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Alcoholic Liver Disease: Overlooked, Underdiagnosed, and Positively Preventable

Alcoholic Liver Disease: Overlooked, Underdiagnosed, and Positively Preventable

Whether it’s at your favorite sporting event, the office holiday party, celebratory occasions, or family gatherings, alcohol consumption is a common component of our daily lives. Alcohol is frequently referenced in popular culture. Advertisements for alcohol are everywhere you look. As pervasive as alcohol use is in our culture, its negative effects on a person’s health often go overlooked.

Alcoholic liver disease (ALD) is a disorder caused by the overuse of alcoholic beverages. ALD is challenging for both doctors and patients because the disease can often progress with little or no symptoms until it reaches a severe stage. Because of this, it is important to recognize the factors that may put you at risk for developing ALD.

ALD can develop with alcohol intake that is greater than two standard drinks per day. A “standard drink” consists of one can of beer (12 oz), a standard glass of wine (5 oz), or a shot of hard alcohol (1.5 oz). To help identify patients at risk for overuse of alcohol, healthcare professionals can use a simple questionnaire consisting of three questions:

How often did you have a drink containing alcohol in the past year?

  • Never (0)
  • Monthly or less (+1)
  • Two to four times a month (+2)
  • Two to three times per week (+3)
  • Four or more times a week (+4)

How many drinks containing alcohol did you have on a typical day when you were drinking in the past year?

  • 1 or 2 drinks (0)
  • 3 or 4 (+1)
  • 5 or 6 (+2)
  • 7 to 9 (+3)
  • 10 or more (+4)

Glasses of champaigne

How often did you have six or more drinks on one occasion in the past year?

  • Never (0)
  • Less than monthly (+1)
  • Monthly (+2)
  • Weekly (+3)
  • Daily or almost daily (+4)

Scores of four or higher for males and three or higher for females could prompt further discussion to learn more about the patient’s drinking habits. Patients with higher scores are more likely to develop more severe problems.

A man thinking with a brandy in his hands

Additional factors that can increase the risk of ALD include daily drinking, male sex, and Caucasian or Native American ethnicity. Higher rates of ALD are found in people with anxiety, depression, and personality disorders, as well as in people with disabilities. If you started drinking as a teenager, you are also at higher risk for ALD. We also see higher rates of ALD in geographic areas with colder climates and fewer sunlight hours, as people in these places tend to have higher rates of alcohol use. People with underlying liver disease that is unrelated to alcohol use can experience a worsening disease if they use alcohol.

Over time, alcohol can cause damage to the liver to varying degrees. Early on, this damage is reversible if the person stops using alcohol. In the later stages of the disease, the damage is permanent and can lead to serious complications. The only cure for late-stage ALD is a liver transplant.

Symptoms of ALD include jaundice (yellowing of the skin), swelling in the legs, a buildup of fluid in the abdomen, itching of the skin, fatigue, fever, abdominal pain, and confusion. Complications of ALD can include liver failure, kidney failure, bleeding from the digestive tract, serious infections, and death.

For many people, alcohol consumption can be done in a responsible manner with little to no long-term health effects. Unfortunately, many people suffer from unrecognized and undiagnosed substance use disorders that put them at higher risk for developing ALD and other alcohol-related health problems. If you or someone you care about may be at risk, we encourage you to speak with a physician to discuss your concerns.

Family physicians will approach these issues in a non-judgmental and practical manner. Taking a proactive approach to problematic alcohol use is an important component of maintaining your personal wellness. The negative health effects of alcohol are often reversible if they are properly treated. Even those with severe diseases can lead normal, productive lives with proper medical management. The faculty and resident physicians at Altru Family Medicine Residency are here to listen, learn, and respond to your concerns. We are eager to work with you in the pursuit of health and happiness.

Our Altru team can help you navigate Alcoholic Liver Disease and other health concerns. Learn about what our family medicine team can help you with at Altru’s Family Medicine and Primary Care Services.