This disease is all too common and has serious repercussions. Mary Randell outlines the facts.
As the liver becomes more severely damaged, more obvious and serious symptoms develop, such as:
- Jaundice (yellowing of skin and eyes);
- Oedema (swelling of ankles, feet and abdomen due to a build-up of fluid);
- Itchy skin and hair loss;
- Clubbed fingers – unusually curved fingertips and nails;
- Weight loss;
- Weakness and muscle wasting;
- Confusion and memory problems, insomnia and changes in personality due to a build-up of toxins in the brain;
- Vomiting blood and black, tarry stools due to internal bleeding;
- A tendency to bleed and bruise more easily.
Complications
A number of serious complications are associated with ARLD. The main ones include:
Portal hypertension and varices: This is a common complication of alcoholic cirrhosis and occurs when the blood pressure inside the liver has risen to a serious level.
When the liver is severely scarred, it is hard for blood to move through it which results in an increase in blood pressure. The blood must also find another way to return to the heart and it does this by opening up new blood vessels, usually along the lining of the stomach or oesophagus. These new blood vessels are known as varices.
If the blood pressure becomes too high for the varices to cope with, it causes the walls of the varices to split and bleed. This can either cause long-term blood loss, leading to severe anaemia, or alternatively, the bleeding can be rapid and massive, causing you to vomit blood or pass blood in your stools (melaena).
Ascites: A build-up of fluid in the abdomen and around the intestines may also develop with portal hypertension. This is known an ascites.One of the problems associated with ascites is the risk of infection in the fluid (bacterial peritonitis). This can result in an increased risk of kidney failure and death.
Hepatic encephalopathy: One of the most important functions of the liver is to remove toxins from the blood. Hepatitis or cirrhosis will prevent the liver from being able to do this, resulting in a high level of toxins in the blood. This is known as hepatic encephalopathy.
Symptoms of hepatic encephalopathy include: Confusion and disorientation, muscle stiffness and tremors, difficulty speaking and even coma.
Liver cancer: Damage to the liver due to heavy drinking over many years can also increase the risk of developing liver cancer. Liver cancer in the UK has risen sharply in recent years as a result of increased levels of alcohol misuse and it is estimated that 3%-5% of people with cirrhosis will develop liver cancer every year.
Treatment and prevention
There is currently no specific medical treatment for ARLD. The main treatment is to stop drinking, completely. This will prevent further damage to the liver and in some cases can allow the liver to repair itself.
If the liver has stopped functioning despite being completely abstinent from alcohol, a liver transplant may be required. This would only be considered if complications of cirrhosis have developed despite total abstinence from alcohol.
Evidence suggests that people who regularly drink more than the maximum recommended amounts of alcohol are most at risk of developing the disease. ARLD can be easily prevented by sticking to the recommended daily limits and have at least two alcohol-free days a week.
The recommended limits of alcohol consumption are:
- Men should not regularly drink more than 3-4 units of alcohol a day – 2 pints of normal strength lager or 4 pub measures (25ml) of spirits.
- Women should not regularly drink more than 2-3 units a day.
It is also recommended that you avoid alcohol for 48 hours after a heavy drinking session.
A good way to assess your drinking pattern and whether you are at risk of ARLD is to use a short test known as the CAGE test, which consists of four questions:
- Have you ever thought you should cut down on your drinking?
- Have people annoyed you by criticising your drinking?
- Have you ever felt guilty about your drinking?
- Have you ever drunk an ‘eye-opener’, (drunk alcohol first thing in the morning to get over a hangover and steady your nerves)?
As well as drinking excessive amounts of alcohol, there are other factors that can increase the chances of developing ARLD, including:
- being overweight;
- being female (women are more vulnerable than men to the harmful effects of alcohol);
- having a pre-existing liver condition, such as hepatitis C;
- genetics – dependence on alcohol and problems processing alcohol often run in families.
Tests for ARLD
Blood tests check the liver function and can detect enzymes in the blood that are normally only present if the liver has been damaged. They can also detect low levels of certain substances, such as a protein (serum albumin), which is made by the liver. Low levels of serum albumin suggest that the liver is not functioning properly.
If symptoms or liver function tests suggest ARLD, further tests are performed to assess the state of the liver. These include:
- Ultrasound scan, CT scan or MRI - These scans provide detailed images of the liver.
- Liver biopsy – to determine degree of scarring
- Endoscopy – to check for varices in the oesophagus and stomach
Underwriting
Terms can only usually be considered if the applicant has totally abstained from alcohol for at least 2 years and there is no history of complications such as portal hypertension or cirrhosis.
Mary Randell is underwriting training and development manager at VitalityLife (formerly PruProtect)
