Alcoholic Liver Cirrhosis

• Symptoms
• Causes and risk factors
• Diagnosis
• Complications
• Treatment
• Outlook

The liver removes toxins from the blood, breaks down proteins, and creates bile. Over time, heavy alcohol use can lead to cirrhosis, a condition in which healthy tissue is replaced with scar tissue.

Alcoholic liver cirrhosis (alcohol-related cirrhosis) is the most advanced form of liver disease linked to drinking alcohol.

The disease is part of a progression. It may start with fatty liver disease, progressing to alcohol-related hepatitis, and then to alcohol-related cirrhosis. But you could develop alcohol-related cirrhosis without ever having alcohol-related hepatitis.

As the condition progresses and more healthy liver tissue is replaced with scar tissue, the liver stops functioning properly.

According to one 2019 study, 20% to 25%Trusted Source of people who misuse alcohol by drinking heavily over many years will develop cirrhosis. Alcohol consumption was also estimated to cause a quarterTrusted Source of all cirrhosis-related deaths globally in 2019.

What symptoms are associated with alcoholic liver cirrhosis?

Symptoms of alcohol-related cirrhosis typically develop around the mean age of 52Trusted Source, with alcohol-related fatty liver disease and alcohol-related hepatitis often showing up about 4 to 8 years before this.

In the early stages of the disease, your body can compensate for your liver’s limited function. As the disease progresses, symptoms will become more noticeable.

The symptoms of alcohol-related cirrhosis are similarTrusted Source to those of other alcohol-related liver conditions. They include:

• jaundice
• portal hypertension, which can cause vomiting blood, abdominal swelling, and other bodily swelling
• itchy skin, which is also known as pruritus
• muscle wasting
• decreased strength
• brain fog or confusion
• unintentional weight loss or gain
• fainting
• shifts in mood
• problems with sleep

Causes and risk factors

Cirrhosis can have a variety of causes. But alcohol-related cirrhosis is directly linked to alcohol misuse, which can become alcohol use disorder.

Damage from prolonged alcohol misuse can lead to alcohol-related cirrhosis. When the liver tissue starts to scar, the liver doesn’t work as well as before. As a result, the body can’t produce enough proteins or filter toxins out of the blood as it should.

The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking as having 5 or more drinksTrusted Source in 1 day on at least 5 days out of the past month.

A standard alcoholic drink contains about 14 grams (g)Trusted Source of pure alcohol. Research shows that in many cases, people with alcohol-related cirrhosis have a history of drinking between 30 to 50 g (about 2 to 3 drinks)Trusted Source and 100 g (7 drinks) daily or more.

Other risk factors

However, people with different genetic backgrounds or those with preexisting metabolic conditions may be more likelyTrusted Source to develop the condition earlier than others, even with lower alcohol consumption.

For example, you may develop the condition sooner if you’ve been born with a deficiency in the enzymes that help to get rid of alcohol.

According to a 2015 studyTrusted Source of people hospitalized with alcohol-related liver disease in Sacramento, California, Hispanic people tend to develop the condition at a younger age than African Americans or people who are white. Symptoms start to show up at least 4 years earlier.

Obesity, a high fat diet, and hepatitis C can also increase your likelihood of developing alcohol-related liver disease.

People who are female also have a higher chance of developing alcohol-related liver disease than people who are male. People who are female don’t have as many enzymes in their stomachs to break down alcohol particles. Because of this, more alcohol can reach the liver and make scar tissue.

Are sex and gender the same thing?

People often use the terms “sex” and “gender” interchangeably, but they have different meanings:

• “Sex” refers to the physical characteristics that differentiate male, female, and intersex bodies.
• “Gender” refers to a person’s identity and how they feel inside. Examples include “man,” “woman,” “nonbinary,” “agender,” “bigender,” “genderfluid,” “pangender,” and “trans.” A person’s gender identity may be different from the sex they were assigned at birth.

Diagnosis

Doctors can diagnose alcohol-related cirrhosis by first taking a medical history and discussing your drinking history.

A doctor will also run some tests that can confirm a diagnosis of alcohol-related cirrhosis. The results of these tests may showTrusted Source the following:

• anemia, which is a low number of red blood levels
• leukocytosis, which is a large number of white blood cells
• high blood ammonia levels
• high blood sugar levels
• low blood magnesium levels
• low blood potassium levels
• low blood sodium levels
• portal hypertension
• unhealthy liver tissue, which may be discovered during a biopsy
• levels of aspartate aminotransferase (AST) that are two times higher than levels of alanine aminotransferase (ALT), which may indicate a liver injury

To confirm that alcohol-related cirrhosis has developed, a doctor will try to rule out other conditions that may affect the liver.

Complications

Alcohol-related cirrhosis can cause decompensated cirrhosis. Examples of the complications associated with decompensated cirrhosis include:

• ascites, or a buildup of fluid in the stomach
• encephalopathy, which can cause mental confusion
• bleeding varices, a type of internal bleeding that affects the veins
• jaundice

Preventing decompensated cirrhosis may be possible, but it depends on the cause. If decompensated cirrhosis is triggered by something like an infection or your diet, the trigger can be identified, and the condition can be reversed or controlled, either with medical treatment or through lifestyle changes.

It’s important to identify the trigger whenever possible in case the condition is reversible. If not, you may need a liver transplant. A liver transplant is a challenging procedure, and the rules about who can receive an organ are complex.

Treatment

Treatments can reverse some forms of liver disease, but alcohol-related cirrhosis usually can’t be reversed. However, a doctor can recommend treatments that may slow the disease’s progression and reduce symptoms.

The first step in treating alcohol-related cirrhosis is to find the support you or your loved one needs to stop drinking.

People with alcohol-related cirrhosis often experience such high levels of alcohol dependence that they could have severe health complications if they try to quit without being in the hospital. A doctor can recommend a hospital or treatment facility where they can start the journey toward sobriety.

Learn more about resources, support, and treatment for alcohol use disorder.

Other treatments a doctor may use include:

• Medications: Medications that a doctor may prescribe include corticosteroids, calcium channel blockers, insulin, antioxidant supplements, and the amino acid S-adenosyl-L-methionine (SAMe).
• Nutritional counseling: Alcohol misuse can lead to malnutrition.
• Extra protein: People with alcohol-related cirrhosis often require extra protein in certain forms to help reduce their likelihood of developing encephalopathy.

Liver transplant

In severe cases, you will need a liver transplant. However,the amount of time without alcohol use must be at least 6 months before you can be considered a candidate for a liver transplant.

The transplant evaluation is thorough and strict, and the rules for receiving a transplant can vary by region. Many factors can be used to make a decision about your transplant candidacy, and these factors aren’t limited to only medical needs.

You may need to be evaluated using different scoring systems, including the Child-Pugh scoring system or the Model for End-Stage Liver Disease (MELD). For children, there is a similar scoring system known as the Pediatric End-Stage Liver Disease (PELD) system.

The results from one or more of these severity scoring systems are one of the things a doctor may look at when deciding the urgency of your need for a liver transplant. If the results suggest your condition is severe, they can be used to help prioritize an organ transplant for you.

The lower your name is placed on the transplant list, the longer you may need to wait. For example, if you’re a young adult, you may need to wait longer than an older adult, even if your medical needs are the same.

Research shows that only about 10%Trusted Source of people with alcohol-related cirrhosis may be referred for transplant each year, and only 4% of those with decompensated alcohol-related cirrhosis may receive a place on the waiting list.

Of these, only 1.2% may actually undergo a transplant. Reasons may includeTrusted Source a shortage of organs, the difficulty of the procedure, and concerns that you may experience an alcohol misuse relapse after the transplant.

Reasons someone might relapse into alcohol misuse after a transplant include a history of mental health conditions, limited access to treatment options, or a lack of social support. You and a doctor can take steps ahead of time to help resolve these issues, which can increase your chance of getting the transplant.

Outlook

Your outlook will depend on your overall health and whether you’ve developed any complications of alcohol-related cirrhosis. It also depends if you are referred for a liver transplant and where you are placed on the organ transplant list.

You’re more likely to have a worse outcome if you have difficulty finding the help you need to stop drinking alcohol or if you develop ascites. Due to how your body metabolizes alcohol, you’re also more likelyTrusted Source to have a worse outcome if you’re female.

ResearchTrusted Source is ongoing on medications that might be able to reverse cirrhosis. Still, it’s likely going to take time and many clinical trials before any drug is found to be successful and can enter the market.