Liver damage from alcohol: An overview

Liver damage from alcohol can manifest in several different ways. Acute alcoholic hepatitis is one form of alcohol related liver damage that can result in acute liver failure and may even cause death of the patient. Initially the liver damage from alcohol may be reversible but that changes as the patient continues to drink. Liver damage from alcohol may progress from fatty liver to alcoholic hepatitis to alcoholic cirrhosis to end stage liver disease. But the progression of liver damage from alcohol does not always follow this timeline. Some patients may develop severe liver damage from alcohol in just a few years while it may take more than twenty years in others.

Liver damage from alcohol: A 42 year old male with severe alcoholism

Mr S is a 42 year old male who has been drinking excessively for the last 5 years. He used drink a lot when he was young but he had cut down on his drinking after he got married at 28. He did occasional binge drinking when his wife was alive. His drinking became extremely problematic after she died in a car accident 5 years ago. Initially his friends did not stop him as they thought he was still grieving for his wife but later on it became an addition. Recently, he does not even recall or talk about his dead wife at all. He just has to get drunk everyday. He drinks almost a liter of Vodka everyday. He starts to drink early in the afternoon and is usually very intoxicated by the time he gets in bed.

I had consulted on his case when he was in the hospital a year ago. At that time, he was in the trauma unit as he was involved in a car accident. He was being treated for a broken wrist by the surgeon who had called me to evaluate his liver damage from alcohol. At that time, he only had mild and possibly reversible liver damage from alcohol. I had recommended that he needed to stop drinking to prevent further liver damage from alcohol. But he did not have any liver failure symptoms back then.

Apparently, he stopped drinking for about 2 weeks after he was discharged from that hospital stay. He said he was worried about liver damage from alcohol and wanted to cut down on his drinking. But, he could not maintain that spirit for than 2 weeks. He declined all help and started drinking again.

This time, he was brought to the hospital in a very poor health condition. He had been vomiting constantly for the last 3 days. He had some pain in the right side of his abdomen. He appeared jaundiced with yellowish greenish discoloration of his sunken eyes. He had lost a lot of weight and appeared malnourished. Just by looking at him, I could tell that the liver damage from alcohol had worsened. When I examined his stomach, my fingers could feel the edge of his enlarged and diseases liver. He had multiple visible veins along the skin of his lower chest and his upper abdomen that were propped up with blood flowing back from the diseases liver. This is an ominous sign in patients with liver damage from alcohol. His whole body was shaky and jerky. He was having cramps all throughout his abdomen.

When I looked at his blood work, it was clear than liver damage from alcohol was very severe. His liver enzymes were more than twenty times of thier upper limits of normal. His liver damage from alcohol was so bad that the blood clotting factors were all messed up. Liver damage from alcohol can interfere with the production of clotting factors in the liver. It puts the patient with liver damage from alcohol at very high risk of bleeding.

When I went to his bedside, he did not even recognize me. He was actively withdrawing from alcohol and was given high dose of sedatives to control his symptoms. I wished we had forced him to stop drinking to prevent liver damage from alcohol to get to this point but that opportunity had been missed. We were treating him the best we could but the prognosis of his liver damage from alcohol was very poor. He had severe acute alcoholic hepatitis with signs of acute liver failure.

Mr. S was lucky he survived the episode. We treated him with steroids and antibiotics. We replaced his vitamins and electrolytes. We treated his withdrawal symptoms. He was in the hospital for a total of 15 days. In the end, he started to show some recovery of the liver damage from alcohol. His liver enzymes slowly started to come down. His bleeding risks somewhat improved. He slowly woke up and required less sedatives. I talked to him about the liver damage from alcohol and told him frankly that he would die very soon if he drank any more alcohol.  I wanted to tell him the truth about liver damage from alcohol. I even told him how most miserable most patients are when they are dying as a result of  liver damage from alcohol. It is a gruesome, slow, painful and undignified death. Some bleed to death with repeated vomiting of blood. Some completely loose their mind and become incontinent of their urine and feces. Some accumulate tens of liters of fluid in the abdomen and succumb to bad infection.

Hearing the truth about the possible outcomes of liver damage from alcohol scared Mr. S and it seemed to work for him. He wanted to get into rehab and made arrangements with the social worker. As his liver failure and liver damage from alcohol seemed to be improving he had a good chance of survival if he stopped drinking.

Not many patients with acute liver damage from alcohol have this kind of happy ending. Many patients with acute liver failure secondary to liver damage from alcohol do not survive the severe illness. In many cases, the bleeding risk is so high that they are not even candidates for liver transfusion. I had personally seen many young patients die in the hospital from severe liver damage from alcohol.

I hope the story of Mr. S helped you understand more about liver damage from alcohol.. Please check back soon as I will be uploading more stories about different aspects of patients with liver damage from alcohol.