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Prepared by Khew Kok How, Pharmacist.

What is alcohol-related liver disease (ARLD)?

The liver is one of the most complex organs in the human body, with over 500 functions. These include filtering out blood toxins, storing energy, making hormones and proteins, and regulating cholesterol and blood sugar. Alcohol-related liver disease (ARLD) is caused by damage to the liver from years of excessive drinking. Years of alcohol abuse can cause the liver to become inflamed and swollen.

 

Types of alcohol-related liver disease

  • Alcoholic fatty liver disease: This is the first stage of ARLD, where fat starts to accumulate around the liver. It can be cured by not drinking alcohol anymore.
  • Acute alcoholic hepatitis: Alcohol abuse causes inflammation (swelling) of the liver in this stage. The outcome depends on the severity of damage. In some cases, treatment can reverse the damage, while more severe cases of alcoholic hepatitis can lead to liver failure.
  • Alcoholic cirrhosis: This is the most severe form of ARLD. At this point, the liver is scarred from alcohol abuse, and the damage cannot be undone. Cirrhosis can lead to liver failure.

Symptoms:

 

  • nausea
  • loss of appetite
  • jaundice
  • fatigue
  • abdominal discomfort
  • increased thirst
  • swelling in the legs and abdomen
  • weight loss
  • darkening or lightening of the skin
  • red hands or feet
  • dark bowel movements
  • fainting
  • unusual agitation
  • mood swings
  • confusion
  • bleeding gums
  • enlarged breasts (in men)

Risk factor

  • Family history of ARLD
  • Heavy drinker
  • Binge drinking
  • Poor nutrition

Diagnosis

Complication

  • Permanent liver scarring and loss of function
  • High blood pressure in the blood vessels of the liver (portal hypertension)
  • Life-threatening complications of ARLD include:
  • Internal (variceal) bleeding
  • Build-up of toxins in the brain (encephalopathy)
  • Fluid accumulation in the abdomen (ascites) with associated kidney failure
  • Liver cancer
  • Increased vulnerability to infection

Treatment

  • Alcoholic rehabilitation program
    • Programs that can help you stop drinking when you can’t stop on your own.
  • Multivitamins
    • Vitamin deficiencies in those with ALD are caused by a combination of decreased intake, absorption, and storage. In addition, alcohol often interferes with the conversion of vitamins to a metabolically active form.
  • Liver transplant
    • A transplant may be necessary if your liver is too scarred by cirrhosis to function properly.
  • Quit drinking
  • S-Adenosylmethionine (SAM)
    • Is important in the synthesis of proteins and polyamines as well as of glutathione. Glutathione plays a major role in the removal of damaging free radicals. The enzyme that produces SAM (SAM synthetase) is deficient in patients with alcoholic cirrhosis, leading to decreased levels of SAM. Administration of SAM potentially could benefit ARLD patients by improving levels of glutathione and decreasing the damage to liver cells caused by alcohol.
  • Milk Thistle
    • Composed of silymaryin (70 to 80 percent), which is its active ingredient. Silymaryin appears to have antioxidant and toxin-reducing properties in the liver.
  • Phosphatidylcholine
    • A soybean extract that also is a component of cell membranes. It appears to have antioxidant properties, and fibrosis-reducing effects.
  • Vitamin E
    • An antioxidant that prevents the degradation of lipids by oxidation (i.e., lipid peroxidation) and free radical formation.

Prevention

  • Stop drinking alcohol or limiting of alcohol consumption.

References

  • (2017). Alcohol-Related Liver Disease: Symptoms, Treatment and More. [online] Available at: https://www.healthline.com/health/alcoholism/liver-disease#diagnosis [Accessed 14 Feb. 2020].
  • uk. (2018). Alcohol-related liver disease. [online] Available at: https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/ [Accessed 14 Feb. 2020].
  • Medical News Today. (2018). Alcoholic liver disease: Symptoms, treatment, and causes. [online] Available at: https://www.medicalnewstoday.com/articles/215638#treatment [Accessed 14 Feb. 2020].
  • Mayo Clinic. (2018). Alcoholic hepatitis – Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/alcoholic-hepatitis/symptoms-causes/syc-20351388 [Accessed 14 Feb. 2020].
  • com. (2018). Alcoholic Liver Disease. [online] Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/alcoholic-liver-disease/ [Accessed 14 Feb. 2020].
  • niaaa.nih.gov. (n.d.). NIAAA Publications. [online] Available at: https://pubs.niaaa.nih.gov/publications/arh294/296-306.htm [Accessed 14 Feb. 2020].
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