What are the symptoms of liver disease?

alcoholic liver disease, when do the signs and symptoms show up

• My husband drinks a minimum of 12 ounces of 80 proof vodka every night. He is 5" 5' tall, weighs aroung 135. The alcohol drinking has been a consistent nightly pattern for approximately the past 8 years. He has drunk on and off since I met him 35 years ago. Many times he drinks more than 12 ounces. He is 59 yrs old. He sees his Dr. regularly. His Dr. has no idea how much he drinks. He eats well and exercises regularly. He has high blood pressure for which he takes antihypertensives. He gets defensive and is in denial about his drinking. I recently convinced my husband, after a bad binge weekend, that his blood pressure was sky high the next day due to excessive drinking. My husband finally agreed with what I said about his blood pressure being related to his drinking, he agreed that I was only concerned about his health, that is how I got him to commit to only 12 ounces every night. Yet he had just seen his Dr. the week before. He was declared in good health. They did blood work, lipid panel, basic metabolic panel, ALT, UA, TSH, and PSA. All came out normal. So my husband thinks he is in good health. Is there other blood work my husband should have done to make sure he hasn't already started to destroy his liver? Or can my husband's body somehow handle what he drinks?

• Answer:

  Hi Rintin, I?ll answer the last part of your question first. You say the tests your husband had run were ?lipid panel, basic metabolic panel, ALT, UA, TSH, and PSA.?. Was an LFT, or Liver Function Tests panel run? This would include the ALT along with an AST, ALP, Total Bilirubin, GGT, Total protein, and Albumin. Some doctors and labs may toss in an SEP (Serum electrophoresis) and a Protime (to detect clotting disorders). A relatively new test that is more specific to alcohol consumption could be ordered, if the doctor suspected your husband had a problem with alcohol. This test is called CDT, carbohydrate-deficient transferrin. (There?s more about this test further on in the answer). None of these tests are completely specific for diagnosing liver problems, meaning one can have early liver disease that the tests may not reveal. Considering the volume of alcohol your husband consumes, his doctor should be apprised of this fact. You can call the doctor?s office and ask the nurse to make a chart note to discuss alcoholism with your husband at his next visit. I don?t want to sound hard-nosed, but drinking 12 ounces minimum of vodka a day, is a considerably large amount of alcohol. Twelve ounces of vodka is comparable to 8 drinks a day, and this is classified as heavy drinking. While some people may tolerate alcohol better than others, this does not mean there is no systemic damage going on. (This is covered further down in the answer too). Let?s not forget the ?other? dangers of alcohol; car accidents and their related injury, death and expense, falls and physical injury, increased depression, violence and aggression, the impact on family dynamics and quality of life, and the expense of the alcohol itself. ?Most adults can drink moderate amounts of alcohol -- up to two drinks per day for men and one drink per day for women and older people -- and avoid alcohol-related problems. (One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)?? As a person ages, certain mental and physical functions tend to decline, including vision, hearing, and reaction time. Moreover, other physical changes associated with aging can make older people feel "high" after drinking fairly small amounts of alcohol. These combined factors make older people more likely to have alcohol- related falls, automobile crashes, and other kinds of accidents. ?In addition, older people tend to take more medicines than younger persons, and mixing alcohol with many over-the-counter and prescription drugs can be dangerous, even fatal. Further, many medical conditions common to older people, including high blood pressure and ulcers, can be worsened by drinking. Even if there is no medical reason to avoid alcohol, older men and women should limit their intake to one drink per day.? http://www.medicinenet.com/alcohol_abuse_and_alcoholism/page5.htm#27whatis It would be impossible to say your husband will or will not develop any serious effects of his drinking. No one escapes all of the negative effects of heavy drinking. All of the ravages of alcohol that are included in this answer take time to develop, and may not appear until it is too late to reverse the damage. At 55, he is gambling with his life. I have seen thousands of patients in the hospital with alcohol related diseases; it is a miserable way to die. As far as high blood pressure, you are correct. Even limited alcohol consumption can elevate blood pressure. ?Alcohol affects every body system, causing a wide range of health problems. Some such problems include poor nutrition, memory disorders, difficulty with balance and walking, liver disease (including cirrhosis and hepatitis), high blood pressure, muscle weakness (including the heart), heart rhythm disturbances, anemia, clotting disorders, decreased immunity to infections, gastrointestinal inflammation and irritation, acute and chronic problems with the pancreas, low blood sugar, high blood fat content, interference with reproductive fertility, and weakened bones? http://www.healthatoz.com/healthatoz/Atoz/ency/alcoholism.jsp ?People who drink alcohol excessively (over two drinks per day) have a one and a half to two times increase in the prevalence of hypertension. The association between alcohol and high blood pressure is particularly noticeable when the alcohol intake exceeds 5 drinks per day. Moreover, the connection is a dose-related phenomenon. In other words, the more alcohol that is consumed, the stronger is the link with hypertension.? http://www.medicinenet.com/high_blood_pressure/page8.htm ?Even modest alcohol consumption can cause blood pressure to increase, according to two recent studies conducted in Japan. Dr. Noriyuki Nakanishi, from the department of social and environmental medicine at Osaka University Graduate School of Medicine in Japan, lead author of the first study, concluded that "Alcohol use represents an important modifiable risk factor for hypertension." http://alcoholism.about.com/cs/heal/a/aa020722a.htm ?Alcohol exerts a depressive effect on the brain. The blood-brain barrier does not prevent alcohol from entering the brain, so the brain alcohol level will quickly become equivalent to the blood alcohol level. Alcohol's depressive effects result in difficulty walking, poor balance, slurring of speech, and generally poor coordination (accounting in part for the increased likelihood of injury). At higher alcohol levels, a person's breathing and heart rate will be slowed. Vomiting may occur, with a high risk of the vomit being breathed into the lungs, which often results in severe problems, including the possibility of pneumonia. Still higher alcohol levels may result in coma and death.? http://www.findarticles.com/p/articles/mi_g2603/is_0001/ai_2603000147 ===================== Diagnosing Alcoholism ===================== It?s not surprising your doctor did not realize your husband has a drinking problem. ?The great majority of alcoholics go unrecognized by physicians and health care professionals. This is largely because of the alcoholic?s ability to conceal the amount and frequency of drinking, denial of problems caused by or made worse by drinking, the gradual onset of the disease, and the body's ability to adapt to increasing alcohol amounts.? http://www.emedicinehealth.com/articles/18863-3.asp ?Alcohol can make some medical concerns hard for doctors to find and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack. Drinking also can make older people forgetful and confused. These symptoms could be mistaken for signs of Alzheimer's disease. For people with diabetes, drinking affects blood sugar levels. Ulcers also may become worse with alcohol use. People who drink more than a little alcohol also may be putting themselves at risk for serious conflicts with family, friends, and coworkers. The more heavily they drink, the greater the chance for trouble at home, at work, with friends, and even with strangers.? http://www.abletochangerecovery.net/alcoholism_aging.html ?Alcoholism is difficult to define, and is easily missed by clinicians. Investigators explored the value of different screening questions for alcoholism in 232 new patients in a university-based primary-care unit.? http://general-medicine.jwatch.org/cgi/content/full/1988/108/1 ?Family members cannot always rely on a physician to make an initial diagnosis. Although 15% to 30% of people who are hospitalized suffer from alcoholism or alcohol dependence, physicians often fail to screen for the problem. In addition, doctors themselves often cannot recognize the symptoms. In one study, alcohol problems were detected by the physician in less than half of patients who had them. Even when physicians identify an alcohol problem, however, they are frequently reluctant to confront the patient with a diagnosis that might lead to treatment for addiction.? http://www.reutershealth.com/wellconnected/doc56.html (Are your husbands palms red? Many people that drink too much have red palms, and ER doctors look for this when a patient comes in with alcohol related problems.) ?A person is generally considered to be dependent on alcohol when they have experienced three or more of the following symptoms during a year: a strong urge to drink, difficulty controlling drinking, physical withdrawal symptoms, such as sweating, shaking, agitation and nausea when they try to reduce drinking, a growing tolerance to alcohol (needing larger quantities to get the same effect), gradual neglect of other activities, persistent drinking even though it is obviously causing harm. http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/alcohol_abuse.html =================== Alcohol Tolerance: =================== ?About alcohol tolerance: even though alcohol passes through all of our bodies the same way, drinking has very different effects on people. Even when an individual drinks exactly the same amount of alcohol on two different occasions, it can have different effects. Physiologically, the following factors affect the body's response to alcohol: Speed of consumption Body weight Type of beverage consumed Whether your stomach is full or empty Psychologically, these factors influence a person's reaction to alcohol: Why you are drinking Drinking history: Drinking regularly develops tolerance Body chemistry: How rapidly the stomach empties into the small intestine can be slowed or increased by anger, fear, stress, euphoria, state of relaxation, etc. Drinking environment: Think about the various environments you have been in when drinking, when the change seemed to occur regarding getting drunk easier, and see if there are any parallels with the particular influences on your drinking.? http://www.goaskalice.columbia.edu/0482.html ?In order to determine if you do have a problem, I would need to know if there were any "red flags" present in your life. These "red flags" are potential symptoms of alcohol abuse or dependence. A list of "red flags" include a high alcohol tolerance (a person can drink a lot of alcohol and not feel drunk), social and/or work problems related to alcohol, health problems related to alcohol use, alcohol-induced relationship problems and withdrawal symptoms, i.e., irritability, anxiety, etc. when not drinking. There are too many red flags to list here but if a person has more than one or two of these red flags, I typically would suggest that they see a mental health professional for a substance abuse evaluation.? ?Dear Dr. Wes: I have recently noticed that my tolerance for alcohol seems higher. I can drink a whole bottle of wine over 2-3 hours and feel perfectly sober. What is up with that? Do I just think I'm sober, or can I really be able to handle more than I used to? Yes, tolerance is the hallmark feature of a drinking problem in development. Your body attempts to tolerate the amount of alcohol you drink. The more you drink the more your body attempts to handle the volume. However, your liver will have to work overtime. That is why the first organ to be damaged with drinking is your liver.? http://www.whatsdrivingyou.org/resources/ask_experts/alcohol_tolerance.html ?Developing a tolerance to alcohol is your body's way of adapting to alcohol use. The intoxicating effect of alcohol decreases as a result of continuous consumption. Your system adapts to alcohol very quickly, as the fact that it has accustomed itself to alcohol is evident even during a single occasion of intoxication. The tolerance is not permanent; it decreases with time as you stop using alcohol or cut down on your consumption. Your body has several means of neutralizing the effect of alcohol. The best known of these is metabolic tolerance, where the body aims at neutralizing the effects of alcohol by accelerating the rate with which it metabolizes alcohol. Metabolic tolerance slowly develops as a result of prolonged, high-scale consumption of alcohol. The most important means is the neural tolerance where the tolerance of the brain and the rest of the nervous system increases. The nervous system tries to function normally in spite of the alcohol. This is why it will before long adapt itself to the alcohol in the body. The intoxicating effect of alcohol decreases. Prolonged, high-scale consumption of alcohol is not needed in order for neural tolerance to develop: occasional, repeated drinking is enough.? http://www.paihdelinkki.fi/english/infobank/300_a_line/314e.htm ====== Tests ====== Tests for alcohol levels in the blood are not useful for diagnosing alcoholism because they reflect consumption at only one point in time and not long-term usage. Certain blood tests, however may provide biologic markers that suggest medical problems associated with alcoholism or indications of alcohol abuse: A test for a factor known as carbohydrate-deficient transferrin (CDT) has been approved as a marker for heavy drinking. It can be helpful in monitoring patients for progress towards abstinence and may also be an indicator for a higher risk for suicide in people with alcoholism. Gamma-glutamyltransferase (GGT). This liver enzyme is very sensitive to alcohol and can be elevated after moderate alcohol intake and in chronic alcoholism. Aspartate and alanine aminotransaminases (AST,ALT) are tests for enzymes and factors that can help identify liver damage. Tests of testosterone levels in men with alcoholism may be low. (This result sometimes persuades men with alcoholism to seek help.) A mean corpuscular volume (MCV) blood test is sometimes used to measure the size of red blood cells, which increase with alcohol use over time. There is quite a bit of useful information on this Reuter?s Health page, from which I gathered the above information. http://www.reutershealth.com/wellconnected/doc56.html ?No single laboratory test or combination of tests has been shown to be optimal in screening for or diagnosing alcoholism. There are, however, several tests that are useful in evaluating patients: Carbohydrate-deficient form of transferrin (CDT), a molecule involved in iron transport in blood. CDT is a newer test that can be used to help in screening and diagnosis of alcoholism. It may also help in the monitoring of patients in treatment to learn whether they have relapsed. Gamma-glutamyl transferase (GGT), a liver enzyme that is increased by heavy alcohol intake Mean corpuscular volume (MCV), which measure the size of red blood cells The GGT result is more useful than the MCV result as a ?red flag? to raise the suspicion that the person is drinking too much. Both of these tests are relatively poor as either a screening or diagnostic test because conditions other than alcohol abuse or alcoholism can cause elevated levels. Physical examination also may reveal signs suggestive of alcoholism, such as evidence of injuries, a visible network of enlarged veins just under the skin around the navel (called caput medusae), fluid in the abdomen (ascites), yellowish-tone to the skin, decreased testicular size in men, and poor nutritional status.? http://www.labtestsonline.org/understanding/conditions/alcoholism-2.html "There are very few conditions that can elevate CDT other than excessive drinking, and those conditions are rare," said John Allen, PhD, associate director of treatment studies at the National Institute on Alcohol Abuse and Alcoholism.? For a CDT test to be positive, a patient would have to consume at least 3.5 standard drinks a day -- roughly five glasses of beer or four glasses of wine -- for one to two weeks. There is also evidence that long-time abusers who relapse will show up positive after much less drinking. Experts say that people can be alcoholics and drink much less than that. http://www.ama-assn.org/amednews/2000/08/28/hlsc0828.htm ===================================== Complications of Alcohol Consumption: ===================================== ?When drunk frequently or in large quantities, alcohol is addictive. Doctors use a number of techniques to identify patients with drink problems, and there are screening questions drinkers may be asked to explore issues such as the amount and frequency of drinking, whether it damages the drinker?s relationships, or whether they have a drink to "get going" in the morning. A person is generally considered to be dependent on alcohol when they have experienced three or more of the following symptoms during a year: a strong urge to drink, difficulty controlling drinking, physical withdrawal symptoms, such as sweating, shaking, agitation and nausea when they try to reduce drinking, a growing tolerance to alcohol (needing larger quantities to get the same effect), gradual neglect of other activities, persistent drinking even though it is obviously causing harm. Problem drinking occurs when a person is not dependent on alcohol, but drinks enough to cause actual physical or psychological harm. Short-term effects Alcohol suppresses the part of the brain that controls judgement, resulting in a loss of inhibitions. It also affects physical co-ordination, causing blurred vision, slurred speech and loss of balance. Drinking a very large amount at one time (binge drinking) can lead to unconsciousness, coma, and even death. Vomiting while unconscious can lead to death by asphyxiation (suffocation). Alcohol is implicated in a large proportion of fatal road accidents, assaults and incidents of domestic violence. Long-term effects Alcohol can be a dangerous drug. Drinking too much too often will cause physical damage, increase the risk of getting some diseases, and make other diseases worse. Excessive drinking over time is associated with: loss of brain cells, liver failure, irritated stomach lining and bleeding from stomach ulcers, high blood pressure (which can lead to stroke), certain types of cancer, nerve damage, heart failure, epilepsy. Excessive drinking has also been linked to: vitamin deficiency, obesity, sexual problems, infertility, muscle disease, skin problems, inflammation of the pancreas. http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/alcohol_abuse.html Hangover -------- One study found that not only does drinking cause significant problems, but the subsequent hangover causes changes in liver function, hormones, the heart, and mental and emotional imbalances. ?Alcohol is absorbed in the small intestine and passes directly into the liver, where it becomes the preferred energy source. The liver, then, is particularly endangered by alcoholism. In the liver, alcohol converts to toxic chemicals, notably acetaldehyde, which trigger the production of immune factors called cytokines. In large amounts, these agents cause inflammation and tissue injury? From the Merck Manual ?Alcohol can affect the body in so many ways that researchers are having a hard time determining exactly what the consequences are from drinking. It is well known, however, that chronic consumption leads to many problems, some of them deadly. As people age, it takes fewer drinks to become intoxicated, and organs can be damaged by smaller amounts of alcohol than in younger people. Also, up to one-half of the 100 most prescribed drugs for older people react adversely with alcohol. Alcohol abusers who require surgery also have an increased risk of postoperative complications, including infections, bleeding, insufficient heart and lung functions, and problems with wound healing. Alcohol withdrawal symptoms after surgery may impose further stress on the patient and hinder recuperation.? Gastrointestinal Problems Alcoholism can cause many problems in the gastrointestinal tract. Violent vomiting can produce tears in the junction between the stomach and esophagus. Alcoholism poses a high risk for diarrhea, hemorrhoids, and increases the risk for ulcers, particularly in people taking the painkillers known as nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen). Alcohol can contribute to serious and chronic inflammation of the pancreas (pancreatitis) in people who are susceptible to this condition. It can also cause inflammation of the esophagus (esophagitis), which can lead to bleeding in heavy drinkers. Effect on Heart Disease and Stroke ---------------------------------- Adverse Effects of Heavy Drinking. On the other hand, cardiovascular disease is the leading cause of death in alcoholics. The following are negative effects on the heart and circulation from high alcohol consumption. Evidence suggests that people who consume more than three drinks a day have abnormal blood clotting factors. Heavy alcohol consumption can raise blood pressure even in people with no history of heart disease. The more alcohol someone drank, the greater the increase in blood pressure, with binge drinkers (people who have nine or more drinks once or twice a week) being at greatest risk. One study found that binge drinkers had a risk for a cardiac emergency that was two and a half times that of nondrinkers. Heavy drinking, and particularly binge drinking, may also increase the risk for hemorrhagic stroke (caused by bleeding in the brain). Large doses of alcohol can trigger irregular heartbeats, which can be dangerous in people with existing heart disease. Alcohol abuse has also been associated with and may actually be one cause of idiopathic dilated cardiomyopathy, a condition in which the heart enlarges and its muscles weaken, putting the patient at risk for heart failure. Cancer ------ Cancer, however, is the second leading cause of death in alcoholics (after cardiovascular disease), and alcoholics have a rate of carcinoma 10 times higher than that of the general population. Alcohol is probably not the direct cause of cancer, but evidence suggests that it increase the effects of factors that can contribute to certain cancers. Effects on the Lung Pneumonia. Acute alcoholism is strongly associated with very serious pneumonia. (Chronic alcoholism also causes changes in the immune system, although in people without any existing medical problems these changes do not appear to be significant.) Acute Respiratory Distress Syndrome ------------------------------------ One study indicated that intensive care patients with a history of alcohol abuse have a significantly higher risk for developing acute respiratory distress syndrome (ARDS) during hospitalization. ARDS is a form of lung failure that can be fatal. Skin, Muscle, and Bone Disorders -------------------------------- Severe alcoholism is associated with osteoporosis (loss of bone density), muscular deterioration, skin sores, and itching. Peripheral neuropathy, damage to the nerves in the limbs, occurs in 5% to 15% of people with alcoholism. Such injuries cause tingling, pain, and numbness in the hands, feet, arms and legs. Fatty Liver ----------- ?Fatty liver or steatosis appears to be the initial change and is the most common response to alcohol ingestion. The liver is large; the cut surface, yellow. The increased liver fat is derived from the diet, from free fatty acids mobilized from adipose tissue, and from lipid synthesized in the liver and inadequately degraded or excreted. Alcoholic Hepatitis/Cirrhosis ----------------------------- Alcoholic hepatitis, Alcoholic cirrhosis represents end-stage disease, developing in 10 to 20% of those who are chronically heavy drinkers. Patients with a fatty liver are usually asymptomatic ? meaning it shows no sympstoms. Routine biochemical studies are often within normal limits; GGT is often elevated. Vascular spiders and features of hyperestrogenism and hypoandrogenism from the alcoholism per se may be evident. Alcoholic hepatitis can be suspected clinically, but the diagnosis depends on examination of a biopsy sample. Cirrhosis may also be relatively asymptomatic, have features of alcoholic hepatitis, or be dominated by complications: portal hypertension with splenomegaly, ascites, hepatorenal syndrome, hepatic encephalopathy, or even hepatocellular carcinoma.? http://www.merck.com/mrkshared/mmanual/section4/chapter40/40a.jsp ?Alcohol Metabolism. Most of the alcohol a person drinks is eventually broken down by the liver. However, some products generated during alcohol metabolism (e.g., acetaldehyde) are more toxic than alcohol itself. In addition, a group of metabolic products called free radicals can damage liver cells and promote inflammation, impairing vital functions such as energy production. The body's natural defenses against free radicals (e.g., antioxidants) can be inhibited by alcohol consumption, leading to increased liver damage. Bacteria that live in the human intestine play a key role in the initiation of ALD. Alcohol consumption increases the passage of a noxious bacterial product called endotoxin through the intestinal wall into the bloodstream. Upon reaching the liver, endotoxin activates specialized cells that monitor the blood for signs of infection. These cells respond to the presence of endotoxin by releasing substances called cytokines that regulate the inflammatory process. Scar Formation. Normal scar formation is part of the wound-healing process. Alcohol-induced cell death and inflammation can result in scarring that distorts the liver's internal structure and impairs its function. This scarring is the hallmark of cirrhosis. The process by which cirrhosis develops involves the interaction of certain cytokines and specialized liver cells (i.e., stellate cells).? http://www.niaaa.nih.gov/publications/aa42.htm Ulcers and Reflux ------------------ ?Alcohol relaxes the lower esophageal sphincter, allowing the reflux of stomach contents into the esophagus. It also increases the production of stomach acid.? http://heartburn.about.com/cs/emailcourses/qt/heartburntip16.htm ?What happens is the liver begins to harden. Scar tissue develops in the body's largest organ which hinders its ability to filter blood. When the scar tissue develops to a certain point, the liver can no longer do its work. The problem is the liver performs more than 1,500 functions for the body, including more than 300 life-saving procedures. If the liver stops doing its job, all kinds of health problems develop quickly and death can come rapidly. The liver detoxifies poisons, both those produced by the body and those from outside; filters bacteria from the blood; regulates fat metabolism; stores and manufactures vitamins; regulates and manufactures cholesterol and fats; synthesizes proteins; maintains the body's water and salt balance; secretes bile for the digestion of fat; stores energy (in the form of glycogen) helps regulate overall body metabolism; transforms the highly toxic ammonia (produced by exercise and by metabolism of proteins) into urea which is eliminated in the urine; manufactures lipoproteins for fat and cholesterol transport; and metabolizes alcohol. If the liver stops doing any of these jobs, or numerous others it does constantly, the result is fatal.? http://alcoholism.about.com/cs/liver/a/aa072397.htm ?Alcoholism is a life-threatening problem that often ends in death, particularly through liver, pancreatic, or kidney disease, internal bleeding, brain deterioration, alcohol poisoning and suicide. As well, alcoholism is a major contributing factor for head injuries, motor vehicle accidents (MVA), violence and assaults, as well as a leading cause of neurological and other medical problems (e.g., cirrhosis, etc.).? http://en.wikipedia.org/wiki/Alcoholism Cancer ------- ?Two more research studies have emphasized the serious health effects of long-term heavy drinking, from an increased risk for having accidents to developing liver cancer. Heavy drinking has long be associated with other liver problems, such as cirrhosis, and now a new Italian study links heavy drinking to the development of liver cancer. Dr. Francesco Donato, a professor of epidemiology and public health at the University of Brescia in Italy, studied 464 Italian men and women diagnosed with hepatocellular carcinoma, the most common form of liver cancer, and 824 patients with no liver damage. Donato's researchers found that drinking more than 60 grams of alcohol a day, equivalent to four to five glasses of wine, was associated with an elevated risk of developing liver cancer for both men and women. They also found that the risk of developing liver cancer was even greater for patients They also found that the risk of developing liver cancer was even greater for patients who had been diagnosed with either hepatitis C or hepatitis B. The study was published in the American Journal of Epidemiology.? http://alcoholism.about.com/cs/liver/a/aa020225a.htm ?Usually alcoholic cirrhosis develops after more than a decade of heavy drinking, but that is not always the case. Due to genetic factors some heavy drinkers can develop cirrhosis much sooner. Some people have livers that are much more sensitive to alcohol. Likewise, the amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol attacks the liver by blocking the normal metabolism of protein, fats, and carbohydrates. Cannot Be Reversed ?A damaged liver cannot remove toxins from the blood, causing them to accumulate in the blood and eventually the brain. There, toxins can dull mental functioning and can cause personality changes, coma, and even death. Loss of liver function affects the body in many ways. Here is a list of common problems, or complications, caused by cirrhosis. One of the well-known symptoms of cirrhosis is jaundice, which causing a yellowing of the skin and eyes. Generally by the time jaundice develops, the liver has been severely damaged. Liver damage from cirrhosis cannot be reversed, but treatment can stop or delay further progression and reduce complications. If the cirrhosis is caused by long-time heavy drinking, the treatment is simply: abstain from any further alcohol. A healthy diet and avoiding alcohol are essential because the body needs all the nutrients it can get, and alcohol will only lead to more liver damage.? http://alcoholism.about.com/cs/liver/a/aa001016a.htm ?A linear correlation generally exists between the dose and duration of alcohol abuse and the development of liver disease, although not all who overuse alcohol develop significant liver damage. The alcohol equivalent to 10 g is 30 mL of 40-proof whiskey, 100 mL of 12% wine, or 250 mL of 5% beer. As little as 20 g of alcohol in women or 60 g in men can produce liver injury when consumed daily for years. For example, ingestion of 150 to 200 g of alcohol for 10 to 12 days produces fatty liver even in otherwise healthy men. For alcoholic hepatitis, patients consume 80 g of alcohol daily for almost a decade, whereas the average threshold to develop cirrhosis is 160 g daily over 8 to 10 yr. Duration is important.? ?genetic factors may also be involved in alcohol metabolism: some people may be deficient in oxidizing alcohol. Certain HLA histocompatibility types have also been associated with alcohol-induced liver disease. Immunologic status does not appear to help determine susceptibility to alcohol, but immunologic mechanisms (particularly cytokine mediators) may be important in the inflammatory response and in liver injury.? ?Whether alcoholics metabolize alcohol differently from nonalcoholics is unknown. Clearly, chronic ingestion of alcohol leads to hepatic adaptation with hypertrophy of the smooth endoplasmic reticulum and increased activity of the hepatic drug-metabolizing enzymes. Alcohol induces the microsomal ethanol oxidizing system, which is responsible in part for alcohol metabolism. Alcohol also induces microsomal P-450, which is involved in drug metabolism. Thus, the alcohol abuser acquires an increased tolerance to alcohol and drugs (eg, sedatives, tranquilizers, antibiotics), and neurologic adaptation develops. The result is a complex interaction between drugs, other chemicals, and alcohol.? http://www.merck.com/mrkshared/mmanual/section4/chapter40/40a.jsp Esophageal Varices/Variceal Hemorrhage --------------------------------------- ?When the liver is damaged (most commonly by Cirrhosis), fluid backs up in the portal veins, blocking the veins of the esophagus. The esophageal veins then dilate (distended much beyond their normal size); the walls weaken and burst like a balloon. When this occurs, there may be massive bleeding in the esophagus.? http://www.ecureme.com/emyhealth/data/Esophageal_Varices.asp ?In Western countries, alcoholic and viral cirrhosis are the leading causes of portal hypertension and esophageal varices. Patients who have bled once from esophageal varices have a 70% chance of rebleeding, and approximately one third of further bleeding episodes are fatal. The risk of death is maximal during the first few days after the bleeding episode and decreases slowly over the first 6 weeks. Mortality rates in the setting of surgical intervention for acute variceal bleeding are high.? http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7982318&dopt=Abstract Alcohol Boosts Effects of Smoking ----------------------------------- ?In tests on human volunteers, Duke University Medical Center researchers have found that even small amounts of alcohol boost the pleasurable effects of nicotine, inducing people to smoke more when drinking alcoholic beverages. The findings provide a physiological explanation for the common observation that people smoke more in bars. The findings also explain statistics showing that alcoholics tend to smoke more than non-alcoholics, and that smokers are more likely to be alcoholics.? http://alcoholism.about.com/b/a/2004_03_22.htm I urge your husband to seek treatment for alcoholism now, before he shows symptoms of irreversible damage. This is not what you were asking, but I feel a truly responsible answer would include a plea that your husband make every attempt to become sober, in order to save his life. ?The key to the treatment of alcohol dependence is to stop drinking alcohol permanently. The first step in this process is detoxification (immediate withdrawal from alcohol). Depending on your symptoms, detoxification can be done as an outpatient, or as an inpatient in a hospital or drug treatment facility. During the withdrawal process, your doctor probably will prescribe tranquilizers called benzodiazepines for a few days to lessen withdrawal symptoms. After that, a medication called naltrexone (ReVia) may be used to help lessen the craving for alcohol. As an alternative to naltrexone, an older medication called disulfiram (Antabuse) may be prescribed. Drinking alcohol while taking disulfiram causes nausea and vomiting. This is meant to be an incentive not to drink impulsively in response to craving. After detoxification, most alcoholics need some form of long-term support or counseling to remain sober. Recovery programs focus on teaching a person with alcoholism about the disease, and helping him or her to learn new coping strategies to deal with the stresses of everyday life without turning to alcohol. Many patients benefit from self-help groups such as Alcoholics Anonymous (AA). If your doctor suspects that you have any alcohol-related damage to your liver, stomach or other organs, you may need additional tests and treatments for these problems. Your doctor also will suggest a healthy diet with vitamin supplements, especially B vitamins.? http://www.intelihealth.com/IH/ihtIH/WSAZR000/9339/9422.html ?Confidential advice and support is available through GPs, and may involve a community alcohol team or specialist consultant care. There are also organisations such as Alcohol Concern and Alcoholics Anonymous that help many people (see below). Treatment To prevent withdrawal symptoms, a chronic heavy drinker may be prescribed medication such as diazepam (Valium) for a few days after stopping drinking. There are two drug treatments that may be used to help someone stop drinking: ·Disulfiram, which causes very unpleasant effects if even a small amount of alcohol is consumed (and severe, occasionally life-threatening effects with large amounts of alcohol). ·Acamprosate, which influences transmitters in the brain and reduces the craving for alcohol. It may have side-effects such as headache, diarrhoea and rash. People with chronic alcohol dependence are often malnourished, and vitamin supplements are essential.? http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/alcohol_abuse.html National Institute on Alcohol Abuse and Alcoholism (NIAAA) 6000 Executive Blvd. Willco Building Bethesda, MD 20892-7003 E-Mail: [email protected] http://www.niaaa.nih.gov/ National Clearinghouse for Alcohol and Drug Abuse Information (NCADI) P.O. Box 2345 Rockville, MD 20847-2345 Phone: (301) 468-2600 Toll-Free: (800) 729-6686 Fax: (301) 468-6433 TDD: (800) 487-4889 E-Mail: [email protected] http://www.health.org/ Alcoholics Anonymous World Services 475 Riverside Dr. 11th Floor New York, NY 10115 Phone: (212) 870-3400 http://www.alcoholicsanonymous.net/ Al-Anon/Alateen Al-Anon Family Group Headquarters, Inc. 1600 Corporate Landing Parkway Virginia Beach, VA 23454-5617 Toll-Free: (888) 425-2666 E-Mail: [email protected] http://www.al-anon.alateen.org/ More information ================ Lots of good information on this site: http://www.niaaa.nih.gov/publications/aa28.htm Forum http://ehealthforum.com/health/topic12134.html ?Cirrhosis of the liver is irreversible but treatment of the underlying liver disease may slow or stop the progression. Such treatment depends upon the underlying etiology. Termination of alcohol intake will stop the progression in alcoholic cirrhosis and for this reason, it is important to make the diagnosis early in a chronic alcohol abuser. Similarly, discontinuation of a hepatotoxic drug or removal of an environmental toxin will stop progression. Treatment of metabolic diseases, such as treatment of iron overload in hemochromatosis or copper overload in Wilson disease, are also effective therapies. Chronic viral hepatitis B and C may respond to treatment with interferon and autoimmune hepatitis may improve with prednisone and azathioprine (Imuran). Drugs such as ursodiol (Actigall) may slow the progression of primary biliary cirrhosis and possibly sclerosing cholangitis. In patients with cirrhosis of the liver, treatment must also be directed at the complications. Bleeding esophageal varices can be treated with endoscopic sclerotherapy or rubber band ligation. Ascites and edema are often responsive to a low sodium diet and such a diet must be emphasized in patients with these symptoms. More advanced ascites and edema can respond to diuretic therapy. A low protein diet and agents such as lactulose may help hepatic encephalopathy. Infections such as spontaneous bacterial peritonitis must be rapidly treated with appropriate antibiotics. Drugs metabolized in the liver must be given with caution. Coagulation disorders will sometimes respond to vitamin K.? http://cpmcnet.columbia.edu/dept/gi/cirrhosis.html There you go, Rintin! I hope this information is what you were seeking. Please request an Answer Clarification, before rating, if any part of this answer is unclear. I wish you and your husband the best! Sincerely, Crabcakes Search Terms Latent alcoholic symptoms Alcohol tolerance Alcohol dependency Effects of alcohol cirrhosis