Alcoholic Liver Disease

What is Alcoholic Liver Disease?

Alcoholic liver disease (ALD) is injury or damage to the liver caused by chronic alcohol consumption. One of the most common causes of liver disease in the United States, ALD can manifest itself as three separate conditions and any or all of these three conditions can occur at the same time, in the same patient.

It is the fourth most common cause of death among middle-aged Americans.


There are three types: alcoholic fatty liver disease, alcoholic hepatitis, and alcoholic cirrhosis.

Alcoholic Fatty Liver Disease (steatosis)

Alcoholic fatty liver disease is the accumulation of fat in the liver caused by excessive consumption of alcohol. In fact, fatty liver may occur after as little as three days of excessive alcohol ingestion.

A person can have fatty liver but not exhibit signs or symptoms of liver disease other than fatigue, although other symptoms like nausea and vomiting may occur. Many people who consume large amounts of alcohol on a regular basis have fatty liver.

Blood test results will usually show elevations in blood levels of AST and/or ALT, however, a liver biopsy is the only way to diagnose fatty liver for certain. Alcoholic fatty liver is generally a benign condition which is reversible by eliminating consumption of alcohol.

Alcoholic Hepatitis

Alcoholic hepatitis is liver inflammation caused by excessive alcohol consumption. Symptoms can be nonexistent in some people and severe in others. In the case of nonexistent symptoms, alcoholic hepatitis may be discovered during a routine blood test.

Some people experience mild symptoms such as loss of appetite, nausea and abdominal discomfort while others experience more severe symptoms such as vomiting, severe pain in the right upper abdomen and fever.

A liver biopsy that determines alcoholic hepatitis indicates that a person is at high risk of developing cirrhosis. However, as is the case with alcoholic fatty liver disease, alcoholic hepatitis is totally reversible if the person immediately and completely abstains from drinking alcohol.

Alcoholic Cirrhosis

Alcoholic cirrhosis is scarring of the liver caused by excessive alcohol consumption – hard, dead, scar tissue replaces soft healthy tissue. In the United States, alcohol is the number one cause of cirrhosis.

Alcoholic cirrhosis can occur in people who have never had evidence of alcoholic hepatitis. Very often, cirrhosis will be the initial condition the first time a patient with alcoholic liver disease sees a doctor.

Symptoms of cirrhosis may include fatigue, bleeding easily, easy bruising, fluid accumulation in the abdomen (ascites), loss of appetite, nausea, swelling in the legs (edema) and weight loss. A liver biopsy may be necessary to establish the existence of cirrhosis if it is not clinically apparent.

All people with cirrhosis are at risk of developing liver cancer. In general, people with alcoholic cirrhosis have about a 15-percent overall lifetime risk of developing liver cancer.

Although alcoholic cirrhosis is irreversible and can lead to end stage liver disease if not treated, it has been shown that people who totally abstain from ingesting alcohol can improve their condition or prevent the disease from worsening.

Who is at Risk?

Although it has been estimated that as many as 10 percent of Americans abuse alcohol, most people who drink excessively do not develop liver disease. The reason some people can drink excessive amounts of alcohol and not develop liver disease while other individuals who have only a few drinks per day will develop liver disease, is not known. It is impossible to predict who will develop alcoholic liver disease, but it is known that people who drink large quantities of alcohol over a long period of time are generally at greatest risk of developing ALD.

Other factors that contribute to its development:

  • Gender – While alcoholism is more common among men, women are more susceptible to the toxicity of alcohol probably due to the fact that women generally weigh less then men.
  • Genetics – Individuals who metabolize alcohol faster, need to drink more than the individuals who metabolize alcohol more slowly, thus they run a higher risk of developing liver damage. Genetic mutations that affect alcohol metabolism increase the risk of alcoholic liver disease.
  • Other Liver Diseases – Any type of liver disease is worsened by the consumption of any amount of alcohol.
  • Malnutrition – Consumption of large amounts of alcohol for many people leads to malnutrition for two reasons – alcohol prevents the body from properly metabolizing and absorbing essential nutrients and alcoholics tend to substitute alcohol for food, thereby robbing the body of needed essential nutrients and calories.
  • Drugs and Alcohol Combined – Because many drugs and chemicals can potentially affect the liver, the combination of the two can be extremely toxic, causing liver damage.

What are the Symptoms?

  • Abdominal pain and tenderness
  • Dry mouth
  • Excessive thirst
  • Fatigue
  • Fever
  • Abdominal fluid retention (ascites)
  • Jaundice
  • Loss of appetite
  • Mental confusion
  • Nausea
  • Bloody, dark black or tarry bowel movements
  • Breast development in males
  • Rapid heart rate
  • Vomiting blood or material that looks like coffee grounds

How is it Diagnosed?

Because there is no specific test that can accurately diagnose ALD, a combination of tests are performed such as the following:

  • Medical history and physical examination – The patient will answer questions regarding lifestyle habits and health history, including alcohol use, and conduct a physical exam
  • Blood tests – These check for high levels of certain liver related enzymes
  • Ultrasound – This test may reveal an enlarged liver or other liver problems
  • Liver biopsy – A small tissue sample is removed from the liver using a long thin needle and then examined under a microscope


Once a diagnosis has been made, complete abstinence from alcohol of any kind is mandatory. Discontinuing the use of alcohol in the case of a diagnosis of fatty liver and alcoholic hepatitis will result in reversal of injury and inflammation to the liver. While alcoholic cirrhosis is not reversible, abstinence from alcohol generally will prevent the condition from progressing if serious complications such as jaundice and ascites haven’t developed.

A healthy diet which includes vitamins, especially B-complex and folic acid, can help reverse malnutrition. Participation in an alcohol recovery program may be necessary for alcohol-dependent individuals and finally in advanced cases of alcoholic cirrhosis, a liver transplant may be necessary. However, only those individuals abstaining from alcohol will be considered for a liver transplant procedure.

This information is for educational purposes only and should not be used in any other manner. This information is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

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About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.

American Liver Foundation "Alcoholic Liver Disease" Retrieved March 4, 2011

Mayo Clinic “Alcoholic Hepatitis" Retrieved March 4, 2011

Medline Plus "Alcoholic Liver Disease" Retrieved March 4, 2011

Palmer, M.D., Melissa. Dr. Melissa Palmer's Guide to Hepatitis & Liver Disease. New York: Avery Trade, 2004.

Worman, MD Howard J. The Liver Disorders and Hepatitis Sourcebook. McGraw-Hill, 2006

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