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.
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.
If you have ALD, you may be also malnourished. A loss of appetite and nausea may have prevented you from ingesting enough nutrients. Your doctor may prescribe nutritional supplements to help repair the damage to your body and help you gain weight.
In a severe situation, you may need enteral therapy. Your doctor will insert a feeding tube, either through your nose or directly into your stomach, in order to provide your body with the necessary nutrients.
Unfortunately, there is no straightforward, long-term treatment of ALD. Nutritional therapy and abstinence are important, but in a severe case, these may not be enough. If you have decompensated liver disease (your liver function has significantly deteriorated), you may be a candidate for a liver transplant.
Survival rates for liver transplants are higher than for patients who received medication alone. However, liver donors are scarce, and the operation is expensive. Transplant centers typically require a demonstrated commitment to sobriety. Many require candidates to prove six months of abstinence and to participate in a rehabilitation program.
Liver Transplantation (Click to Enlarge)
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 irreversible. There are a number of causes, including alcohol consumption, viral hepatitis, exposure to certain drugs and toxins, or other viral and infectious diseases.
In patients with cirrhosis, excessive fibrous connective tissue replaces the normal liver substance. This abnormal regeneration permanently alters your liver and leads to impaired liver function and scarring. 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 medication, if an underlying disease is causing the cirrhosis
Stop drinking alcohol
Eat a low-sodium diet
Take medication to reduce your blood pressure
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 or X-ray. Obstructions may also occur in your veins, increasing the pressure and the potential for rupture.
If you have severe internal bleeding from these varices, you will require prompt attention. The goal of therapy for portal hypertensive bleeding is to prevent all bleeding episodes. The goal is to lower your portal pressure and eliminate the varices.
Treatment methods include:
Medication . Once it is confirmed that the cause of the hemorrhage is a varicose vein, you can begin medication. The goal of drug therapy is to reduce the resistance and allow the blood to flow more easily.
Variceal banding . Also called variceal ligation, this is a procedure in which your gastroenterologist places small rubber bands directly over the varices. This is the most commonly used procedure to treat variceal bleeding.
Endoscopic therapy . An endoscope is a thin, lighted tube inserted through your mouth. The endoscope provides detailed visualization of your upper gastrointestinal tract. During an endoscopy, your doctor can diagnose as well as treat portal hypertensive bleeding.
Balloon tamponade . This treatment uses compression to control variceal bleeding. We may recommend this method if medication and endoscopic therapy have failed. Your doctor inserts a catheter through your nose and then places a balloon through the catheter. The balloon reaches the bleeding site and compresses the blood vessels.
Transjugular intrahepatic portal-systemic shunt (TIPSS) . This procedure is another method to control acute bleeding. It is a nonsurgical, delicate and highly complex procedure. 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.
Surgical shunt . Your doctor may choose to insert a shunt (a hole or small passage that allows movement) surgically in order to reduce the pressure on the portal veins and to maintain easy blood flow.
Ascites is a condition when fluid develops in your abdomen. The high blood pressure in the liver causes the excess fluid. Sometimes, a diuretic may be enough to help remove the fluid. 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, leading to a deterioration of brain function. This condition can range from mild changes in behavior, such as slow reaction times, to a deep coma. The purpose 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.