Medical Information
Alcoholic Liver Disease (ALD)

Alcoholic Liver Disease (ALD)

Digestive Health
Diseases & Conditions
Contributed byMaulik P. Purohit MD MPHApr 18, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Acute Alcoholic Hepatitis
  • Acute Alcoholic Liver Disease
  • Alcohol-Induced Liver Disorder

What is Alcoholic Liver Disease? (Definition/Background Information)

  • Alcoholic Liver Disease (ALD) is a condition that causes damage to the liver, due to excessive consumption of alcohol. There are 3 types of Alcoholic Liver Disease, namely:
    • Alcoholic Hepatitis
    • Fatty Accumulation in Liver
    • Cirrhosis of Liver
  • Alcoholic Hepatitis is the inflammation of liver cells that can occur, due to excessive alcohol intake. A persistent inflammation can lead to damage of the liver, ranging from a condition termed as fatty liver (deposition of fat in liver cells, due to damage of the oxidation process of fat), to cirrhosis (fibrosis of the liver cells).
  • Fatty liver disease occurs due to accumulation of fat, due to alcohol intake. This is usually the first step in the progress towards ALD. Moreover, in many cases, especially during early ALD, fatty liver disease does not cause any signs and symptoms.
  • The condition is reversible in many, if the individual stops consuming alcohol. Advanced fatty liver disease can cause symptoms, such as weakness and slow weight loss.
  • Temporary fat deposition in the liver can occur with a single heavy drinking episode, which then reverses after the individual ceases to drink. More advanced and permanent damage is typically seen, after 10 or more years of heavy drinking.
  • The damage is thought to be caused by acetaldehyde that is produced during alcohol metabolism. Acetaldehyde alters the surface proteins of liver cells, which affects the fluidity of the cell lining. This type of alteration triggers the immune system that destroys liver cells causing failure of liver cells; a condition termed as alcohol-induced chronic liver failure.
  • The diagnosis of ALD is based on history, liver function blood test, and a liver biopsy. The most basic step towards treating the condition is complete stoppage of alcohol consumption.
  • The prognosis depends on the extent of liver damage from alcohol intake; greater the damage to liver cells, worse is the prognosis.

Who gets Alcoholic Liver Disease? (Age and Sex Distribution)

  • Alcoholic Liver Disease is generally prevalent amongst individuals in the 30-60 years age group
  • Although a majority of the individuals with ALD are men, women are more susceptible than men to the toxic effects of alcohol; with the risk rising at lower levels of consumption
  • Despite a lack of significant differences in alcohol consumption by various ethnic groups, it is observed that African Americans and Hispanic men suffer higher rates of alcohol-related liver damage. Genetic differences are not necessarily causative. Social-economic differences in diet and access to healthcare may also play an important role in these ethnic groups.
  • Obesity alone is associated with liver damage. This is known as Non-Alcoholic Liver Disease (NALD), which shares many of the pathological changes found in alcoholic liver condition. Obesity as an independent risk factor for the development of ALD
  • Viral hepatitis, especially hepatitis C, markedly advances progression to cirrhosis in individuals, who consume excessive quantities of alcohol
  • Alcoholics are more highly susceptible to hepatotoxic drugs, such as acetaminophen, even in quantities considered safe for the general population

What are the Risk Factors for Alcoholic Liver Disease? (Predisposing Factors)

The risk factors of Alcoholic Liver Disease include:

  • Individuals, who consume alcohol on a regular basis
  • Women are more susceptible to ALD, than men
  • African Americans and Hispanic men are known to suffer higher rates of alcohol-related liver damage
  • Presence of obesity and viral hepatitis increases the damage to the liver, due to alcohol consumption
  • Individuals with a family history of the condition are more likely to develop ALD

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Alcoholic Liver Disease? (Etiology)

  • Alcoholic Liver Disease causes liver injury. The extent of liver injury is directly proportional to the amount and duration of alcohol abuse
  • It has to be noted that not all individuals, who develop ALD, are heavy drinkers. However, the chances of developing liver disease increases, the more alcohol an individual has been consuming. Permanent damage typically occurs after more than 10 years of heavy drinking

What are the Signs and Symptoms of Alcoholic Liver Disease?

The general signs and symptoms of Alcoholic Liver Disease include:

  • Abdominal pain and tenderness
  • Dry mouth and increased thirst
  • Lack of energy, easily feeling fatigued
  • Jaundice
  • Loss of appetite and weight loss
  • Nausea and vomiting
  • Fluid build-up in the legs (edema) and in the abdomen (ascites), when cirrhosis is present
  • Enlarged spleen (splenomegaly)

Skin changes could include:

  • Abnormally dark or light skin
  • Redness on feet or hands
  • Small, red spider-like blood vessels on the skin
  • Yellow coloration of the skin, mucus membranes, or eyes (jaundice)

Abnormal bleeding:

  • Bloody, dark black, or tarry bowel movements (melena)
  • Nosebleeds or bleeding gums
  • Vomiting blood or material that looks like coffee grounds

Liver damage affects the detoxification process; toxic products, such as ammonia that remain in the body can cause brain damage, a condition called hepatic encephalopathy. Brain and nervous system symptoms may include:

  • Agitation (being stirred up, excited, or irritable)
  • Changing mood
  • Confusion (encephalopathy)
    • Periods of decreased alertness or awareness
    • Hallucination
    • Impaired short-term or long-term memory
  • Pain, numbness, or tingling in the arms or legs
  • Problems paying attention or concentration
  • Poor judgment
  • Slow, sluggish movements

Other symptoms that can occur with ALD:

  • Breast development in males (gynecomastia)
  • Light-headedness or fainting, especially when rising to standing position (orthostatic hypotension)
  • Paleness

How is Alcoholic Liver Disease Diagnosed?

A diagnosis of Alcoholic Liver Disease may involve:

  • Physical exam and evaluation of medical history
  • Complete blood count (CBC)
  • Liver function test, to check the levels of certain enzymes secreted by the liver
  • Liver biopsy (which is considered, when the diagnosis is in question)

Tests to rule out other diseases include:

  • Abdominal CT scan
  • Blood tests for other causes of liver disease, such as viral hepatitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Alcoholic Liver Disease?

The complications from an Alcoholic Liver Disease could include:

  • Bleeding in the blood vessels at the lower part of the food pipe, due to distension of the blood vessels (varices), caused by an increased pressure of the liver blood vessels (portal hypertension)
  • Advanced scarring of liver, called cirrhosis
  • Brain damage due to toxins (hepatic encephalopathy)
  • Increased blood pressure in liver can cause a condition called portal hypertension
  • Malnutrition
  • Cirrhosis can cause liver cancer

How is Alcoholic Liver Disease Treated?

A treatment of Alcoholic Liver Disease may involve:

  • A complete stoppage of alcohol intake: A complete abstinence early in the process can reverse any liver damage that has occurred. However, the damage cannot be reversed, after cirrhosis develops
  • Treat malnutrition, especially vitamin B1 and folic acid vitamin deficiency, by providing suitable supplementation. Consider a healthy diet
  • If moderate cirrhosis develops, the symptoms can often be managed with dietary restrictions, especially regulating salt intake
  • Medications, if complication develops due to liver failure
  • During end-stage cirrhosis, the only curative therapy would be a liver transplant

How can Alcoholic Liver Disease be Prevented?

Alcoholic Liver Disease can be prevented by the complete avoidance of alcohol.

What is the Prognosis of Alcoholic Liver Disease? (Outcomes/Resolutions)

  • The prognosis of Alcoholic Liver Disease depends on the extent of liver damage
  • Mortality due to ALD is very high with continued drinking

Additional and Relevant Useful Information for Alcoholic Liver Disease:

All alcohol types namely, beers, wines, and hard liquor, can cause Alcohol Liver Disease.

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Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team


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