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Alcoholic cirrhosis is one of a number of alcohol-related liver diseases (ARLDs). It is by far the worst ARLD. Its effects can be managed but it is currently incurable.

In this informational page, we go over the causes of cirrhosis, its symptoms, risk factors and complications. We also look at the various stages of cirrhosis, as well as some of the treatments.

Alcohol, the liver and ARLDs

Before we get into the details of alcoholic cirrhosis, it may be helpful to give a quick run-down of what constitutes an alcohol-related liver disease, and some other examples of ARLDs.

Alcohol-related liver disease is (as the name suggests) a disease of the liver caused by drinking too much.

Drinking too much alcohol causes liver disease because alcohol is a toxin, and the liver is the organ of the body tasked with breaking down toxins.

Every time the liver has to break down alcohol it causes a small amount of damage. Over time this damage gets worse and worse, until – in those who drink excessively – we start to see a level of damage that begins to impair the liver’s functionality.

The first stage of ARLD is fatty liver disease or steatosis. This is when a large amount of fat builds upon the liver. In most cases, it can be treated by a few weeks’ abstinence and is relatively harmless.

However, if left untreated it can lead to other complications and diseases, such as fibrosis (scarring), liver cancer and cirrhosis.

The second stage is alcoholic hepatitis. Less well-known than other forms of hepatitis, such as hepatitis C, alcoholic hepatitis is a very dangerous form of ARLD which causes inflammation of the liver. More serious than fatty liver disease, it can also lead to symptoms, such as fatigue, tenderness of the abdomen and jaundice.

The third and final stage of ARLD is cirrhosis. Cirrhosis is the most dangerous of the ARLDs. As stated above there is currently no cure for cirrhosis.

What is alcoholic cirrhosis?

Alcoholic cirrhosis is a build-up of scar tissue in the liver. This scar tissue is a direct result of the reaction which happens in the liver when alcohol is broken down. Too much scar tissue and the capacity of the liver to do its job is reduced.

However, the liver is very resilient and can continue to work despite a number of its cells being incapacitated. This means that some people with cirrhosis may not even know until their cirrhosis becomes more serious.

Some terminology: when someone is suffering from cirrhosis, but their liver is still managing to function, this is called compensated cirrhosis. When there is too much scar tissue for the liver to work properly, this is called non-compensated cirrhosis.

What are the effects of cirrhosis on the body?

In this section, we take a brief look at the science behind cirrhosis, and how it damages your body.

Under normal conditions, the liver does several important things. It produces proteins which help the blood to clot, it breaks down toxic chemicals, it controls the provision of glucose and lipids as fuel, and it produces bile.

Apart from the production of bile, all of these functions rely on the liver cells being close to the portal vein. The portal vein is a vein which carried blood from the intestines to the heart.

When liver cells get damaged, they are no longer able to control the level of substances such as alcohol or glucose in the blood. Furthermore, the scarring in the liver slows the blood in the portal vein down. This causes something called ‘portal hypertension’.

The liver’s role in the production of bile is also hampered. Bile helps digestion and is vital in ridding the body of toxins. When liver cells are damaged, they don’t produce enough bile. This slows down digestion and leads to a build-up of toxins.

What are the stages of cirrhosis?

Cirrhosis is the final stage of alcohol-related liver disease, which comes after inflammation (often associated with hepatitis) and scarring (fibrosis).

There are also four stages to cirrhosis.

  • Stage 1: Known as compensated cirrhosis, this is when there is a small amount of scarring, but the liver is still working. It is unlikely that there will be any symptoms at this point
  • Stage 2: Portal hypertension (a blockage in the portal vein) gets worse
  • Stage 3: At this point, the liver is now decompensated, which means that it has stopped working properly. There are considerable inflammation and scarring
  • Stage 4: At this point, cirrhosis has destroyed the liver completely. A transplant may be necessary to avoid death

What are the signs and symptoms of alcoholic cirrhosis?

Since the liver is responsible for so many things in the body, and cirrhosis entails the total or partial shutdown of the liver, the list of symptoms of cirrhosis is pretty extensive.

Those suffering from cirrhosis may only have a few of these symptoms. However, as the disease progresses, they may begin to see more of them, unless they stop drinking and take steps to halt the spread of the disease.

Here is the list of symptoms:

  • Bleeding in the mouth
  • Brain fog, confusion and memory loss
  • The build-up of fluid in the legs and abdomen
  • Changes in personality
  • Darker urine
  • Difficulty breathing
  • Difficulty with walking and mobility
  • Dizziness
  • Fevers and a higher risk of infection
  • Hair falling out
  • Insomnia
  • Jaundice
  • Losing weight
  • Loss of muscle definition
  • Rapid heartbeat
  • Red palms
  • Reduced appetite
  • Vomiting blood

If you or a loved one are suffering from any of these symptoms, please do not hesitate in contacting a doctor.

How much alcohol causes cirrhosis?

There isn’t an exact science to determining what amount of alcohol is sufficient to trigger cirrhosis. It depends on several factors, including sex and genetics.

For instance, women may be at risk of cirrhosis if they average 2 drinks a day for ten years, whereas men need to drink between three and five drinks a day for the same period in order to have the same level of risk.

The risk of cirrhosis depends more on the length of time spent drinking than on amount drunk. So someone may develop cirrhosis even when drinking moderately if they drink for a long enough period.

Generally speaking, given the severity of the condition, and the relative hardiness of the liver, one needs to drink a large amount of alcohol over a long period of time to run the risk of cirrhosis.

But there are exceptions, and some develop cirrhosis at an early age. One way to minimise the risk cirrhosis is to drink in moderation or not at all.

How do doctors diagnose cirrhosis?

The first thing a doctor will do in order to diagnose an alcohol-related liver disease is to ascertain the patient’s levels of alcohol abuse over time. Several years of heavy drinking will make the presence of an ARLD much more likely.

As far as tests go, there are several that doctors can perform in order to check if someone has cirrhosis.

These are mainly blood tests, Someone with cirrhosis may have any or all of the following:

  • Low levels of magnesium, potassium and sodium in the blood.
  • Portal hypertension
  • Unhealthy liver tissue
  • Too many white blood cells (leukocytosis)
  • Anaemia
  • High blood sugar and blood ammonia

Before making a diagnosis, the doctor will also make sure that the patient is not suffering from another ARLD, such as alcoholic hepatitis.

What are the risk factors in developing alcoholic cirrhosis?

The main risk factor in developing alcoholic cirrhosis is alcohol abuse. Those who abuse alcohol for an extended period of time, without giving their liver a break, are the most likely to develop this disease.

The risk is also higher in women since they do not have as many enzymes in their stomachs with which to digest alcohol. This puts more stress on their livers.

Finally, those who are obese and those who are suffering from hepatitis C are more at risk from ARLDs generally.

Having said that, only 8-20% of long-term heavy drinkers develop alcoholic cirrhosis, compared to 10-35% who contract alcoholic hepatitis. [1]

Complications of alcoholic cirrhosis

Due to the central role played by the liver, alcoholic cirrhosis can lead to several unpleasant complications.

These include:

  • The build-up of toxins in the brain. The liver’s job is to rid the body of toxins. When it stops doing this, these toxins get free rein to travel the body. When they amass in the brain, this is called ‘hepatic encephalopathy’. It can lead to confusion, and, in extreme cases, coma.
  • One of the complications associated with alcoholic cirrhosis is that the body is less able to deal with infections. It can be very difficult to get rid of the infection once it has been contracted.
  • It is very common for those with cirrhosis to experience malnutrition. ‘It has long been established that patients with ALD […] are nearly all malnourished, and the degree of malnutrition correlates with disease severity.’ [2]
  • Bone disease. It is much easier to break a bone when you are suffering from a severe case of cirrhosis because your bones get weaker.
  • Cirrhosis can cause the spleen to get bigger, as platelets and white blood cells flood into it.
  • Liver cancer. Cirrhosis is one of the leading causes of liver cancer.
  • Multi-organ failure. So important is the liver to the body’s processes, several organs can fail if the liver fails.

How is cirrhosis treated?

The emphasis in treating alcoholic cirrhosis is on slowing the progress of the disease since currently there is no known cure. There are several good ways to slow down cirrhosis, which we will go through in this section.

The first and most important step in treating cirrhosis is to stop drinking. This is crucial since any continued alcohol abuse will only create more scarring and render the liver even more incapable of doing its job.

Quitting alcohol should not be attempted alone. If you are suffering from alcohol addiction, you should strongly consider going to a rehab where a medical professional can perform a detox. Detoxing by yourself can be very dangerous.

Another important step for slowing down cirrhosis is to start on a nutritional plan. As mentioned earlier, many cirrhosis sufferers are severely underweight. A nutritionist can help to get you back to a healthy weight by recommending certain foods.

The added protein is also a good way for those with cirrhosis to prevent brain disease caused by toxins entering the brain.

There are several medications to take as well: these include antioxidant supplements, calcium channel blockers, corticosteroids, insulin, and S-adenosyl-L-methionine (SAMe).

Finally, if a patient with cirrhosis has been abstinent for several months they may apply for the waiting list for a liver transplant. This is the most effective treatment for cirrhosis but there is always a long waiting list to receive a new liver.

Final thoughts

This informational page has looked at alcoholic cirrhosis. It has gone through the science behind this disease, the symptoms it causes, risk factors, complications and treatments.

Alcohol-related liver diseases are unfortunately on the rise in the UK. In order to combat this, people need to educate themselves on the dangers and risks of alcohol.

Though it remains one of the most socially-acceptable drugs, alcohol can be incredibly damaging to the body, as will be clear to anyone who has seen the horrific symptoms associated with cirrhosis and other alcohol-related liver diseases.

One prevention method for cirrhosis is simply not drinking in the first place, or drinking in moderation. If you or a loved one needs help to quit drinking, don’t hesitate in checking into a rehab, where a trained medical professional can provide you with a detox.

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036962/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036962/