ALCOHOL AND ITS EFFECTS ON THE LIVER

In many societies alcohol is the most common cause of chronic liver disease. In fact it has become a major source of concern in our communities because it accounts for a high percentage of deaths among the youths especially male within the age range of 25 – 35 years.

HOW DOES ALCOHOL CAUSE LIVER DAMAGE?

Alcohol is metabolised almost exclusively by the liver, alcohol is a powerful inducer of mixed-function enzymes called oxidases and these enzymes break down alcohol into toxins called acetate. Acetate is toxic to the liver cells (hepatocytes); the amount of acetate in the blood depends on the quantity of alcohol ingested therefore persistently high levels of acetate in the blood results in liver damage hence liver disease.

Five years or more than 10 years of drinking is required to produce alcoholic cirrhosis and a steady daily intake is more hazardous than intermittent drinking.

Alcohol causes several lesions in the liver which can occur either singly or in combination and can be seen by the aid of the electron microscope. These include:

Fatty liver (steatosis), Mallory Hyaline, Siderosis, Autoimmune hepatitis, Fibrosis, Cirrhosis and Hepatocellular Carcinoma

PRESENTATION OF ALCOHOLIC LIVER DISEASE

Alcohol liver disease manifests as a spectrum ranging from non – specific symptoms with few or no physical abnormalities to advanced cirrhosis, liver failure and eventually death.

Laboratory investigations can pick up early liver disease in asymptomatic persons usually undergoing routine general medical examinations.

Alcoholic liver disease is classified into four clinical syndromes they are: (i) Fatty Liver – characterised by; Asymptomatic and Hepatomegaly (enlarged liver)

(ii) Hepatitis (Inflammation of the liver) characterised by; Severe generalised illness, Malnutrition, Jaundice, Hepatomegaly, Ascites (collection of excess fluid in the abdomen) and Encephalopathy (irritation within the brain)

(iii) Cholestasis (Biliary or bile obstruction) – characterised by; Jaundice, Abdominal pain and Hepatomegaly (often tender)

(iv)         Cirrhosis (End state liver disease)

INVESTIGATIONS OF ALCOHOL ABUSE

Investigations are aimed at excluding other causes of liver disease or liver damage. It is also aimed at assessing the severity of liver damage.

Clinical history from the patient, relatives, parents or friends is very important. History helps to establish alcohol abuse, duration of drinking and also the estimated quantity of alcohol intake per unit time.

The universally used indicators to biologically confirm alcohol abuse is the presence of macrocytes in peripheral blood examination. However, absence of this marker does not exclude alcohol abuse.

Investigations of the extent of liver damage often requires a liver biopsy, abnormally high levels of liver enzymes also indicates chronic liver damage.

MANAGEMENT OF ALCOHOLIC LIVER DISEASE

Caseation of alcohol intake is the single most important treatment. Lifelong abstinence from alcohol consumption is the best advice and is essential for those with severe liver damage.

Good nutrition is essential; other forms of management include the treatment of complications of liver damage. These complications are –

(1)          Ascites (Abnormal fluid collection within the abdomen)

(2)          Encephalopathy (Irritation within the brain due to high bilirubin levels)

(3)          Oesophageal varices / variceal bleeding – these are dilated veins within the oesophagus. These may rupture causing severe bleeding, anaemia and death

(4)          Malnutrition – Due to malabsorption and poor digestion. This is characterised by weight loss, poor strength, poor immunity, anaemia etc

(5)          Liver cirrhosis

(6)          Liver Cancer (Hepatocellular carcinoma) – ultimately, chronic liver damage leads to liver failure and then DEATH.               

PROGNOSIS OR OUTCOME OF ALCOHOL LIVER DISEASE

The most important prognostic factor is the patient’s ability to stop drinking. General health and longevity are improved when a patient stops drinking irrespective of the stage of liver disease. Alcoholic fatty liver has a good prognosis and usually disappears after about 3 months of abstinence. Alcoholic hepatitis has a significantly arouse prognosis because about one third of the patients die in the acute episode if liver function is poor. Patients despite stopping drinking may still progress to cirrhosis; however progress to liver cirrhosis is almost certain if drinking continues.