OVERVIEW
Cirrhosis is described as a chronic disease condition that results in the damage of the liver thereby making the liver unable to function adequately. There are many causative factors responsible for the development of cirrhosis, some of which include viral hepatitis, alcohol-related cirrhosis, non-alcoholic fatty liver disease, some medications and even autoimmune hepatitis. This article is tailored to address Alcoholic Liver Cirrhosis (ALC)/Alcohol Related Liver Disease (ARLD).

ALC is the destruction of the tissues of the liver caused by excess intake of alcohol. There are several stages of severity and a range of associated symptoms.

The liver plays a very important role in the body. Its functions include:

  • Filtration of toxins out of the blood,
  • Breaking down of proteins, and
  • Production of bile to help the body absorb fats.

Drinking for long period of years may result in the destruction of the healthy tissues of the liver. The healthy tissues then get replaced by scars. This condition is alcoholic liver cirrhosis. Not all heavy drinkers develop this disease, the duration or number of years spent in drinking determines one’s chance of developing the disease. As the disease progresses and more of the healthy liver tissues are replaced with scar tissue, the liver will stop functioning properly.

According to the American Liver Foundation (ALF), between 10 and 20 percents of heavy drinkers will develop cirrhosis. Alcoholic liver cirrhosis is the most advanced form of liver disease that is related to drinking alcohol. The disease is part of a progression. It may start with fatty liver disease, then progress to alcoholic hepatitis, and then to alcoholic cirrhosis. It is, however, possible for a person to develop alcoholic liver cirrhosis without ever having alcoholic hepatitis.

SYMPTOMS
ALC typically does not develop symptoms until a person is between the ages of 30 and 40. As the disease sets in, the body compensates for the inefficiency of the liver. Thus, the symptoms may not be detected early but as the disease progresses, symptoms will become more noticeable and may include:

  • feeling sick
  • weight loss
  • anorexia (loss of appetite)
  • yellow coloration of the eyes and skin (jaundice)
  • swelling in the ankles and tummy
  • confusion or drowsiness
  • vomiting blood (hematemesis) or passing blood in your stools
  • portal hypertension, which increases blood pressure in the vein that travels through the liver
  • skin itching (pruritus)

CAUSES
ALC is caused by long time usage of alcohol.  Repeated and excessive alcohol abuse leads to the destruction of the liver and this result in the condition called alcoholic liver cirrhosis. When the liver tissue starts to scar, the liver doesn’t work as well as it did before. As a result, the body can’t produce enough proteins or filter toxins out of the blood as it should.

Cirrhosis of the liver can occur due to a variety of causes. However, alcoholic liver cirrhosis is directly related to alcohol intake.

RISK FACTORS
Abuse of alcohol is enough a risk to developing this disease condition. Having a free access to alcohol by someone who loves to get his thoughts foggy will likely develop ALC. The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking as drinking five or more drinks in one day on at least five of the past 30 days.

ALC/ARLD may be genetic too. For example, some people are born with a deficiency in enzymes that help to eliminate alcohol.

Other risk factors may include:

  • Obesity,
  • a high-fat diet, and
  • Having hepatitis C

These factors can also increase a person’s likelihood they will have alcoholic liver disease.

STATISTICAL INDEX ON ALC/ARLD
According to the 2015 National Survey on Drug Use and Health (NSDUH), an estimated 88, 0009 people (approximately 62,000 men and 26,000 women) die from alcohol-related causes annually, making alcohol the fourth leading preventable cause of death in the United States. In Africa, the harmful use of alcohol is a particularly grave threat to men. It is the leading risk factor for death in males ages 15–59, mainly due to injuries, violence and cardiovascular diseases. Globally, 6.2% of all male deaths are attributable to alcohol, compared to 1.1% of female deaths. Men also have far greater rates of total burden attributed to alcohol than women – 7.4% for men compared to 1.4% for women. Men outnumber women four to one in weekly episodes of heavy drinking – most probably the reason for their higher death and disability rates.

DIAGNOSIS
Diagnosis of ALC is really important in that if detected early, it can help in the administration of the necessary treatment. The diagnosis may include:

  • medical history: this includes the person’s drinking history.
  • anaemia (low blood levels due to too little iron)
  • high level of ammonia in the blood
  • high blood sugar levels
  • leukocytosis (large amount of white blood cells)
  • unhealthy liver tissue when a sample is removed from a biopsy and studied in a laboratory
  • liver enzyme blood tests that show the level of aspartate aminotransferase (AST) is two times that of alanine aminotransferase (ALT)
  • low blood magnesium levels
  • low blood potassium levels
  • low blood sodium levels
  • portal hypertension

COMPLICATIONS
Alcoholic liver cirrhosis can cause serious complications. This is known as decompensated cirrhosis. Examples of these complications include:

  • Ascites( accumulation of fluid in the abdomen)
  • Encephalopathy (mental confusion)
  • Internal bleeding (bleeding varies)
  • Jaundice (yellowing of the eyes and the skin)

TREATMENTS
ALC cannot be reversed but can be managed and slowed with the right treatment. The steps involved in the management of this condition may include:

Lifestyle changes such as:

             Stopping the intake of alcohol and quitting completely.

             Discussing both prescribed and non-prescribed medication with the physician. These could increase the risk of liver damage and bleeding.

             Getting immunised against hepatitis A and hepatitis B, influenza, and pneumococcus.

             Reducing your sodium intake can help prevent ascites.

Other treatments a doctor may use include:

Medications: Other medications doctors may prescribe include corticosteroids, calcium channel blockers, insulin, antioxidant supplements, and S-adenosyl-L-methionine (SAMe).

Nutritional Counselling: Alcohol abuse can lead to malnutrition.

Extra protein: Patients often require extra protein in certain forms to help reduce the likelihood for developing brain disease (encephalopathy). This is because protein synthesis becomes impaired once the liver is diseased.

Liver Transplant: A person often must be sober for at least six months before they are considered a candidate for liver transplant.

PROGNOSIS
This depends on the overall health and the likelihood of developing complications related to cirrhosis by the client. This is true even when a person stops drinking.

TREATING COMPLICATIONS OF CIRRHOSIS
Cirrhosis can cause other problems (complications) that need treatment with medicines or procedures. Complications may include:

  • Ascites. It can be deadly if it is not controlled. Treatment can include:

–              Following a low-sodium diet.

–              Medicines such as diuretics and antibiotics.

–              Removing fluid with a needle (paracentesis).

–              Transjugular intrahepatic portosystemic shunt (TIPS). This procedure diverts fluid from the belly.

  • Bleeding from enlarged veins (Variceal bleeding) in the digestive tract can be treated with:

–              Beta-blocker and vasoconstrictor medicines.

–              Shunts to move blood or other fluid away from the belly.

–              Endoscopic variceal banding or sclerotherapy to stop bleeding.

–              Balloon tamponade. A doctor inserts and inflates a balloon in the lower part of the esophagus or upper part of the stomach. This stops bleeding by pressing against the veins.

END-OF-LIFE CARE
As the disease progresses, treatment may no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But the client can still get treatment to make him/her as comfortable as possible during the time he/she has left.

SOURCES/REFERENCES

Alcoholic liver disease. (n.d.).

http://www.hepatitis.va.gov/patient/basics/alcoholic-liver-disease.asp

Alcohol-related liver disease. (2015, January 20).

http://www.liverfoundation.org/abouttheliver/info/alcohol/

Drinking levels defined. (n.d.). Retreived http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

EASL clinical practical guidelines: management of alcoholic liver disease. (2012). Journal of Hepatology. 58, 399-420.

http://www.easl.eu/medias/cpg/issue9/Report.pdf

Fairbanks, K. D. (2012, November). Alcoholic liver disease.

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/alcoholic-liver-disease/

Gramenzi, A., Caputo, F., Biselli, M., Kuria, F., Loggi, E., Andreone, P., & Bernardi M. (2006). Review article: Alcoholic liver disease – pathophysiological aspects and risk factors. Alimentary Pharmacology & Therapeutics. 24, 1151-1161.

https://www.med.upenn.edu/gastro/documents/AlimentaryPharmacolTherapAlcoholicLiverDz.pdf

Liver disease: Frequently asked questions. (n.d.).

https://www.uihealthcare.org/liver-disease-frequently-asked-questions/

Mayo Clinic Staff. (2015, November 25). Alcoholic hepatitis.

http://www.mayoclinic.org/diseases-conditions/alcoholic-hepatitis/symptoms-causes/dxc-20163923

Orfanidis, N. (2015, October). Alcoholic liver disease.

http://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/alcoholic-liver-disease/alcoholic-liver-disease

O’Shea, R.,  Dasarathy, S., & McCullough A. (2009, November 10). Alcoholic liver disease.

http://gi.org/guideline/alcoholic-liver-disease/

What is decompensated cirrhosis? (2015, September 1).

http://www.hepatitis.va.gov/patient/complications/cirrhosis/decompensated.asp