There are three stages to liver damage caused by alcohol:
- fatty liver (steatosis) – this is when fat builds up in the cells that make up your liver
- steatohepatitis – this is when the build-up of fat causes your liver to become inflamed and some of the cells to die
- cirrhosis – this is when damage to your liver is replaced by fibrous scar tissue
These stages are progressive, but can also overlap.
In general, the more alcohol you drink and the longer you drink it for, the more likely you are to get liver damage. If you drink around seven to eight units of alcohol a day, you’re almost certain to develop fatty liver.
Fatty liver is reversible if you stop drinking alcohol. But if you continue to drink, the damage will get worse and you’ll then be at risk of more serious liver disease, including alcohol-related hepatitis and alcohol-related cirrhosis. In both, your liver stops working as it should and this causes problems.
If you have severe alcohol-related hepatitis, your treatment might differ from what’s described here. You may be given more specific treatment, for example with corticosteroids.
To find out how much you’re drinking and for information on how to drink sensibly, see our prevention section below.
If your liver is damaged from drinking too much alcohol, you might not have any symptoms in the early stages. But if the damage gets worse, your liver might struggle to cope and symptoms can develop.
At first, symptoms can be vague and not very specific. You might:
- feel generally unwell and tired
- have upper abdominal (tummy) pain on the right side
- lose your appetite
- lose weight even though you’re not trying
- notice that you’re muscles are weaker and wasting away
If the damage continues to get worse, you might have the following signs and symptoms:
- itchy skin
- a yellowing of your skin or whites of your eyes (jaundice)
- redness on the palms of your hands
- hair loss
- swelling in your abdomen (tummy) and legs, causing you to gain weight unintentionally
- bruising and bleeding easily
- feelings of confusion, and trouble concentrating and remembering things
- hormonal changes – men may develop smaller testicles and more breast tissue and women may have irregular periods
These symptoms aren't always caused by alcohol-related cirrhosis. But if you have them, see your GP.
If you have any of the symptoms below, you need to see a doctor urgently as they can be life threatening:
- vomiting blood (vomit may look like coffee grounds)
- very black and tarry stools
- a high temperature and shivering (fever) because of an infection – you're more likely to get certain infections if you have cirrhosis
- confusion and drowsiness
- shortness of breath
- sudden onset of jaundice – a yellowy tinge to your skin and the whites of your eyes
Your GP will ask about your symptoms and examine you. They’ll also ask how often you drink alcohol and how much. This will help them to understand if you could have liver damage caused by drinking too much alcohol. They may also ask about your medical history.
You may need to have one or more of the following tests:
- blood tests to see how well your liver is working and check your blood cell count
- scans, such as an ultrasound
Blood tests alone aren’t always that reliable. Some people have liver damage despite having normal blood tests.
If your GP suspects that you have liver damage, you may be referred to a hepatologist (a doctor who specialises in conditions of the liver).
Your hepatologist may want you to have a new type of ultrasound scan called transient elastography. This measures the stiffness of your liver tissue, so shows how scarred it is.
You may have a liver biopsy, although this is not always necessary, particularly if you’ve had an elastography scan. Biopsy means having a small sample of liver tissue removed and examined under a microscope.
Alcohol-related cirrhosis can cause veins to enlarge in your oesophagus (foodpipe) or stomach. These are called varices (pronounced vah-rih-sees). They have delicate walls and can bleed. Your doctor may ask you to have an endoscopy to see if you have varices. This means having a sedative and then having a tube with a camera attached (an endoscope) put down your throat into your stomach.
The best way to prevent further damage to your liver is to stop drinking alcohol. If you’re struggling to stop drinking, talking to your GP should be your first step. They can put you in touch with professional services and support groups that can give you the help you need.
Your GP may be able to refer you for a medically supervised alcohol detox, or recommend support groups, such as Alcoholics Anonymous. These groups, and the support provided by others sharing personal experiences and advice, can help you give up alcohol and ensure that you don’t start drinking again.
You may also find it helpful to speak to family or friends.
If you have any underlying problems, such as anxiety or depression, these may get better if you stop drinking alcohol. If they don’t, your GP can help you get the support and any treatment you might need.
Your GP or dietician will also advise you to follow a balanced diet. If you’re losing weight, they may suggest you have several meals a day, including breakfast and a bedtime snack. They may also ask you to take vitamins and diet supplements. People with alcohol-related cirrhosis can be malnourished and correcting this can help to prevent complications.
If you’re retaining fluid in your body, your doctor may advise you to have a low-salt diet. However, it’s important not to make your meals too bland and risk becoming malnourished because you don’t want to eat them.
Taking regular exercise might also help you to stay well. As well as the general health benefits exercise brings, it can help to stop muscle wasting, which can be a problem in alcohol-related cirrhosis.
The aim of treatment is to stop further liver damage and prevent any damage from getting worse. Your doctor will also want to control as many symptoms as possible and help to stop complications developing.
The most important thing is for you to stop drinking alcohol. Your doctor will want to help as much as possible.
To help you stop drinking, your doctor may refer you for a supervised alcohol detox. You may be given tablets to help manage any withdrawal symptoms and reduce your alcohol cravings, if you need them.
If you have liver damage, you can retain salt, which upsets the fluid balance in your body. Fluid collecting in your abdomen (tummy) is called ascites (pronounced ass-sight-ees). You may also have swollen feet and ankles.
Your doctor may ask you to cut down your salt intake to less than two grams per day. You may see a dietician to help you with fluid retention. You may also have tablets to help remove fluid from your body (a diuretic or water tablet). Together, these measures are helpful in most people with ascites.
Having a damaged liver leads to high blood pressure in the veins carrying blood from your digestive system to your liver (portal hypertension). This can cause the veins to swell (varices). If you have varices, you could be at risk of bleeding from your oesophagus or stomach. Your doctor may give you a tablet called a beta-blocker to reduce the risk.
Other medicines your doctor may prescribe include:
- zinc supplements, as people with cirrhosis can be low in zinc
- medicines for itching
- calcium and vitamin D to lower your risk of osteoporosis
- preventive antibiotics, to stop you picking up infections
Your doctor may also suggest that you have vaccinations to help prevent chest infections, flu and hepatitis A (an infectious liver disease).
Some people with alcohol-related cirrhosis get hepatic encephalopathy – a problem with the brain and how well it functions. It can cause you to feel confused, lose consciousness, feel sleepy or have trouble sleeping, and may cause you to have a tremor in your hands. If you’ve had encephalopathy, your doctor might give you a medicine called rifaximin to reduce the chance of it happening again.
It’s important to remember not to take non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, and high doses of paracetamol. These medicines may cause further damage to your liver. NSAIDs can also cause you to retain fluid and can increase your risk of bleeding.
Always ask your pharmacist or GP for advice and read the patient information leaflet that comes with your medicines.
Procedures and surgery
If you have an endoscopy that shows you have enlarged veins (varices) in your oesophagus (foodpipe), your doctor may suggest a procedure called band ligation. This means that small elastic bands are placed around your varices to tie them off and prevent them from bleeding. It can also be used to treat varices that are already bleeding. If your varices are bleeding, your doctor may suggest having a transjugular intrahepatic portosystemic shunt (TIPS). TIPS procedure involves creating a new channel in your liver, which blood can flow through to help relieve pressure.
If you have fluid in your abdomen (tummy) that can’t be controlled with diet and water tablets, you may need to have a procedure to have it drained. This is called abdominal paracentesis (pronounced para-sen-tee-sis). The doctor will numb a small area of your abdomen, put in a needle and drain the fluid slowly into a bag. Your doctor might suggest having TIPS if your ascites is difficult to control.
If you develop alcohol-related cirrhosis, you may be offered a liver transplant. This is a major operation to remove your damaged liver and replace it with a healthy liver from a donor.
To have a liver transplant, you must have stopped drinking alcohol. A transplant is a very big undertaking and, apart from your liver damage, you must be fit enough to have it. Your doctor will be able to advise you whether this is a suitable option for you. For more information on drinking alcohol and having a liver transplant, see our FAQs below.
If you have a liver transplant, you must not drink alcohol for the rest of your life. You’ll also need to take medicines to prevent your body rejecting your donor liver.
As its name suggests, alcohol-related cirrhosis is caused by drinking alcohol – usually many years of heavy drinking. Your liver has many functions, one of which is to process substances like alcohol. Your liver can handle a certain amount of alcohol, but drinking heavily and regularly puts a strain on it.
Liver damage builds up gradually over many years. The liver is usually able to repair and renew itself. But if liver cells become too badly damaged, it can become permanently scarred. As scar tissue builds up, it stops your liver from working properly. This stops it from processing chemicals and drugs, which can cause harmful substances (toxins) to build up in your body.
There’s no specific amount of alcohol that will cause cirrhosis – it varies from person to person. But, the more alcohol you drink, the higher your chance of developing alcohol-related cirrhosis. It doesn't only affect people who have an alcohol addiction. If you're a heavy social or binge drinker, you also have a higher chance of developing cirrhosis.
Other causes of cirrhosis, which aren’t related to alcohol include:
There can be a number of complications of alcohol-related cirrhosis:
- high blood pressure within the blood vessels around your liver (portal hypertension)
- fluid in the abdomen
- organ failure
- liver cancer
Scar tissue can restrict the flow of blood to your liver, causing a build-up of pressure in the veins that carry blood to your liver. This is known as portal hypertension and can lead to varices in your stomach and oesophagus (foodpipe). These can bleed, which is a medical emergency.
If you don’t have varices when you’re diagnosed, your doctor may suggest you have endoscopies in the future to check whether you have developed them.
There’s more about varices in the treatment section on this page.
Fluid in your abdomen
A common complication of cirrhosis is fluid in your abdomen (ascites). Your abdomen becomes swollen due to the build-up of fluid. If the fluid becomes infected, it can cause abdominal pain and a fever. If this happens you will need urgent medical attention.
There’s more about ascites in the treatment section on this page.
If you have alcohol-related cirrhosis, the healthy cells of your liver are gradually replaced by scar tissue. This may cause liver failure – when your liver is no longer able to work as it should.
Cirrhosis can also lead to kidney failure (hepatorenal syndrome) and problems with how well your brain functions (hepatic encephalopathy).
There’s more information on hepatic encephalopathy in the treatment section on this page.
If you have alcohol-related cirrhosis, your risk of getting hepatocellular carcinoma, the most common type of liver cancer, increases. Your doctor may suggest that you have an ultrasound scan six monthly to check for this.
The best way to reduce your chance of getting alcohol related cirrhosis is to limit the amount of alcohol you drink, or not drink at all. Not drinking alcohol can also prevent cirrhosis progressing if you already have it.
Sensible drinking means staying within recommended limits. In the UK, guidelines recommend that you should not regularly drink more than 14 units over the course of a week. If you do drink as much as 14 units, you should spread it over three days or more, rather than 'saving up' units.
An easy way to cut back on your intake is to have several drink-free days each week.
The examples below might give you an idea of how much you're drinking. Keep them in mind to make sure you stay within the sensible drinking limits.
- A pint of cider is around 2.8 units if it’s 4.3% alcohol.
- A pint of lager or bitter is around 2.3 units if it’s 4% alcohol.
- A regular glass of wine (175ml) is around 2.3 units if it’s 13% alcohol.
- A pub measure of spirits (25ml) is 1 unit.
If you want to find out how many units you’re drinking, try using an alcohol calculator.
FAQ: Continuing to drink and liver transplant Can I have a liver transplant if I continue to drink alcohol?
No, you can’t have a liver transplant if you don’t give up alcohol altogether.
A liver transplant is a major operation to remove your damaged liver and replace it with a healthy liver from a donor. You may only be offered a liver transplant if other treatments haven't worked or you have developed a complication.
Before you’re considered for a transplant, you’ll be assessed by an alcohol specialist on the transplant team. Depending on their assessment, you may need to have treatment to help you stop and abstain from drinking alcohol in the future.
You can’t drink after a liver transplant because drinking alcohol could damage your new liver. You’ll be asked to sign an agreement, which states that you won't drink alcohol after your transplant and will take part in regular follow-up assessments. This includes routine blood tests to check that you haven’t had any alcohol.
Routine blood testing starts as soon as you are on the waiting list for a transplant. If you are found to have been drinking, you will be permanently taken off the list and so won’t be able to have the transplant.
If you have alcohol-induced cirrhosis, your liver will be scarred and damaged. If you continue to drink, you’ll cause further damage to your liver and it may lead to liver failure. This is where your liver is no longer able to function as it should.
You may not be able to reverse the damage to your liver from cirrhosis. But you can prevent further damage if you stop drinking alcohol. If you have cirrhosis and stop drinking, you can improve your chances of survival.
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Reviewed by Laura Blanks, Specialist Heath Editor, Bupa Health Content Team, May 2017
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