Loose bowel motions may be due to an infection (gastroenteritis) but if the symptoms persist for more than 3 weeks then other conditions need to be considered. Sometimes the problem is......

Alcohol and the Liver

The long term results of excess alcohol is cirrhosis - this is scarring and nodularity of the liver
Excess fat in the liver - commonly caused by too much alcohol

Alcohol is one of the most common cause of liver disease and liver-related death in most western countries.

  • Risk factors for developing alcohol-related liver disease.
    • The risk varies widely from person to person.
    • Some people will never develop liver disease despite very high alcohol intake over many years.
    • Some people will develop cirrhosis when they have consumed alcohol at only just over the considered safe limits.
    • “Safe levels” of alcohol are: 21 units per week for men;14 units per week for women (1 unit = 10g of alcohol or one standard drink).
    • There is an increased risk of liver disease in females (given the same alcohol intake).
    • Only 10-20 % of people with major dependency on alcohols (alcoholics) develop cirrhosis. This suggests that there is a genetic susceptibility.
    • There is an increasing amount of alcohol-related liver disease in our community.
    • Poor nutrition and obesity aggravate the problem (see section on fatty liver).
    • Hepatitis B or Hepatitis C infection are important additional risk factors for serious liver disease.

How is the liver disease or "damage" from alcohol diagnosed?

  • Blood tests.
    • Often the first indication of a problem is the “incidental finding” of abnormal liver enzymes on routine blood test.
    • The GGT liver enzyme may be disproportionately raised. This doesn't prove alcohol as the problem as the same pattern of tests can be seen with fatty liver that is not due to alcohol.
    • A raised serum ferritin can be a clue. Tests of iron studies may have been part of routine tests. The ferritin level is high in fatty liver, particularly if due to alcohol.
  • Abdominal ultrasound.
    • There may be an incidental finding of fatty liver on ultrasound. One significant risk factor for this condition is high alcohol intake.
  • Some people are unaware of a problem until there is an admission to hospital with serious liver disease.
    • Alcoholic hepatitis is the consequence of heavy drinking over many years and can be fatal. The symptoms are nausea, vomiting, upper abdominal pain, fever, and jaundice.
    • Cirrhosis of liver (a severe from of scarring of the liver) may have been slowly developing over years without any symptoms. The condition becomes apparent because of complications of cirrhosis. This can be the sudden accumulation of fluid in the abdomen or the sudden onset of vomiting of blood.
  • A Fibroscan is very helpful to determine if there is fibrosis of the liver.  This cannot be seen on normal ultrasound. Fibrosis can be divded into stages - even early stage fibrosis is important but severe fibrosis usually means the development of cirrhosis and the risk of serious complications from advanced liver disease  A liver biopsy may be required to assess the severity of the liver disease but may be avoided now using a Fibroscan.
    • A liver biopsy will help confirm alcohol as the cause of the liver disease and  may show fatty liver only, alcoholic hepatitis or cirrhosis.



What is the treatment?

  • The only successful treatment is complete abstinence from alcohol.
    • Stopping a habit of a lifetime (plus the possible physical dependance on alcohol ) means this is a difficult change - however the knowledge that there is now a physical effect of the alcohol with significant risk of harm can be enough to motivate change
    • Fatty liver is a completely reversible condition.
    • Scarring, fibrosis or cirrhosis (a condition with severe fibrosis) is not reversible.
    • However even when this stage has been reached there is still a better outcome with abstinence from alcohol.
    • Alcoholic hepatitis often requires hospital admission. A full recovery is possible with complete abstinence but may take several months. The diagnosis of alcoholic hepatitis is a sign that cirrhosis will develop rapidly if there is ongoing alcohol intake.
  • Liver transplantation is possible for advanced cirrhosis due to alcohol.
    • This would only be considered if there has been abstinence for a significant period of time.


Useful links


American Liver Foundation www.liverfoundation.org


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