Alcoholic liver disease

Disease Description (Causes and Symptoms)

• Definition: A spectrum of liver diseases caused by excessive alcohol consumption (alcoholic fatty liver → alcoholic hepatitis → alcoholic cirrhosis and end-stage liver failure).
• Causes/Pathophysiology: Long-term exposure to large amounts of alcohol causes liver-cell damage and inflammation, followed by fat accumulation and fibrosis. Individual risk varies according to sex, genetic predisposition, nutritional status, and other factors. As a general example of risk, consuming approximately 80 g or more per day for 10–20 years may result in cirrhosis in about 20% of people. One drink is roughly equivalent to 10 g of alcohol.
• Main symptoms: Ranging from no symptoms (fatty liver) to fatigue, loss of appetite, nausea and vomiting, right upper abdominal pain, fever, jaundice, ascites, gastrointestinal bleeding (esophageal variceal bleeding), and hepatic encephalopathy (coma and behavioral changes). As the disease progresses, complications such as ascites, bleeding, and hepatic encephalopathy may occur.
• Diagnostic features (summary): Blood tests may show elevated AST/ALT (generally, AST is higher than ALT) and possibly elevated r-GT. Ultrasound may show fatty liver, enlargement of the liver and spleen, and ascites. If necessary, a liver biopsy may be performed to identify ballooning degeneration of liver cells, Mallory bodies, inflammation, and fibrosis.

Treatment Methods

• Top priority: Absolute abstinence from alcohol (complete abstinence). Continued alcohol consumption reduces the effectiveness of medications or other treatments.
• Drug treatment:
  • In severe acute alcoholic hepatitis, short-term corticosteroids (e.g., prednisolone) may be considered (only for selected patients). Some medications, such as pentoxifylline, have also been used in certain cases, but patient selection and assessment of risks and benefits are necessary.
  • Management of hepatic encephalopathy: Lactulose, antibiotics (e.g., rifaximin), and others.
  • Treatment of complications (ascites: diuretics, large-volume paracentesis; esophageal variceal bleeding: endoscopic ligation, medications, embolization, and others).
• Nutrition and supportive treatment:
  • A high-protein, high-calorie, balanced diet (if hepatic encephalopathy is present, follow guidelines for adjusting protein intake).
  • Vitamin supplementation (especially thiamine/vitamin B1) — important in people with alcohol use.
  • A low-sodium diet (in cases of ascites or edema).
• Surgery and procedures:
  • Liver transplantation may be considered in end-stage cirrhosis and liver failure (selection criteria and abstinence requirements vary by institution).
• Lifestyle management and precautions:
  • Avoid medications, poor nutritional status, and exposure to hepatotoxic substances (e.g., excessive acetaminophen).
  • Have a plan for withdrawal symptoms (anxiety, tremor, seizures, etc.; medication treatment under medical supervision may be necessary).
  • Recommended vaccinations: hepatitis A and hepatitis B vaccines (depending on immune status).

Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)

• Items/documents to bring:
  • A list of all currently used medications and supplements (including doses).
  • Copies of recent blood test results (if possible, AST, ALT, total bilirubin, albumin, INR, etc.) and imaging findings (ultrasound and CT).
  • Alcohol-use history: recent alcohol consumption (per week and per day), duration of alcohol use, attempts to stop and history of unsuccessful attempts, and whether withdrawal symptoms have occurred.
  • History of liver disease (hepatitis, liver nodules, liver biopsy results, etc.) and information about other chronic diseases.
  • A record of symptom changes (the onset and course of jaundice, ascites, changes in consciousness, bleeding, etc.).
• Examples of useful questions to ask during an outpatient visit (including items to ask the doctor first):
  • Are there any test results that require particular attention? (e.g., AST/ALT, INR, albumin)
  • What are the side effects and risk of liver toxicity of this medication (the medication prescribed by the doctor)?
  • What support (medications, counseling, rehabilitation programs) do you recommend to help me stop drinking?

Examples of General Questions to Ask the Doctor

• "What is the prognosis (possibility of recovery) of this condition? How much does abstaining from alcohol affect the prognosis?"
• "What examinations and treatments are needed to prevent complications such as ascites or variceal bleeding?"
• "What emergency measures should be taken if liver function test results worsen?"

Examples of Disease-Specific Questions

• "Based on my current test results (e.g., AST/ALT, bilirubin, albumin, INR), what is the degree of progression of cirrhosis (e.g., the Child–Pugh and MELD scores)?"
• "At what point should liver transplantation be considered, and what are the evaluation criteria? How long is the required period of abstinence before transplantation?"

(Summary) Abstinence from alcohol is the key factor determining treatment and prognosis in alcoholic liver disease. In cases of severe alcoholic hepatitis or cirrhosis, specialized drug treatment, procedures, and consideration of liver transplantation may be necessary. Before an outpatient visit, it is important to prepare a list of medications, test results, and an accurate alcohol-use history, and to discuss complication prevention and a rehabilitation plan with the doctor.