Marijuana May Protect the Liver from Alcohol — But Experts Urge Caution

What Is Alcoholic Liver Disease?

Alcoholic liver disease (ALD) is caused by drinking too much alcohol. There are two types of ALD: primary and secondary. Primary alcoholic liver disease (PALL) occurs when there is no known cause or risk factor for the condition. Secondary alcoholic liver disease (SAL) results from one or more factors such as genetic predisposition, viral infection, certain medications, certain medical conditions, or environmental exposure.

Primary alcoholic liver disease (PALL) may develop within 3 months after first drinking alcohol. Symptoms usually appear 2–3 weeks later. The most common symptoms include nausea, vomiting, abdominal pain, fatigue, loss of appetite and jaundice (yellowing of the skin). Other symptoms may include dark urine or blood in your vomit.

If left untreated with prompt treatment, these symptoms can be controlled with rest and fluids. However, if not treated promptly, they can progress to severe liver failure.

Secondary alcoholic liver disease (SAL) is a chronic condition that develops over time. Symptoms may occur at any age but typically begin between the ages of 20 and 40 years. They include:

Nausea, vomiting, diarrhea, weight loss and increased thirst. These symptoms often last several days before subsiding and becoming less frequent. Signs of dehydration may also occur during this period.

Inability to control limbs due to muscle weakness (a condition called hepatic encephalopathy).

Jaundice.

Muscle pain, bone pain and mental confusion.

Stomach pain.

Symptoms become more severe as the condition progresses. If left untreated, SAL can result in death.

The liver is a large organ located in the upper right part of the abdomen. It has many functions but mainly it helps the body to get rid of waste and toxins. Alcohol abuse can lead to the build-up of these toxins in the body and can damage the liver cells. If enough liver cells are damaged then this can cause severe illness, or even death.

What Are The Different Stages Of Alcoholic Liver Disease?

The World Health Organization (WHO) has developed a standardized system of classifying PALL. The stages are broken down into five categories:

Stage one: No liver damage.

Stage two: The illness is in the initial stages.

Stage three: The disease is now becoming more severe.

Stage four: Severe liver disease with signs of liver failure.

Stage five: The last stage of the illness which is liver failure with the need for a liver transplant.

What Are The Related Factors Of Alcoholic Liver Disease?

The disease can occur in anyone that consumes a dangerous amount of alcohol on a daily basis over a period of several years. However, there are some factors which can increase your risk of developing it:

If you are female, you are more at risk than male drinkers.

If you have a parent, brother or sister with liver disease you are more at risk.

If you already have high levels of ‘bad’ cholesterol or triglycerides in your blood you are more likely to develop liver disease.

If you have suffered from NASH (Non-Alcoholic Steatohepatitis) in the past, there is an increased risk that you will develop ALD.

What Are The Symptoms Of Alcoholic Liver Disease?

The initial or ‘acute’ symptoms of liver disease may include:

Sudden nausea.

Abdominal pain.

Vomiting of blood or ‘dark’ vomit.

Swelling in your abdomen due to the build-up of fluid (a condition known as ascites).

Fatigue.

Yellowing of the skin and the whites of the eyes (a condition known as jaundice).

It is important to seek immediate medical advice if you are suffering from these symptoms.

The ‘chronic’ or ‘late’ effects of liver disease may include:

Itchy skin.

Swollen ankles and legs (a condition known as edema).

Hair loss.

Loss of sexual desire and impotence in men.

Infertility in women.

A general feeling of being unwell.

Confusion.

Mood swings.

Severe constipation.

Ascites (fluid retention causing swelling in the abdomen).

Enlargement of the liver and spleen.

If left untreated, there is a high risk that ALD will progress to liver failure and eventually cause death.

What Are The Risk Factors Of Alcoholic Liver Disease?

Drinking more than four units of alcohol per day on a regular basis for several years or more is considered to be a high-risk drinking behavior.

There are also some factors that are believed to make certain people more at risk from developing ALD, these factors include:

Having certain genes which slow down the rate at which your body can break down alcohol.

Having other illnesses or health conditions such as HIV or hepatitis C which can make the liver ill.

Taking certain medications which can damage the liver.

Drinking alcohol while pregnant as this can lead to ‘foetal alcohol syndrome’ (FAS) or other birth problems in children.

How Is Alcoholic Liver Disease Diagnosed?

Your doctor will ask you about your medical history and give you a physical examination to find out if you have any of the symptoms of ALD. They may also suggest some blood tests to rule out other causes for your symptoms and a CT scan or ultrasound of your liver to look for signs of damage.

What Are The Treatment Options For Alcoholic Liver Disease?

If you have been diagnosed with ALD, the best thing you can do is to stop drinking alcohol immediately. This may be easier said than done, and if you do not think you can do it on your own, you may need some medical help to aid your withdrawal from alcohol. In any case, your doctor may suggest that you attend some counselling or support groups such as Alcoholics Anonymous (AA) to help you with the psychological aspects of giving up the booze.

Your treatment options for ALD will depend upon the specific type of disease you have been diagnosed with. In primary NASH, the main treatment is to cut down on your alcohol intake and giving up alcohol completely if you are able. Your doctor may also suggest that you take medication to aid your liver function (such as ursodeoxycholic acid) or medication to control any itching, swelling or pain (such as a non-steroidal anti-inflammatory drug).

In ALD associated with HIV, treatment will depend upon the stage of the disease. If you have not yet developed liver failure, treatment is aimed at stopping the progression of the disease. The antiretroviral drugs that are used to treat HIV can slow down the rate at which the disease worsens. If you have developed liver failure, a transplant may be recommended.

In both types of ALD, it is very important for you to avoid alcohol completely in order to prevent the disease from worsening.

What Are The Side Effects Of Alcoholic Liver Disease?

Some of the potential side effects of both types of ALD include:

A bleeding disorder called ‘coagulopathy’ – where your blood does not clot normally, leading to an increased risk of bleeding or bruising. This is due to liver cells failing to produce proteins that help with blood clotting. This is often tested for by your doctor ordering a blood test to check your prothrombin time (PT). If this test comes back longer than normal, it indicates a problem with your blood clotting.

Anaemia – where you have a reduced number of red blood cells (RBCs) in your blood. This can make you feel tired and dizzy.

Jaundice – a condition where the skin and the whites of the eyes appear yellow due to the build-up of bile pigments.

Hepatic encephalopathy – where damage to the liver affects brain function causing problems with behaving appropriately or with concentrating.

Swelling of the legs, ankles and abdomen caused by a build-up of fluid (known as oedema).

Skin infections such as cellulitis and impetigo.

How Can You Reduce The Risk Of Alcoholic Liver Disease?

To reduce the risk of ALD, there are several recommendations that can be made. These are:

If you have been diagnosed with chronic hepatitis B infection, it is recommended that you avoid alcohol completely.

It is recommended that people who are diagnosed with chronic hepatitis C avoid alcohol.

If you have any signs of liver disease such as unexplained weight loss, it is recommended that you avoid alcohol.

If you have been diagnosed with primary sclerosing cholangitis, it is recommended that you avoid alcohol.

If you have been diagnosed with alcoholic liver disease, it is recommended that you avoid alcohol.

If you have been diagnosed with ALD and are considering having a transplant, it is recommended that you do not return to alcohol once the transplant has taken place as this may reduce the life of your new liver.

It is also recommended that people who are experiencing psychological or behavioural changes due to alcohol should seek treatment for this.

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