Damage to the liver from years of excessive drinking causes alcohol-related liver disease (ARLD). Alcohol misuse can cause the liver to swell and become inflamed over time. Cirrhosis is a scarring condition caused by liver injury. Cirrhosis is the most advanced form of liver disease.

1. Pathophysiology
Alcohol Liver Disease
Presented by:
Ms. Sipora Sudin Gaikwad

2. Alcohol Liver Disease
• Alcohol liver disease is inflammation of the liver caused by drinking alcohol.
• Alcohol liver diseases most likely to occur in people who drink heavily over many years.
• However, the relationship between drinking and Alcohol liver diseases is complex. Not all heavy
drinkers develop Alcohol liver diseases, and the disease can occur in people who drink only
moderately.

3. How much of alcohol cause liver damage
• Consumption of 60–80g per day (about 75–100 ml/day) for
20 years or more in men.
• Consumption of 20g/day (about 25 ml/day) for women
significantly increases the risk of liver damage.
• Women have double the risk of getting ALD when compared
to men

4. Stages of Alcohol Liver Disease
ALD occurs in three stages viz. Fatty Liver, Alcoholic Hepatitis, and Liver Cirrhosis.
• Fatty Liver – It is the first stage of ALD, and is also known as steatosis. Fatty Liver is a highly prevalent liver disease,
which is characterized by an excessive accumulation of fat inside the liver cells. It makes it hard for the liver to function
properly. Heavy drinkers usually get to the fatty liver stage in their early years of alcohol abuse. This reversible if alcohol
use is stopped.
• Alcoholic Hepatitis – The second stage of ALD, Alcoholic Hepatitis is characterized by the inflammation of the liver
leading to the degeneration of liver cells quickly. This stage might last for some years but will eventually progress to
absolute liver damage if the patient continues to drink. In critical cases, it can lead to life-threatening complications like
liver cirrhosis and absolute liver damage. Jaundice is the most common symptom in this stage along with nausea, vomiting,
abdominal pain, etc.
• Liver Cirrhosis – Liver cirrhosis is the last and final stage of Alcoholic Liver Disease where permanent scarring of healthy
liver tissue occurs. It is a severe condition and an irreversible one. A patient with liver cirrhosis will witness liver failure
symptoms, along with the symptoms of alcoholic hepatitis: Fluid accumulation in the abdomen, Spleen enlargement,
Bleeding from veins

5. Pathophysiology of Alcohol Liver Disease
• Alcohol is metabolized by several processes or pathways.
• The most common of these pathways involves two
enzymes—alcohol dehydrogenase (ADH) and aldehyde
dehydrogenase (ALDH).
• These enzymes help break apart the alcohol molecule,
making it possible to eliminate it from the body.
• First, ADH metabolizes alcohol to acetaldehyde, a highly
toxic substance and known carcinogen. Then, in a second
step, acetaldehyde is further metabolized down to another,
less active byproduct called acetate, which then is broken
down into water and carbon dioxide for easy elimination

6. Symptoms
The most common sign of alcoholic hepatitis is yellowing of the skin and whites of the eyes
(jaundice).
• Other signs and symptoms include:
• Loss of appetite
• Nausea and vomiting
• Abdominal tenderness
• Fever, often low grade
• Fatigue and weakness

7. Causes of ALD

8. Diagnosis Tests
• Blood tests. Including liver function tests, which show whether the liver is working the way it should.
• Liver biopsy. This involves removing small tissue samples from the liver with a needle or during surgery.
These samples are checked under a microscope to find out the type of liver disease.
• Ultrasound. This test uses high frequency sound waves to create a picture of the organs.
• CT scan. This imaging test uses X-rays and a computer to makes detailed images of any part of the body,
including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
• MRI. MRI uses a magnetic field, radio frequency pulses, and a computer to make detailed pictures of internal
body structures. Sometimes injecting dye into a vein is used to make images of body parts. The dye helps
show the liver and other organs in the belly (abdomen).

9. Complication
• Enlarged veins (varices). Heavy bleeding in the upper stomach or esophagus is life-threatening and
requires immediate medical care.
• Ascites. Fluid that accumulates in the abdomen might become infected and require treatment with
antibiotics. Ascites isn't life-threatening but are usually a sign of advanced alcoholic hepatitis or
cirrhosis.
• Confusion, drowsiness and slurred speech (hepatic encephalopathy). A damaged liver has trouble
removing toxins from your body. The buildup of toxins can damage your brain. Severe hepatic
encephalopathy can result in coma.
• Kidney failure. A damaged liver can affect blood flow to the kidneys, resulting in damage to those
organs.
• Cirrhosis. This scarring of the liver can lead to liver failure.