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The commonest cause of long-drawn (Chronic) liver disease in India is Alcoholic liver disease. The long drawn disease is silent in its initial phases lasting for 1-2 decades. The disease evolves in three patterns – to begin with fat accumulates in liver (Alcoholic fatty liver). Swelling or inflammation of liver cells follows( Alcoholic hepatitis). After many years inflammation, scar tissue (Fibrosis) forms inside the liver and when these accumulate silently , ultimately results in cirrhosis of liver.
Cirrhosis generally occurs due to heavy alcohol consumption (20-40 grams of absolute alcohol per day); but this quantification of alcohol needed to develop cirrhosis is highly variable and depends on other factors like genetic makeup of the individual and lifestyle. Those who have lifestyle disorders like Diabetes, raised blood pressure , raised cholesterol levels have more risk of fatty liver and alcoholism in them may accelerate liver damage resulting in cirrhosis at an younger age.
Alcoholic liver disease is largely silent... Only in the advanced stages of alcoholic cirrhosis patient develops symptoms...
ALD Occurs in Three Stages
Alcoholic fatty liver:– the first stage of ALD. Protracted – a decade or more, but essentially asymptomatic. Abstinence from alcohol can reverse this stage of fat accumulation. Ongoing drinking
Alcoholic Hepatitis:– The second stage where liver inflammation occur. This can be catastrophic with high death rate. Symptomatic alcoholic hepatitis necessitating critical care occurs in heavy drinkers and may present with the following symptoms.
Nausea
Vomiting
Loss of appetite
Abdominal tenderness
Fatigue and weakness
Weight loss
Bleeding tendency
Brain dysfunction
Alcoholic Liver Cirrhosis: as the phase of liver cell swelling progresses, in due course scar tissue accumulates in liver, distorts the structure and causes rise in liver pressure (Portal hypertension). This eventually results in water logging- accumulation of water inside the abdomen and swelling of legs. Bleeding from veins in the food pipe and stomach, brain dysfunction (Hepatic encephalopathy), loss of muscle mass. Raised liver pressure can cause changes in heart, lung and kidney. Formation of liver cancer is yet another risk.
Once cirrhosis sets in, the most important step to improve survival is total abstinence from alcohol. Medical management in advanced stages of cirrhosis is mostly palliative, managing complications of end stage liver disease.
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