If you have alcoholic liver disease (ALD), the crucial first step is to abstain completely from consuming alcohol, as continued consumption will lead to further progression of the disease. All of the alcohol-related disorders will improve with the cessation of drinking.
Alcohol Withdrawal Treatment
The most crucial step for beginning treatment for alcoholic liver disorder (ALD is to quit drinking completely. Unfortunately, because the body has become dependent on alcohol, the sudden cessation of alcohol may cause painful withdrawal symptoms.
If you are hospitalized with acute alcohol hepatitis, your treatment plan will include treatment for alcohol withdrawal. Withdrawal causes a wide range of symptoms, including:
At the hospital, we will monitor your blood pressure, temperature and heart rate. You will receive intravenous (IV) fluids and medication, and possibly a sedative until withdrawal is complete.
Alcoholic Liver Disease Treatment: Nutritional Support
If you have ALD, you may be also malnourished. A loss of appetite and nausea may have prevented you from ingesting enough nutrients. Providing sufficient calories with nutritional supplements is very crucial to your recovery and healing of your liver inflammation.
In a severe situation, you may need enteral therapy. Your doctor will insert a simple feeding tube into your stomach, in order to provide your body with the necessary nutrients.
Alcoholic Liver Disease Treatment: Liver Transplantation
In severe cases, patients’ condition may deteriorate further and develop liver failure. At that point, liver transplantation is the only cure.
Survival rates for liver transplants are higher than for patients who received medical therapy (corticosteroid) alone. Transplant centers typically require a demonstrated commitment to sobriety.
Liver Transplantation (Click to Enlarge)
Treating Complications of Alcoholic Liver Disease
There are a number of complications that may arise in patients with ALD. Your medical team will help you manage these complications.
Cirrhosis of the Liver
Cirrhosis is a result of chronic liver disease. It occurs when the disease has destroyed normal liver tissue, leaving nonfunctioning scar tissue in its place. Cirrhosis is rarely reversible. There are a number of causes, including alcohol consumption, viral hepatitis, autoimmune diseases, exposure to certain drugs and toxins, or other viral and infectious diseases.
In patients with cirrhosis, excessive scar tissue replaces the normal liver substance which permanently alters your liver and leads to impaired liver function and structure. There is no cure for cirrhosis, but your doctor will work with you to manage the symptoms and keep the condition from progressing. You may need to:
Take medications, if an underlying disease is causing the cirrhosis can be treated
Stop drinking alcohol
Lose weight if you are overweight
Eat a low-sodium diet
Portal Hypertensive Bleeding
Because of the liver scarring resulting from ALD, your blood cannot circulate easily throughout your body. Portal hypertension is when you develop varices (varicose veins) in your esophagus or stomach, as a result of high blood pressure in your portal vein. The varices can be examined during an endoscopy.
If you have severe internal bleeding from these varices, you will require prompt attention. The goal of therapy for portal hypertensive bleeding is to lower your portal pressure and eliminate the varices, and to prevent future bleeding.
Treatment methods include:
Mdication. Once it is confirmed that the cause of the hemorrhage is a varicose vein, you can take medications to lower the blood pressure inside the veins and stop the bleeding.
Endoscopic Variceal banding. Also called variceal ligation, this is a procedure in which your gastroenterologist places small rubber bands directly over the varices in the endoscopy unit. This is the most commonly used procedure to treat variceal bleeding.
Transjugular intrahepatic portal-systemic shunt (TIPS). This procedure is another method to control acute bleeding, if endoscopic method failed to control the bleeding. It is a nonsurgical, delicate procedure usually performed by experienced interventional radiologist. Through your internal jugular vein, your hepatic (liver) veins are accessed. Then, your doctor passes a needle into the portal vein, dilates it and places a stent to keep the vein open and relieve the pressure in the bleeding veins.
Ascites is a condition when excess fluid accumulate in your abdomen due to high blood pressure in the liver. Low salt diet in combination with diuretics (water pills) will help to remove the fluid in majority of patients. If not, you may need an abdominal paracentesis. Your stomach will be anesthetized, and your doctor will insert a needle into the abdomen to remove the ascitic fluid.
Hepatic encephalopathy occurs when your liver can no longer remove toxic substances in your blood such as ammonia, leading to a deterioration of brain function. This condition can range from mild changes in behavior and personality, such as forgetfulness, change in sleep patterns to a deep coma. The purpose of treatment of hepatic encephalopathy is to reduce the production and absorption of toxic substances. Your doctor may use a combination of dietary changes and medications to achieve this goal. Common medications for this conditions are lactulose and rifaximin.