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Evolution of an Alcoholic Liver

In alcoholics, the liver is the organ that takes the most abuse. It is responsible for metabolizing alcohol and filtering it from the blood. In the process of metabolizing alcohol, the liver is temporarily exposed to a toxic intermediate product called acetaldehyde. This doesn’t pose a danger for moderate drinkers, but heavy prolonged drinking causes cumulative damage to the liver.

Alcoholic liver disease actually takes several forms. Heavy prolonged drinking may result in fatty liver, alcoholic hepatitis, and chronic hepatitis with fibrosis or cirrhosis. The liver is a robust organ and can continue to function normally even when badly damaged. Relatively few alcoholics, only about 15 to 20 percent, ever progress to hepatitis or cirrhosis.

It’s not totally clear why some people suffer severe liver damage while others don’t. Women are at greater risk than men because of differences in alcohol metabolism and relatively higher percentage of body fat. Drinking frequently on an empty stomach is a factor as well as malnutrition. Higher chronic alcohol consumption increases risk, especially for people with a preexisting liver disease, such as hepatitis C. There seems to be a genetic component as well.

Liver damage from drinking first appears as excess fat in the liver. There are typically not symptoms at this point and it is usually discovered as part of blood tests during routine medical exams. At this point, the damage to the liver is easily reversible if the patient stops drinking.

Fatty liver increases your chances of progressing to hepatitis, or liver inflammation. In its mildest form, there are no symptoms of alcoholic hepatitis and it is only discovered by elevated enzymes in a blood test. If the hepatitis is severe, it may result in fatigue, jaundice, abdominal swelling from fluid accumulation, and brain dysfunction due to liver damage. At this point, the disease is potentially fatal. When symptoms of severe alcoholic hepatitis appear, there is a 50 percent chance of death within a month.

If alcoholic hepatitis persists long enough, it may progress to cirrhosis. Alcoholic hepatitis does not cause cirrhosis but it increases the chances of developing cirrhosis. Cirrhosis is when liver cells die and harden, creating scarring in the liver. It occurs in ten to twenty percent of heavy drinkers. At this point, liver failure is inevitable without total abstinence from alcohol. Although hepatitis can often be treated with abstinence and medication, cirrhosis usually requires a liver transplant. Recipients are required to be sober for six months before being eligible to receive a new liver.

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