Alcohol-related liver disease (ALD)

You may not experience any symptoms of liver damage early on. In fact, many people who have alcohol-related fatty liver or hepatitis find out during routine tests for an unrelated illness. Early symptoms of alcohol-related liver disease can be non-specific. These include:

• pain in the liver
• fatigue
• flu-like symptoms
• loss of appetite
• nausea
• pale stools
• rapid heart rate
• increased sensitivity to alcohol or drugs

Later symptoms as the liver struggles to function include:

• jaundice
• vomiting blood (haematemesis)
• dark, black, tarry stools (melena)
• significant weight loss
• swollen abdomen (ascites)
• confusion or 'brain fog' (hepatic encephalopathy)

Your consultant will discuss your symptoms with you and may recommend tests to aid diagnosis. Diagnosis is made through a combination of an assessment of your medical history, a physical examination and a number of diagnostic tests. These might include:

• Liver Function Tests (LFTs) which measure various enzymes and proteins in the blood that are made or cleared by the liver.
• Imaging tests like FibroScan measures the amount of scar tissue (fibrosis) in your liver, while CT and MRI scans show scarring in cirrhosis.
• A liver biopsy may be required, where a tiny piece of your liver is taken to determine the extent of liver injury.
• An endoscopy to check for varices (abnormally dilated vessels, a sign of cirrhosis) in the oesophagus or stomach.

If you've been diagnosed with ALD, your consultant will discuss your treatment options with you to help determine the best approach for you. Treatment options can include:

• Stop drinking. For most people with fatty liver and alcoholic hepatitis, the liver can potentially heal itself if they stop drinking.
• A good balanced diet. Drinking alcohol can lead to malnutrition, due to consumption of empty calories, loss of appetite and malabsorption.
• Enteral nutrition. Nutrients fed through a tube can help your liver repair itself.
• Steroids. To control the inflammation of your liver.
• Liver transplantation. Where other treatments are no longer helpful.