Introduction

Liver cirrhosis symptoms are caused by alcohol consumption or addiction to alcohol. It is the formation of scar tissues in the liver. Every time our liver filters alcohol some of its cells get damaged or hurt.  The liver repairs or replaces those hurt tissues with tough functional scar tissues which is termed liver cirrhosis. Daily drinking poses a higher risk than binge drinking. In this topic, we will learn more about liver cirrhosis caused due to alcohol.

The cirrhosis of the liver proceeds in three stages

Stage-1

Fatty liver is also known as steatosis (Alcohol causes fat build-up in the liver and the liver is enlarged  ).

Stage-2

Alcoholic Hepatitis-liver inflammation and cell damage also known as alcoholic liver disease (ALD).

Stage-3

Liver cirrhosis is a build-up of scar tissues in place of hepatic tissues (fibrosis) and liver shrinkage.

However initially there are no symptoms, but there can be pain in the upper right abdomen, loss of appetite, heaviness after meals, the feeling of nausea, and fatigue can be a few indicators of early development of liver damage or fatty liver symptoms. These can be reversed by total abstinence from alcohol with a healthy diet and vitamin supplements.

Liver Cirrhosis

About liver

• The liver is the largest organ of the body and helps the body digest food and store energy.
• It also helps to detoxify our body of harmful substances.
• Sometimes due to certain dietary habits, pre-exposure to infections fat buildup in the liver occurs.
• This condition is non-alcoholic fatty liver.

Alcoholic fatty liver

• Non-alcoholic fatty liver typically does not cause much liver damage. It is reversible.
• Alcoholic liver disease (ALD) is due to heavy consumption of alcohol. It progresses through three stages to give rise to cirrhosis.
• The stages are alcoholic fatty liver, alcoholic hepatitis, and cirrhosis.
• The liver breaks down most of the alcohol and generates harmful substances. These cause inflammation and weaken the body’s natural defense.
• Chronic alcohol consumption leads to hepatic lipid metabolism. This leads to fat deposits in the liver cells ( hepatocytes). This is the stage of alcoholic fatty liver and is reversible. The individual should totally stop the consumption of alcohol.

Alcoholic hepatitis

• It is liver inflammation–the next stage. Jaundice and associated fever is common manifestation at this stage.
• With continuous alcohol intake, the fat-stored hepatocytes burst and release liver enzymes. Regenerative nodules start building up within the liver This is the starting point of liver scarring. The build-up of fibrotic tissue and collagen fibers takes place. It is the end stage of cirrhosis and is irreversible.
• Fibrosis is initiated by stellate cells which play a major role in wound healing process under normal conditions.
• Stellate cells also store vitamin A and remain dormant. Injured hepatocytes secrete paracrine factors and activate the stellate cells.
• These stellate cells now lose vitamin A. They start proliferating under the influence of Transforming growth factor (TGF)  beta 1. This leads to the production of collagen in the extracellular matrix.
• This slowly over a period of time develops to scar tissues. The liver shrinks – the main sign of cirrhosis and other associated symptoms develop.

 Role of alcohol in liver cirrhosis

•  The liver is the main organ for alcohol metabolism.
• An enzyme called alcohol dehydrogenase (ADH) converts alcohol to acetaldehyde, which produces free radicals harmful to the body.
• Acetaldehyde is metabolized to acetate with the help of the mitochondrial enzyme acetaldehyde dehydrogenase (ALDH).
• Here a compound NAD+ ( Nicotinamide adenine dinucleotide) is reduced to NADH( H is for hydrogen). Higher NADH levels make more fatty acids and lower NAD+ levels mean less fatty acid oxidation both of which lead to excess fat production in the liver.
•  The liver now starts looking more yellowish, large, and heavy.
•  This is the fatty liver (steatosis).
• As alcohol is converted to acetaldehyde, compounds like ROS (reactive oxygen species ) are also generated. ROS are highly reactive as they contain oxygen. These start reacting with the different components of hepatocytes (liver cells) like protein and even DNA. This causes serious damage to cells.
• Acetaldehyde can also bind to all sorts of compounds inside the cell like enzymes and cell membranes. The result is that the functioning of that compound is inhibited. This leads to the formation of acetaldehyde adducts.
• These adducts are now recognized as foreign by the immune system. This sends neutrophils to repair the damage, which results in the destruction of hepatocytes.
• As the cells get inflamed and damaged, alcoholic hepatitis develops.
• Liver enzymes like ALT  (alanine aminotransferase) and AST ( aspartate aminotransferase) leak from the damaged hepatocytes.  Alcoholic hepatitis individuals have elevated levels of AST in the blood.
• The cytoplasm of hepatocytes develops protein bundles called Mallory bodies.
• Cells gradually become more damaged and die off. Scar tissues start to form around the central veins of the liver giving rise to perivenular fibrosis.

Common liver cirrhosis symptoms

1. Early symptoms

• Fatigue
• Weakness
• Enlarged liver (hepatomegaly)
• Loss of appetite
• Nausea
• Vomiting
• Fever
• Abdominal pain

2. Advanced symptoms

• Jaundice yellowing of skin and eyes due to the inability of the liver to clear bilirubin.
• High pressure in portal vein
• Edema is fluid accumulation in the leg
• Enlarged spleen
• Fluid build-up in the belly(ascites).
• Internal bleeding
• Confusion due to the build-up of toxins( ammonia) in the brain (hepatic encephalopathy) and kidney failure.
• Shrinkage of liver.

3. Complications

• Increased risk of liver cancer
• Needing a liver transplant

Diagnosis of liver cirrhosis

• Liver biopsy
• Elevated serum bilirubin
• Elevated levels of liver enzymes: AST, ALT (transaminases ),  ALP
• Thrombocytopenia ( low platelet levels)

Management of liver cirrhosis by changing lifestyle

• Total abstinence from alcohol
• The Paleo diet consists of more vegetables fruits, nuts, and whole grains, and omitting sugary processed food especially those that contain corn starch syrup.
• Avoiding dairy products.
• Maintaining a correct body weight.
• A good amount of exercise.

Prevention

• Adoption of a healthy lifestyle – Healthy weight and balanced diet with regular exercise
• Regular tests for liver disease –  liver function tests measure bilirubin and liver enzymes in the blood.
• Individuals with fatty liver, diabetes, and Hepatitis B, and C should be always under medical supervision.

Q&A

1. Can a person with liver cirrhosis drink alcohol?

No, total stoppage of intake of alcohol.

2. How long can an alcoholic live with cirrhosis?

About five to eight years.

3. What are the first signs of liver damage from alcohol?

Enlarged liver –hepatomegaly.

4. Can alcoholic liver cirrhosis be cured?

Only through a liver transplant.

Summary

• Liver cirrhosis develops due to alcohol is the replacement of functionally damaged liver cells by nonfunctional scar tissues.
• Cirrhosis progresses in three major stages.
• The first stage is fatty liver condition.
• Second stage is known as alcoholic hepatitis.
• In the third stage, liver cirrhosis is a build-up of scar tissues in place of hepatic tissues (fibrosis) and liver shrinkage.
• A major change in lifestyle, nonconsumption of alcohol, eating healthy, exercising, and maintaining correct weight can control liver cirrhosis.
• Life expectancy in liver cirrhosis is five to eight years.  Now with advanced treatment facilities, it can be up to fifteen years. 

References

1. Liver Physiology: Metabolism and Detoxification by Chiang J.
2. https://www.semanticscholar.org/paper/Physiology-of-the-liver-Tso-McGill/451216cfb9d6f78181c49ad75e7a0e3291376312

Written By: Ahana Mitra