Alcohol-Related Liver Disease (ARLD): Causes, Symptoms & Treatment
Last Updated: January 15, 2024
ARLD comprises various liver conditions, underscoring the urgency of understanding causes, symptoms and treatment for effective management.
Alcohol-related liver disease (ARLD) is an umbrella term for a group of liver conditions that affect millions globally. ARLD is characterized by damage to the liver due to excessive alcohol consumption. This condition can be mild to severe and lead to life-threatening complications if not addressed promptly. Understanding the causes, symptoms and available treatment options is crucial for managing ARLD effectively.
What Is Alcohol-Related Liver Disease?
ARLD is a term that encompasses multiple conditions relating to liver damage from excessive alcohol use. The liver is a vital organ responsible for detoxifying the body, and continuous exposure to alcohol can severely impair its functions.
ARLD can range from mild conditions like fatty liver disease to more severe and potentially fatal conditions like cirrhosis. While multiple conditions could be considered ARLD, this primarily includes fatty liver disease, hepatitis and cirrhosis. These can be thought of as three progressive stages of ARLD.
Causes of Alcohol-Related Liver Disease
The sole primary cause of ARLD is chronic alcohol abuse, leading to inflammation and damage to liver cells. The amount and duration of alcohol consumption, along with genetic predisposition and other health conditions, can influence the development and progression of ARLD. Ultimately, the accumulated damage that alcohol use causes leads to liver damage over time and causes ARLD.
A wide variety of symptoms are associated with each stage of ARLD. These symptoms will be different for everyone and gradually worsen as liver disease progresses. While symptoms can develop differently based on the person, they can generally be categorized as early symptoms, warning that something is wrong, and late symptoms that can lead to serious health problems.
Early Symptoms of ARLD
In the earliest stages, ARLD may not have any noticeable symptoms. When early symptoms do occur, they tend to be more vague and can include:
- Unexplained weight loss
- Mild abdominal pain
These symptoms are often mild and can be easily overlooked or dismissed as signs of aging or one’s lifestyle.
Advanced Symptoms of ARLD
As ARLD progresses, more severe symptoms may develop. Some of these include:
- Swelling in the legs and abdomen
- Yellowing of the skin and eyes
- Confusion and mental changes
- Severe drowsiness
These symptoms signal more serious liver damage and the need for immediate medical attention. If left untreated, these symptoms can lead to death in some cases.
Alcohol and Liver Function
The liver is essential for metabolizing and detoxifying substances, including alcohol. Chronic alcohol consumption can overwhelm the liver, leading to inflammation, scarring and, eventually, liver failure. The liver’s regenerative ability is also compromised, making recovery increasingly difficult with prolonged alcohol abuse.
Stages of ARLD
ARLD progresses through three distinct stages, each characterized by increasing severity and damage to the liver. Early detection and intervention are crucial to managing the condition effectively and preventing irreversible damage in the last stage of ARLD. Understanding each stage is vital for timely and appropriate treatment.
Alcoholic Fatty Liver Disease
Fatty liver disease related to alcohol, also called alcoholic hepatosteatosis, is the initial stage of ARLD, marked by the accumulation of excess fat in the liver cells. It usually develops in those who consume a large amount of alcohol and is often asymptomatic. This stage is typically reversible with abstinence from alcohol alone, although lifestyle modifications may increase the speed of healing.
Alcohol-related hepatitis is a more severe form of ARLD. In this stage, the fat cells accumulating in the liver begin to irritate the liver. This leads to inflammation of the liver cells and impairs their ability to function.
Hepatitis caused by alcohol is typically the first serious stage of ARLD. Symptoms may include jaundice, fever and abdominal pain. Immediate medical attention and cessation of alcohol consumption are crucial to managing this condition and preventing further complications. Stopping alcohol can completely reverse alcohol-related hepatitis; however, this is the last stage of ARLD that is reversible.
Cirrhosis is the most advanced stage of ARLD. In this stage, the inflammation of the liver leads to scarring and permanent loss of its ability to function properly. Cirrhosis is an irreversible condition that can lead to liver failure and requires intensive medical management. A liver transplant may be the only possible treatment option in severe cases.
While cirrhosis is irreversible, cirrhosis and hepatitis often occur together. Stopping alcohol can help reverse hepatitis and improve liver function, which can still be saved. In this case, the outcome will depend on how much scarring the liver has experienced.
How Is ARLD Diagnosed?
Diagnosing ARLD involves a combination of clinical assessments, blood tests, imaging studies and, sometimes, invasive procedures. Technically, ARLD is an umbrella term for multiple conditions, and it is the specific condition that will be diagnosed, not ARLD in general.
Early diagnosis is crucial to halt the progression of the disease and initiate appropriate treatment. A detailed medical history and physical exam are the starting points in the diagnostic process, followed by objective medical tests.
Blood tests are important for assessing liver function and detecting inflammation and damage. Liver enzymes, specifically, provide the most information on the status of the liver. Elevated liver enzymes are indicative of liver damage and are often the first sign of ARLD. These tests help determine the extent of liver impairment and guide the treatment plan.
Imaging tests like ultrasound, CT scans and MRIs allow your doctor to visualize the liver’s structure and identify abnormalities, inflammation or damage. These non-invasive tests provide detailed images that assist in diagnosing and monitoring ARLD. They are very important for evaluating the severity of liver damage and planning the treatment approach.
A liver biopsy involves extracting a small sample of liver tissue for examination under a microscope. This procedure is very definitive in assessing the degree and type of developing liver damage. It provides valuable information to confirm the diagnosis and decide the treatment strategy.
Endoscopy is not used to diagnose ARLD but can help identify some of the complications that ARLD can create. Endoscopy involves inserting a thin tube with a camera down the throat to visualize the internal structures. This procedure can identify varices, or swollen veins, that can develop in your esophagus and increase your risk of internal bleeding.
Prevention and Treatment Options for ARLD
Preventing the progression of ARLD is, in one way, quite simple, but in another, very difficult. Stopping alcohol use is the only way to prevent the progression of ARLD. Unfortunately, this can often be easier said than done.
While abstinence from alcohol is the cornerstone of ARLD management, this typically requires professional intervention, as the heavy drinking that causes ARLD is often linked to addiction. Treating alcohol addiction ultimately is the main intervention needed to prevent the progression of ARLD.
Stopping Drinking Alcohol (Abstinence)
Stopping alcohol is essential to preventing and treating ARLD. Alcohol is the only cause of ARLD, and abstaining from alcohol use will prevent further ARLD from developing.
While not drinking alcohol can prevent ARLD from occurring, it is also an important component of treating ARLD. Trying to use other treatments to improve liver health while drinking is analogous to trying to put a fire out while also pouring gasoline on it. Removing the underlying cause of ARLD by stopping alcohol will make the condition much more responsive to treatments.
Managing Withdrawal Symptoms
Managing alcohol withdrawal symptoms is a critical aspect of maintaining abstinence. Alcohol withdrawal can be quite dangerous, and it is important to have medical intervention and support during the withdrawal. Medical monitoring and strong prescription medications are important in managing withdrawal safely.
Relapse prevention is a vital part of sustaining long-term abstinence and mitigating the risk of ARLD progression. Relapse prevention can involve ongoing counseling, therapy and support to address the underlying issues contributing to alcohol abuse. Developing coping mechanisms and building a support network are crucial in preventing relapse.
Alcohol rehabilitation is typically the most important step once you are off alcohol. Rehab offers a structured and comprehensive approach to addressing the factors underlying alcohol addiction and its repercussions. It provides medical, psychological and emotional support to help you overcome addiction and rebuild your life. Good rehab programs are tailored to meet individual needs and focus on holistic recovery.
Support groups play an important role in helping someone avoid relapse during and after rehab. These groups provide a platform for shared experiences, encouragement and peer support. Groups like Alcoholics Anonymous offer a sense of community and understanding that is invaluable in maintaining sobriety. Regular attendance and participation can significantly enhance your recovery outcomes and provide a sense of community that helps you through difficult recovery periods.
Balanced Diet and Nutrition
Maintaining a balanced diet can help support liver health and improve ARLD symptoms more quickly once you stop drinking. Good nutritional choices can address deficiencies, promote liver regeneration and improve overall well-being. A diet filled with fruits, vegetables, lean proteins and healthy fats is recommended for individuals with ARLD.
Medication for Symptoms
Medications are necessary for someone with serious symptoms or complications associated with ARLD. Prescription medicines can reduce inflammation, prevent infections and address other related conditions. Proper medication management is crucial to alleviate symptoms and improve the quality of life for individuals with ARLD. Medications for ARLD will require a physician to prescribe and monitor, as they must be used correctly.
In cases of advanced cirrhosis, a liver transplant may be the only life-saving option. This involves replacing the damaged liver with a healthy one from a donor. A liver transplant is a major surgery and requires lifelong management.
Because of the limited availability of organs, liver transplants are typically only available to those who will take good care of their new liver. Someone with ARLD will typically need to prove they can maintain sobriety for a prolonged period to be eligible for a liver transplant.
Complications of ARLD
If ARLD becomes advanced, it can lead to several severe and life-threatening complications. Even if managed correctly, these complications can significantly impact the quality of life and may require intensive medical intervention. Understanding these complications and getting medical care as early as possible is essential for achieving the best outcome.
Portal Hypertension and Varices
Portal hypertension is increased blood pressure within the main vein of the liver. It is caused by liver damage and can lead to the development of varices, or swollen veins, in the esophagus. These enlarged veins can rupture and cause severe internal bleeding, a life-threatening medical emergency. Management includes medications and procedures to reduce the pressure and prevent bleeding.
Ascites is a medical term that refers to fluid accumulation in the abdomen. It is caused by imbalances in a protein called albumin produced in the liver. Ascites can cause discomfort and breathing difficulties. Treatment involves treating the underlying liver condition and, in severe cases, drainage of the fluid.
Hepatic encephalopathy is a severe complication caused by the inability of the liver to remove toxins from the blood. It leads to a build-up of toxins that can create confusion, drowsiness and, in severe cases, coma. Immediate medical intervention is crucial to manage symptoms and prevent irreversible brain damage.
Chronic liver inflammation and cirrhosis elevate the risk of developing liver cancer. This is a potentially fatal complication that requires early detection and aggressive treatment to survive. Management strategies can include surgery, chemotherapy and targeted therapies, depending on the cancer stage and your overall health.
Prevent ARLD Complications with Professional Alcohol Addiction Treatment in Atlanta
Professional alcohol addiction treatment is the key to avoiding the complications ARLD can cause. Stopping alcohol will allow your liver to recover as much as possible, decreasing the risk of serious complications.
At The Recovery Village Atlanta, we realize how challenging it can be to stop using alcohol. We have extensive experience helping people overcome their addictions and live healthy lives, free from the worry of the health problems alcohol addiction can bring. Contact us today to learn how we can help you take the first steps on your journey to lasting recovery.
MedlinePlus. “Alcohol.” March 22, 2022. Accessed September 27, 2023.
NHS. “Overview: Alcohol-related liver disease.” September 20, 2022. Accessed September 27, 2023.
NIDirect. “Alcohol-related liver disease.” 2023. Accessed September 27, 2023.
Patel, Roshan & Mueller, Matthew. “Alcoholic Liver Disease.” StatPearls [Internet]. July 13, 2023. Accessed September 27, 2023.
MedlinePlus. “Fatty Liver Disease.” April 26, 2017. Accessed September 27, 2023.
Shah, Niraj J.; Royer, Amor; & John, Savio. “Alcoholic Hepatitis.” StatPearls [Internet]. June 5, 2023. Accessed September 27, 2023.
National Institute of Diabetes and Digestive and Kidney Diseases. “Cirrhosis.” 2023. Accessed September 27, 2023.
NHS. “Diagnosis: Alcohol-related liver disease.” September 20, 2022. Accessed September 27, 2023.
National Institute of Diabetes and Digestive and Kidney Diseases. “Liver Biopsy.” August, 2019. Accessed September 27, 2023.
Hofer, Benedikt Silvester; Simbrunner, Benedikt; & et al. “Alcohol Abstinence Improves Prognosis Across All Stages of Portal Hypertension in Alcohol-Related Cirrhosis.” Hepatology. August, 2023. Accessed September 27, 2023.
Frazier, Thomas H. “Treatment of alcoholic liver disease.” Therapeutic Advances in Gastroenterology. January, 2011. Accessed September 27, 2023.
Runyon, Bruce A. “Patient education: Esophageal varices (Beyond the Basics).” UpToDate. August, 2023. Accessed September 27, 2023.
Mandiga, Pujyitha; Foris, Lisa A.; Bollu, Pradeep C. “Hepatic Encephalopathy.” StatPearls [Internet]. March 6, 2023. Accessed September 27, 2023.