Alcoholism - Complications

Alcohol is absorbed in the small intestine and passes directly into the liver, where it becomes the preferred energy source. The liver is particularly endangered by alcoholism. In the liver, alcohol converts to toxic chemicals, notably acetaldehyde, which trigger the production of immune factors called cytokines. In large amounts, these factors cause inflammation and tissue injury.

Cirrhosis is a chronic liver disease that causes damage to liver tissue, scarring of the liver (fibrosis; nodular regeneration), progressive decrease in liver function. Consequences of a failing liver include excessive fluid in the abdomen (ascites), bleeding disorders (coagulopathy), increased pressure in certain blood vessels (portal hypertension), and brain function disorders (hepatic encephalopathy). Excessive alcohol use is the leading cause of cirrhosis.

Fatty liver is an accumulation of fat inside liver cells. It is the most common type of alcohol-induced liver disease and can occur even with moderate drinking. Symptoms include an enlarged liver with pain in the upper right quarter of the abdomen. Fatty liver can be reversed once the patient stops drinking. Fatty liver can also develop without exposure to alcohol, especially in people who are obese or have type 2 diabetes.

Alcoholic hepatitis is inflammation of the liver that develops from heavy drinking. Symptoms include fever, jaundice (yellowing of the skin), right-side abdominal pain, fatigue, and nausea and vomiting. Mild cases may not produce symptoms. Patients who are diagnosed with alcoholic hepatitis must stop drinking. Patients who continue to drink may go on to develop cirrhosis and liver failure.

Between 10 - 20% of people who drink heavily (five or more drinks a day) develop cirrhosis, a progressive and irreversible scarring of the liver that can eventually be fatal. Alcoholic cirrhosis (also sometimes referred to as portal, Laennec’s, nutritional, or micronodular cirrhosis) is the primary cause of cirrhosis in the U.S. [For more information, see In-Depth Report #75: Cirrhosis.]