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Alcoholic Liver Disease

Alcoholic Liver Disease

Alcoholic liver disease is liver injury that is due to alcohol abuse. Approximately 75 percent of Americans drink alcohol, though most of them do not develop serious consequences. However, those who consume more than the daily "threshold" level of alcohol will have some evidence of liver injury.

Alcoholic Liver Disease Symptoms

Symptoms of alcoholic liver disease vary. Some patients do not experience any symptoms at all, or symptoms may be nonspecific. Often, by the time a patient consults a physician, severe liver decompensation, or liver failure, has already developed.

If you consume alcohol on a regular basis and experience any of the following symptoms, make an appointment with a gastroenterologist:

  • Nausea

  • Dry retching ("dry heaves")

  • Diarrhea

  • Anorexia

  • Abdominal pain

  • Jaundice (yellowing of the skin and whites of the eyes)

  • Confusion

    Signs and symptoms of alcohol-related liver disease
    Signs and symptoms of alcohol-related liver disease (Click to Enlarge)

Although "cirrhosis" is the most commonly used term to describe liver damage, there are actually three stages of liver damage:

  • Fatty liver is an abnormal accumulation of fat in the liver. This can cause your liver to become enlarged. It is usually asymptomatic and is completely reversible once you stop drinking alcohol.

  • Alcoholic hepatitis occurs when your liver becomes inflamed, destroying liver cells and often resulting in permanent scarring. This can also present without any symptoms.

  • Fibrosis/cirrhosis (scar formation) occurs when the normal liver tissue is destroyed, leaving nonfunctioning scar tissue in its place. Blood flow through your liver becomes difficult and fluid accumulates in the abdominal cavity. This could lead to kidney failure and liver cancer.

Alcoholic Liver Disease Diagnosis at Johns Hopkins

A diagnosis of liver disease begins with a comprehensive physical exam during which you describe your symptoms and medical history. It is important to discuss your alcoholic intake with your doctor.

If you drink more than two alcoholic drinks per day, no matter what kind of beverage, you are at risk for liver damage. Often, patients underestimate how much they drink. Other diagnostic procedures include:

Diagnostic procedures your doctor may order:

Biochemical Tests

Blood tests are useful in evaluating liver disorders. Certain abnormalities will appear on a blood test if you have alcoholic liver disease. However, blood tests are only one part of a full diagnostic workup, since the results do not indicate the severity of the disease.


An ultrasound uses sound wave technology to provide your doctor with a detailed image of your liver. Ultrasound is a noninvasive test that is easy to perform. You may need an ultrasound to monitor your condition if you have any hepatic (liver) dysfunction.

However, because an ultrasound cannot detect subtle changes in your liver, it cannot predict if you are at risk for developing cirrhosis.

Computed Tomography

A computed tomography (CT) scan is a powerful X-ray. Your doctor may use a CT scan to help diagnose cirrhosis, portal hypertension (resistance to blood flow through the liver) and liver masses.

Liver Biopsy

If your doctor thinks you may have alcoholic hepatitis, you may need a biopsy for a definitive diagnosis. During a liver biopsy:

  1. You receive local anesthesia.

  2. Your doctor removes a small piece of liver tissue and sends it to a pathology lab.

  3. Pathologists analyze the tissue and determine if you have hepatitis or cirrhosis.

Alcoholic Liver Disease Treatment at Johns Hopkins

The first step in treating alcoholic liver disease is immediate and total abstinence from alcohol. Continuing to drink alcohol will lead to further progression of the disease. Abstinence benefits all liver disease patients, regardless of the stage of the disease. Patients who are hospitalized for acute alcohol hepatitis also need treatment for alcohol withdrawal symptoms. Learn more about alcoholic liver disease treatment at Johns Hopkins.

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