Alcohol, liver cirrhosis, and the point of no return

A 40-year-old male with a long history of daily alcohol consumption presented with yellowish discoloration of the eyes and urine, swelling of the lower limbs, and progressive abdominal distention over a short span of 15 days. These symptoms, which were ignored in the early stages (as is common), revealed significant liver damage. Medical testing and imaging showed severe liver disease, revealing how slowly alcohol-related liver damage might proceed.

In this case, the diagnosis of cirrhosis was confirmed after  scan results from an abdominal ultrasonography that also revealed a substantial buildup of fluid— known as ascitic fluid—in the abdominal cavity. Bilirubin levels were high, well outside the usual maximum limit of 1.2 mg/dL. Put together, these tests showed that this patient’s liver had reached decompensation due to liver cirrhosis, an important point at which the liver can no longer adequately perform all its basic metabolic and detoxifying processes.

Alcohol and liver disease

Alcohol-related liver disease goes through various phases, the first of which is steatosis (fat buildup). Steatosis can be completely reversed if individuals stop drinking alcohol. Hepatitis is defined as the development of acute inflammatory changes within the liver due to alcohol consumption, and can appear as a change in liver function (i.e., liver parameters/levels), jaundice, abdominal pain, and worsening liver function; alcoholic hepatitis can appear with multiple levels of clinical severity, but if the patient remains abstinent and receives nutritional support and appropriate medical treatment, the outcomes of alcoholic hepatitis are reversible.

The most severe form of liver disease is cirrhosis. At this point, scar tissue that cannot be healed completely replaces healthy liver cells. This scar tissue leads to a condition known as portal hypertension, with further possible concerns such as fluid buildup in the abdominal cavity (ascites), bleeding from varices, infections, and issues with brain function (hepatic encephalopathy). As such, a patient with cirrhosis has a poor prognosis. Medical intervention can stabilise the patient’s liver, but it won’t undo any structural damage or alterations.

No ‘safe’ alcohol amounts

It is commonly believed that there is “safe” limit to alcohol intake, an amount one can consume that does not damage the liver. . This is a dangerous myth: there is no set amount of alcohol that is safe for anybody. It has been shown that most men develop alcoholic liver disease after consuming an average of 40–80 grams of alcohol per day, whereas women develop this condition after consuming an average of 20–40 grams of alcohol per day. However, this does not imply that those who consume less alcohol are not at risk of developing liver disease: nutrition and concomitant metabolic disorders can also influence a person’s risk.

What patients should know

If a patient is diagnosed with steatosis or alcoholic hepatitis, the most important step is to entirely abstain from alcoholic drinks, since at these stages of the disease, a person can still recover their health. For cirrhosis, a liver transplant surgery is often the only effective treatment; this procedure is the last option for those who continue to suffer problems related to liver deficiency, even after receiving all the necessary medical care for this complicated condition.

What is crucial to understand is the need to treat liver cirrhosis early, rather than trying to cure cirrhosis-related issues after a patient has reached this irreversible stage. Early detection of alcohol-related liver disease and quitting alcohol intake can prevent cirrhosis and the eventual need for surgery and transplants.

(Dr. Aditya Girish Borawake is a consultant in medical gastroenterology at Manipal Hospital, Kharadi, Pune. aditya.borawake@manipalhospitals.com)