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The Liver

Drinking too much alcohol can lead to three types of liver conditions - fatty liver, hepatitis, and cirrhosis. You are unlikely to develop these problems if you drink within the recommended safe limits detailed below. For all types of liver disease caused by alcohol, the main treatment is to stop drinking alcohol completely

What does the liver do?

The liver is in the upper right part of the abdomen. Its functions include:

  • Storing glycogen, a chemical made from sugars. When required, glycogen is broken down into glucose which is released into the bloodstream.
  • Helping to process fats and proteins from digested food.
  • Making proteins that are essential for blood to clot (clotting factors).
  • Processing many medicines which you may take.
  • Helping to remove or process alcohol, poisons and toxins from the body.
  • Making bile which passes from the liver to the gut and helps to digest fats.

What happens when you drink alcohol?

When you drink alcohol, it is absorbed into the bloodstream from the stomach and intestines. All blood from the stomach and intestines first goes through the liver before circulating around the whole body. So, the highest concentration of alcohol is in the blood flowing through the liver.

Liver cells contain enzymes (chemicals) which process (metabolise) alcohol. The enzymes break down alcohol into other chemicals which in turn are then broken down into water and carbon dioxide. These are then passed out in the urine and from the lungs. The liver cells can process only a certain amount of alcohol per hour. So, if you drink alcohol faster than your liver can deal with it, the level of alcohol in your bloodstream rises.

What are the problems of drinking too much alcohol?

Drinking over the recommended limits (detailed below) can be harmful. If you drink heavily you have an increased risk of developing:

  • Serious liver problems (alcoholic liver disease).
  • Some stomach disorders.
  • Pancreatitis (severe inflammation of the pancreas).
  • Mental health problems, including depression and anxiety.
  • Sexual difficulties such as impotence.
  • Muscle and heart muscle disease.
  • High blood pressure.
  • Damage to nervous tissue.
  • Accidents - drinking alcohol is associated with a much increased risk of accidents. In particular, injury and death from fire and car crashes. About 1 in 7 road deaths are caused by drinking alcohol.
  • Some cancers (mouth, gullet, liver, colon and breast).
  • Obesity (alcohol has many calories).
  • Damage to an unborn baby in pregnant women.
  • Alcohol dependence (addiction).

In the UK, deaths due to alcohol-related diseases (particularly liver disease) have risen considerably over the last 20 years or so. This is because heavy drinking and binge drinking have become more common. 

The rest of this leaflet is about alcoholic liver disease. See separate leaflets called 'Alcohol and Sensible Drinking' which deals with general aspects of alcohol, and 'Alcoholism and Problem Drinking' which includes information on alcohol dependence.

What is alcoholic liver disease?

Drinking too much alcohol can lead to three types of liver conditions - fatty liver, hepatitis, and cirrhosis. Any, or all, of these conditions can occur at the same time in the same person.

Fatty liver

A build-up of fat occurs within liver cells in most people who regularly drink heavily. In itself, fatty liver is not usually serious and does not cause symptoms. Fatty liver will usually reverse if you stop drinking heavily. However, in some people the fatty liver progresses and develops into hepatitis.

Alcoholic hepatitis

Hepatitis means inflammation of the liver. The inflammation can range from mild to severe.

  • Mild hepatitis may not cause any symptoms. The only indication of inflammation may be an abnormal level of liver enzymes in the blood which can be detected by a blood test. However, in some cases the hepatitis becomes persistent (chronic), which can gradually damage the liver and eventually cause cirrhosis.
  • A more severe hepatitis tends to cause symptoms such as feeling sick, jaundice (yellowing of the skin, caused by a high level of bilirubin - a chemical normally metabolised in the liver), generally feeling unwell and, sometimes, pain over the liver.
  • A very severe bout of alcoholic hepatitis can quickly lead to liver failure. This can cause deep jaundice, blood clotting problems, confusion, coma, bleeding into the guts, and is often fatal.
  • The main treatment for alcoholic hepatitis is to provide adequate nutrition (this sometimes involves passing liquid feeds through a tube in the stomach) and steroids.

Alcoholic cirrhosis

Cirrhosis is a condition where normal liver tissue is replaced by scar tissue (fibrosis). The scarring tends to be a gradual process. The scar tissue affects the normal structure and regrowth of liver cells. Liver cells become damaged and die as scar tissue gradually develops. So, the liver gradually loses its ability to function well. The scar tissue can also affect the blood flow through the liver which can cause back pressure in the blood vessels which bring blood to the liver.

About 1 in 10 heavy drinkers will eventually develop cirrhosis. It tends to occur after 10 or more years of heavy drinking. Note: cirrhosis can develop in people who have never had alcoholic hepatitis.

Cirrhosis can happen from many causes other than alcohol. For example, persistent viral hepatitis and some hereditary and metabolic diseases. If you have another persistent liver disease, and drink heavily, you are likely to increase your risk of developing cirrhosis.

Cirrhosis can lead to end-stage liver disease (liver failure). However, in the early stages of the condition, often there are no symptoms. You can get by with a reduced number of working liver cells. But, as more and more liver cells die, and more and more scar tissue builds up, symptoms start to appear. The eventual symptoms and complications are similar to a severe episode of hepatitis (listed above). However, unlike a bout of severe hepatitis, the symptoms and complications tend to develop slowly.

See separate leaflet called 'Cirrhosis' for more details.

It is not clear why some people are more prone for their liver cells to be damaged by alcohol and to develop hepatitis and/or cirrhosis. But, as a rule, the heavier you drink, and the more regularly that you drink, the more your risk of developing hepatitis and/or cirrhosis.

The scaring and damage of cirrhosis is usually permanent and cannot be reversed. However, recent research has led to a greater understanding of cirrhosis. Research suggests that it may be possible to develop medicines in the future which can reverse the scarring process of cirrhosis.

How is alcoholic liver disease diagnosed?

A doctor may suspect that you have liver problems from your symptoms, and a physical examination. (For example, they may detect that your liver is enlarged, or that you are retaining fluid.) They may especially think of liver problems as a cause of your symptoms if you have a history of heavy alcohol drinking. Some tests may be done:

  • Blood tests may show abnormal liver function. (See separate leaflet called 'Blood Test - Liver Function Tests' for details.)
  • An ultrasound scan may show that you have a damaged liver.
  • To confirm the diagnosis, a biopsy (small sample) of the liver may be taken to be looked at under the microscope. (See separate leaflet called 'Biopsy - Liver' for details.) The scarring of the liver caused by cirrhosis, or the typical features of liver cells with alcoholic hepatitis can be seen on a biopsy sample.

What is the treatment for alcoholic liver disease?

For all types of liver disease caused by alcohol, you should stop drinking alcohol completely. Also, you may be referred to a dietician to review your diet. This is because many people who drink heavily do not eat properly and need advice on getting back into eating a healthy diet. Vitamin supplements may be prescribed for a while.

  • If you have fatty liver, or alcoholic hepatitis which is not severe, you should fully recover from these conditions if you stop drinking alcohol.
  • If you have severe hepatitis and require hospital admission, you may require intensive care treatment. Some people with severe hepatitis will die.
  • If you have cirrhosis, stopping drinking alcohol can improve your outlook. It depends on how severe the cirrhosis has become. If cirrhosis is diagnosed when it is not too advanced, and you stop drinking alcohol, the cirrhosis is unlikely to progress. However, the cirrhosis and symptoms will usually get worse if you continue to drink alcohol. In severe cases where the scarring is extensive, and the liver can barely function, then a liver transplant may be the only option

British Liver Trust (link)