Alcoholic liver disease

  • Definition
    • Alcoholic liver disease is damage to the liver and its function due to alcohol abuse.

      Digestive system organs
  • Alternative Names
    • Liver disease due to alcohol; Cirrhosis or hepatitis - alcoholic; Laennec's cirrhosis

  • Causes
    • Alcoholic liver disease occurs after years of heavy drinking. Over time, scarring and cirrhosis can occur. Cirrhosis is the final phase of alcoholic liver disease.

      Alcoholic liver disease does not occur in all heavy drinkers. The chances of getting liver disease go up the longer you have been drinking and more alcohol you consume. You do not have to get drunk for the disease to happen.

      The disease seems to be more common in some families. Women may be more likely to have this problem than men.

  • Symptoms
    • There may be no symptoms, or symptoms may come on slowly, depending on how well the liver is working. Symptoms tend to be worse after a period of heavy drinking.

      Early symptoms include:

      • Fatigue and loss of energy
      • Poor appetite and weight loss
      • Nausea or belly pain
      • Small, red spider-like blood vessels on the skin

      As liver function worsens, symptoms may include:

      • Fluid buildup of the legs (edema) and in the abdomen (ascites)
      • Yellow color in the skin, mucous membranes, or eyes (jaundice)
      • Redness on the palms of the hands
      • In men, impotence, shrinking of the testicles, and breast swelling
      • Easy bruising and abnormal bleeding
      • Confusion or problems thinking
      • Pale or clay-colored stools
  • Exams and Tests
    • Your health care provider will do a physical exam to look for:

      • An enlarged liver or spleen
      • Excess breast tissue
      • Swollen abdomen, as a result of too much fluid
      • Reddened palms
      • Red spider-like blood vessels on the skin
      • Small testicles
      • Widened veins in the abdomen wall
      • Yellow eyes or skin (jaundice)

      Tests you may have include:

      • Complete blood count (CBC)
      • Liver biopsy
      • Liver function tests
      • Coagulation studies

      Tests to rule out other diseases include:

      • Abdominal CT scan
      • Blood tests for other causes of liver disease
      • Ultrasound of the abdomen
  • Treatment

      Some things you can do to help take care of your liver disease are:

      • Drink less alcohol.
      • Eat a healthy diet that is low in salt.
      • Get vaccinated for diseases such as influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia.
      • Talk to your doctor about all medicines you take, including herbs and supplements and over-the-counter medicines.


      • "Water pills" (diuretics) to get rid of fluid build-up
      • Vitamin K or blood products to prevent excess bleeding
      • Medicines for mental confusion
      • Antibiotics for infections


      • Endoscopic treatments for enlarged veins in the throat (bleeding varices)
      • Removal of fluid from the abdomen (paracentesis)
      • Placement of a transjugular intrahepatic portosystemic shunt (TIPS) to repair blood flow in the liver

      When cirrhosis progresses to end-stage liver disease, a liver transplant may be needed.

  • Support Groups
  • Outlook (Prognosis)
    • Continued excessive drinking can shorten your lifespan. Your risk for complications such as bleeding, brain changes, and severe liver damage go up. The outcome will likely be poor if you keep drinking.

      Cirrhosis is caused by scarring of the liver. In most cases, the liver cannot heal or return to normal function once the damage is severe. Cirrhosis can lead to serious complications.

  • Possible Complications
    • Complications may include:

      • Bleeding disorders (coagulopathy)
      • Buildup of fluid in the abdomen (ascites) and infection of the fluid (bacterial peritonitis)
      • Enlarged veins in the esophagus, stomach, or intestines that bleed easily (esophageal varices)
      • Increased pressure in the blood vessels of the liver (portal hypertension)
      • Kidney failure (hepatorenal syndrome)
      • Liver cancer (hepatocellular carcinoma)
      • Mental confusion, change in the level of consciousness, or coma (hepatic encephalopathy)
  • When to Contact a Medical Professional
    • Call your provider if:

      • You develop symptoms of alcoholic liver disease.
      • You develop symptoms after a long period of heavy drinking.
      • You are worried that drinking may be harming your health.

      Get emergency medical help right away if you have:

      • Abdominal or chest pain
      • Abdominal swelling or ascites that is new or suddenly becomes worse
      • A fever (temperature greater than 101°F, or 38.3°C)
      • Diarrhea
      • New confusion or a change in alertness, or it gets worse
      • Rectal bleeding, vomiting blood, or blood in the urine
      • Shortness of breath
      • Vomiting more than once a day
      • Yellowing skin or eyes (jaundice) that is new or gets worse quickly
  • Prevention
    • Talk to your provider about your alcohol intake. The provider can counsel you about how much alcohol is safe for you.

  • References
    • Carithers RL, McClain C. Alcoholic liver disease. In: Feldman M, Friedman LS, Brandt LJ. Feldman: Sleisinger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 86.

      Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer Al, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 153.

      Garcia-Tsao G, Lim JK; Members of Veterans Affairs Hepatitis C Resource Center Program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol. 2009;104:1802-1829. PMID: 19455106

      O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Am J Gastroenterol. 2010;105(1):14-32. PMID: 19904248

      Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371:838-851.