Excessive and habitual alcohol consumption or alcoholism is bad for the liver. Everybody knows that. Sometimes, though, patients ask what exactly alcohol does to your liver.

Alcoholic liver disease is a spectrum of manifestations, ranging from asymptomatic fatty liver to an end stage liver disease. The severity of liver disease varies significantly among individuals. The amount of alcohol ingested, preexisting liver problems, like steatohepatitis and a concomitant infection with Hepatitis B or C will affect the extent of liver disease as well.

Good history taking, physical exam and some basic blood tests (liver enzymes) are often sufficient to diagnose alcoholic live disease. Excessive alcohol consumption can also affect the heart, muscles, brain, peripheral nerves and pancreas. Liver biopsy occasionally is necessary when the diagnosis is in doubt or there is a possibility of multiple factors affecting liver.

Alcoholic fatty liver or steatosis is present in 90 to 100% of alcoholics. It is being described as liver infiltration with droplets of fat. At this stage most patients are asymptomatic. The condition is reversible once the patient stops drinking. On an imaging study, like a CT scan, the liver looks enlarged. Abdominal Ultrasound often shows abnormal echogenicity due to fat infiltration.

Ten to thirty five percent of patients with a fatty liver develop alcoholic hepatitis. Symptoms may include fever, enlarged liver, anorexia and jaundice. In severe cases, hepatic encephalopathy and bleeding can occur. Inflammation in the liver with resulting necrosis is a hallmark of this disease. The prognosis of alcoholic hepatitis depends on its severity. The mortality is high in severe cases.

And finally, there is alcoholic cirrhosis. Accumulation of scar tissue as a result of ongoing alcohol toxicity, leads to a progressive loss of liver function. The liver might look small and shrunk on a CT scan. Loss of liver function leads to multiple metabolic derangements.

Toxic metabolites, including ammonia, tend to accumulate causing encephalopathy or abnormal brain function. Clotting factors are not being adequately replaces with the blood becoming thinner – coagulopathy. Immune function is affected as well.

The blood flow through the fibrotic liver is impaired. This leads to an elevated pressure in the portal vein leading to a fluid accumulation in the abdomen – ascites. Collateral venous blood vessels get engorged leading to esophageal varicies and, potentially, bleeding.

Advanced liver failure can affect the kidneys (hepatorenal syndrome) and lungs (hepatopulmonary syndrome) as well.