to the hospital for regular follow-up examinations.

Patients should pay attention to a balanced and healthy diet, timely supplement protein, energy, vitamins, and trace elements, eat small meals frequently, and have a light diet. Engage in appropriate exercise to prevent muscle atrophy, aiming for a brisk walk of over 20 minutes each day and incorporating resistance training. Medication should be strictly taken as prescribed, avoiding drugs that cause significant damage to the liver. Make every effort to quit drinking, and avoid taking medication with alcohol.