Alcoholic liver disease | signs and stages

Alcoholic liver disease, now often called alcohol-related liver disease, develops when heavy drinking over a long period damages liver cells. There are often no symptoms at first: fat builds up in the liver before any inflammation or permanent scarring sets in. Some early damage can improve if you stop drinking, while advanced disease requires ongoing medical care.

What raises your risk

The liver processes alcohol, but drinking heavily over time can overwhelm its ability to repair itself. Risk depends on how much and how often you drink, as well as on your sex, genetics, diet and any existing liver conditions. The NHS notes that alcohol-related liver disease develops more quickly in women and at lower levels of drinking.

The 3 stages of liver damage

There are 3 broad stages: fatty liver, alcohol-related hepatitis and cirrhosis. These stages can overlap, and progression does not always follow a neat sequence. You can have fatty changes, inflammation and scarring in your liver at the same time.

Alcohol-related fatty liver disease

Alcohol-related fatty liver disease develops when fat accumulates inside liver cells. It often causes no obvious symptoms, so you can look well and get through your day as normal while the damage continues. The liver can often recover at this stage if you stop drinking. 

Are you thinking of quitting alcohol to cut the risk but finding it hard to get started? You can call us anytime on +27 21 541 0643 or leave your details below. We can go through your situation together and work out a safe way forward.

Hepatitis and cirrhosis

Alcohol-related hepatitis involves inflammation and damage, which can range from mild to life-threatening. Cirrhosis develops when extensive scar tissue replaces healthy liver tissue. Cirrhosis is generally irreversible, although giving up alcohol can limit further damage and improve your outlook.

Early symptoms of alcoholic liver disease can include tiredness, a poor appetite, nausea, unexplained weight loss or discomfort under your right ribs. It is easy to mistake these symptoms for stress or another illness. As liver function worsens, you may notice yellowing of the skin or eyes, itching, swollen legs and a build-up of fluid in the abdomen. Symptoms alone cannot tell you which stage you have reached. Are you worried about your health? Call us on +27 21 541 0643. We can talk through your situation and advice you on a next step.

Early-stage liver disease and nails

Nail changes linked to alcoholic liver disease can include whitening, a change in shape or clubbing, where the fingertips broaden and the nails curve. These changes tend to appear late, and many other conditions cause them as well. So your nails are not a reliable way to judge how far the damage has progressed. Red eyes are not a reliable sign of alcoholic liver disease either. What matters in the eyes is the colour: jaundice turns the whites yellow, not red.

Decompensated and end-stage disease

Decompensated alcoholic liver disease means a scarred liver can no longer carry out its essential work. Warning signs include jaundice, abdominal swelling, confusion, internal bleeding and severe weakness. Symptoms of end-stage alcoholic liver disease may also include muscle loss, repeated infections or kidney complications. Carrying on drinking with end-stage alcoholic liver disease can speed up the damage and make treatment harder.

When symptoms become an emergency

Vomiting blood, passing black stools, sudden confusion or struggling to stay awake can all be signs of a life-threatening complication of advanced liver disease. These signs need emergency medical care straight away. Advanced alcoholic liver disease can be fatal.

Assessment usually starts with an honest account of how much you drink, and a physical examination. Blood tests can show inflammation or impaired liver function, although normal results do not always rule out fibrosis, the early scarring that comes before cirrhosis. Ultrasound and specialised scans that measure liver stiffness can pick up fat, scarring and raised pressure in the portal vein, which carries blood to your liver.

Treatment begins with giving up alcohol and treating the effects the damage has already had. Care may include nutritional support, vitamin supplements, medicines for complications and monitoring for liver cancer. Severe alcohol-related hepatitis or decompensated cirrhosis may require hospital admission. If the disease is advanced and irreversible, you may be referred for a liver transplant assessment.

When addiction treatment is also needed

Medical liver care and alcohol addiction treatment do two different jobs: one treats the organ, the other the drinking, and you may need both. Addiction treatment tackles the drinking itself, while a liver specialist assesses the damage and any complications. Treating the liver without treating the alcohol addiction does nothing about what is causing the damage.

Stopping alcohol safely

Stopping alcohol suddenly can trigger dangerous withdrawal if your body has become dependent. Alcohol withdrawal symptoms that need medical attention include shaking, sweating, vomiting, agitation, hallucinations and seizures. If you drink heavily every day, you can call us on +27 21 541 0643 before you stop and we will go through the options with you. Our detox is medically supervised around the clock, which keeps you safe while longer-term treatment gets under way.

At Connection Mental Healthcare, our addiction assessment looks at your drinking, your withdrawal history, your physical health and your emotional wellbeing. Treatment is residential, at our rehabilitation centre in South Africa. Doctors assess and treat the liver damage itself; we treat the addiction behind it. Call us on +27 21 541 0643 with questions about drinking and alcoholic liver disease, even if you are not sure it has become a problem.