Alcohol and liver disease

Drinking excessive alcohol is bad for you. A small amount of alcohol (1-2 units per day) may help to prevent heart disease and stroke.

When you drink alcohol, it is absorbed into the bloodstream from the stomach and intestines. All blood from the stomach and intestines first goes through the liver before circulating around the whole body. So, the highest concentration of alcohol is in the blood flowing through the liver.

Liver cells contain enzymes that process alcohol. The enzymes break down alcohol into other chemicals, which in turn are then broken down into water and carbon dioxide. These are then passed out in the urine and from the lungs. The liver cells can process only a certain amount of alcohol per hour. So, if you drink alcohol faster than your liver can deal with it, the level of alcohol in your bloodstream rises

If you drink heavily, you have an increased risk of developing:

■ Serious liver problems.

■ Some stomach disorders.

■ Inflammation of the pancreas.

■ Mental health problems, including depression and anxiety. ■Sexual difficulties such as impotence.

■Muscle and heart muscle disease.

■High blood pressure. ■Damage to nervous tissue. ■Accidents - drinking alcohol is associated with a much-increased risk of accidents. In particular, injury and death from fire and car crashes. About 1 in 7 road deaths are caused by drinking alcohol.

■ Some cancers (mouth, gullet, liver, colon and breast).

■ Obesity (alcohol has many calories).

■ Damage to an unborn baby in pregnant women.

■ Alcohol dependence.

Deaths due to alcohol-related diseases (particularly liver disease) have risen considerably over the last 20 years or so. This is because heavy drinking and binge drinking have become more common. Drinking too much alcohol can lead to three types of liver conditions - fatty liver, hepatitis, and cirrhosis. Any, or all, of these conditions can occur at the same time in the same person.

Fatty liver

A build-up of fat occurs within liver cells in most people who regularly drink heavily. In itself, fatty liver is not usually serious and does not cause symptoms. Fatty liver will usually reverse if you stop drinking heavily. However, in some people the fatty liver progresses and develops into hepatitis.

Alcoholic hepatitis

Hepatitis means inflammation of the liver. The inflammation can range from mild to severe. ■Mild hepatitis may not cause any symptoms. The only indication of inflammation may be an abnormal level of liver enzymes in the blood, which can be detected by a simple blood test. However, in some cases the hepatitis becomes persistent, which can gradually damage the liver and eventually cause cirrhosis.

■A more severe hepatitis tends to cause symptoms such as feeling sick, jaundice, generally feeling unwell and, sometimes, pain over the liver.

■ A very severe bout of alcoholic hepatitis can quickly lead to liver failure. This can cause deep jaundice, blood clotting problems, confusion, coma, bleeding into the guts, and is of ten fatal.

■The main treatment for alcoholic hepatitis is to provide adequate nutrition and steroids.

Alcoholic cirrhosis

Cirrhosis is a condition where normal liver tissue is replaced by scar tissue. The scar tissue affects the normal structure and regrowth of liver cells. Liver cells become damaged and die as scar tissue gradually develops. So, the liver gradually loses its ability to function well. The scar tissue can also affect the blood flow through the liver, which can cause back pressure in the blood vessels that bring blood to the liver. About 1 in 10 heavy drinkers will eventually develop cirrhosis.

It tends to occur after 10 or more years of heavy drinking. It is not clear why some people are more prone for their liver cells to be damaged by alcohol and to develop hepatitis and/or cirrhosis. But, as a rule, the heavier you drink, and the more regularly that you drink, the more your risk of developing hepatitis and/or cirrhosis. The scaring and damage of cirrhosis is usually permanent and cannot be reversed.

A doctor may suspect that you have liver problems from your symptoms, and a physical examination. They may especially think of liver problems as a cause of your symptoms if you have a history of heavy alcohol drinking.

Some tests may be done:

■ Blood tests may show abnormal liver function. ■ An ultrasound scan may show that you have a damaged liver.

■ To confirm the diagnosis, a small sample of the liver may be taken to be looked at under the microscope. For all types of liver disease caused by alcohol, you should stop drinking alcohol completely. Also, you may be referred to a dietician to review your diet. This is because many people who drink heavily do not eat properly and need advice on getting back into eating a healthy diet. Vitamin supplements may be prescribed for a while.

■ If you have fatty liver, or alcoholic hepatitis that is not severe, you should fully recover from these conditions if you stop drinking alcohol.

■ If you have severe hepatitis and require hospital admission, you may require intensive care treatment. Some people with severe hepatitis will die.

■ If you have cirrhosis, stopping drinking alcohol can improve your outlook. It depends on how severe the cirrhosis has become. If cirrhosis is diagnosed when it is not too advanced, and you stop drinking alcohol, the cirrhosis is unlikely to progress. However, the cirrhosis and symptoms will usually get worse if you continue to drink alcohol.

Recommended safe limits.

should drink no more than 21 units of alcohol per week (and no more than four units in any one day).

should drink no more than 14 units of alcohol per week (and no more than three units in any one day).

The exact amount that is safe is not known. Therefore, advice from the Department of Health is that pregnant women and women trying to become pregnant should not drink at all. If you do chose to drink when you are pregnant then limit it to one or two units, once or twice a week.

In general, the more you drink above the safe limits, the more harmful alcohol is likely to be. And remember, binge drinking can be harmful even though the weekly total may not seem too high.