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Alcoholic Liver Disease (ALD)

Overview

Alcoholic liver disease (ALD) or alcohol-related liver disease is an umbrella term for a group of liver diseases caused due to excessive alcohol consumption over time. ALD is a progressive condition and individuals with early ALD may be asymptomatic (not outwardly show any symptoms), with simple steatosis (fat accumulation in liver also known as alcoholic fatty liver disease) or alcoholic steatohepatitis (an advanced stage of alcoholic steatosis associated with inflammation and cell damage) and early-stage fibrosis (reversible accumulation of collagen in the liver), while patients with advanced ALD may have advanced fibrosis (irreversible, widespread fibrosis), which can cause cirrhosis and associated complications (hepatocellular carcinoma), alcohol-associated hepatitis with jaundice, portal hypertension, and/or acute-on-chronic liver failure. Thus, ALD includes a range of conditions, including alcoholic fatty liver disease (alcoholic steatosis), alcoholic steatohepatitis, fibrosis, portal vein hypertension, alcohol-associated hepatitis, cirrhosis, liver failure, and hepatocellular carcinoma.

Excess and prolonged consumption of alcohol is the primary cause of ALD. The liver breaks down alcohol into smaller molecules, leading to detoxification but drinking too much alcohol over a prolonged duration can overwhelm this ability, leading to the development of ALD.

  • Heavy drinking
  • Genetic factors
  • Nutritional deficiencies: Alcohol interferes with the absorption of essential nutrients, a phenomenon that can contribute to liver disease.
  • Coexisting conditions: Pre-existing conditions, like metabolic syndrome, viral hepatitis, or obesity, can increase the risk of developing ALD.

Symptoms may vary depending on disease severity. Common symptoms have been enumerated below:

  • Fatty liver (alcoholic steatosis)
  • Slight discomfort in the upper abdomen.
  • Jaundice
  • Swelling of the lower limbs (oedema)
  • Fluid buildup in the abdomen (ascites)
  • Itchy skin
  • Fever and shivering
  • Excessively curved fingernails
  • Muscle weakness
  • Blood in vomit or stools
  • Easy bleeding and bruising
  • More sensitive reactions to alcohol or drugs
  • High blood pressure in the liver (portal hypertension)
  • Bleeding from veins in the oesophagus (oesophageal varices)
  • Confusion and behavioural changes (hepatic encephalopathy)
  • Enlarged spleen
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