Alcoholic Liver Disease

Alcoholic liver disease encompasses a range of conditions, including fatty liver, alcoholic hepatitis, and alcohol-induced cirrhosis. This article aims to shed light on the clinical manifestations, pathogenesis, and management options for this concerning liver disease.

Clinical Manifestations

Alcoholic liver disease can present with various symptoms. Chronic alcohol intake may lead to

  • parotid swelling,
  • plethora,
  • redness of the eyes, and
  • obesity due to excess calorie intake.

Patients with fatty liver are usually asymptomatic, while alcoholic hepatitis can range from mild to severe, presenting with fever, jaundice, abdominal pain, hepatomegaly, oedema, ascites, spider naevi, and splenomegaly. Cirrhosis, in its early stages, may not cause symptoms but can progress to portal hypertension, variceal bleeding, and hepatic encephalopathy.


Alcohol exerts multiple effects on the liver. As it is metabolized in the liver cells, it leads to oxidative stress, increased lipid peroxidation, and the release of acetaldehyde, triggering an inflammatory response. Chronic alcohol ingestion also increases gut permeability, allowing endotoxins to enter the liver, activating Kupffer cells and promoting cytokine production. These cytokines, including TNF-alpha, contribute to hepatocyte damage and stimulate stellate cells, initiating liver fibrosis.


Diagnosis and Investigations

Diagnosis of alcoholic liver disease involves a careful history of alcohol intake, supported by objective tools like the CAGE and AUDIT questionnaires. Transaminase levels may be elevated in fatty liver and alcoholic hepatitis, with a higher AST: ALT ratio (>2:1) indicating alcoholic liver disease. Ultrasound scans can reveal fatty liver or hepatomegaly.

Fatty Liver

Abstinence from alcohol and lifestyle modifications, such as controlling carbohydrate intake, regular aerobic exercise, and weight management, are recommended. Certain medications like metformin, pioglitazone, and vitamin E may have transient benefits.

Alcoholic Hepatitis

Severity assessment using scoring systems like Maddrey’s discriminant function and MELD score guides treatment decisions. Prednisolone is initiated in severe cases, with pentoxifylline being another useful drug. In some cases, intravenous N-acetylcysteine (NAC) may be considered. Withdrawal symptoms should be managed with appropriate medications, such as chlordiazepoxide and thiamine to prevent Wernicke’s encephalopathy.


Alcoholic liver disease poses significant health risks and requires careful management. Abstinence from alcohol remains the most crucial step in preventing disease progression and promoting liver health. Alongside lifestyle modifications, counselling, and pharmacological interventions, a comprehensive approach involving healthcare professionals is essential for the successful management of this condition. Remember, seeking medical advice and support is crucial for individuals affected by alcoholic liver disease to improve their outcomes and overall well-being.

By Dr. Yomal Amarathunge

Dr. Yomal Amarathunge is a young and promising doctor who is making a difference in the world of medicine. He graduated from the University of Kelaniya in Sri Lanka, where he earned his Bachelor of Medicine, Bachelor of Surgery (MBBS) degree. In addition to his work as a doctor, Dr. Amarathunge is also a software developer. He is the creator of DewMal’s Health Blog, a website that provides information on health and wellness to the people of Sri Lanka. He is also the developer of DewMal’s Health App, a mobile app that provides users with access to health information and resources.

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