Alcohol-induced liver disease (ALD)

We are often told that too much alcohol is bad for us, and you may have wondered how alcohol affects your liver when sipping a glass of wine or beer.

Your liver can cope with drinking a small amount of alcohol. However the liver can only handle a certain amount of alcohol at any given time, so if you drink more than the liver can deal with by drinking too quickly, or drinking too much over a short period of time, your liver cells struggle to process it.

When alcohol reaches the liver, it produces a toxic enzyme called acetaldehyde which can damage liver cells and cause permanent scarring, in addition to damage to other organs such as the stomach lining causing gastritis or peptic ulcer disease. Your liver also requires water to do its job effectively, when alcohol enters the body it acts as a diuretic causing dehydration. Severe dehydration is part of the reason why excessive alcohol drinking causes the hangover headache.

Types of ALD

Regular and heavy drinking over time can affect the way alcohol is metabolised within the body, which can lead to alcoholic liver disease. There are three primary types of alcohol-induced liver disease, including the following:

  • Fatty Liver

    Fatty liver is the most common alcohol-induced liver disease, and is due to excessive accumulation of fat inside the liver cells. The liver becomes enlarged, which may cause upper abdominal discomfort on the right side. If the person stops drinking alcohol, this stage of ALD will usually reverse.

  • Alcoholic hepatitis

    Alcoholic hepatitis is an acute inflammation of the liver, with destruction of individual liver cells and frequently followed by permanent scarring. This form of ALD is often seen after a period of very high levels of alcohol consumption over days to weeks. Symptoms may include fever, jaundice, general fatigue, right-sided abdominal pain, and nausea. The white blood count is elevated, and the liver is enlarged and tender.

  • Alcoholic cirrhosis

    Alcoholic cirrhosis is the destruction of normal liver tissue, leaving permanent scar tissue (fibrosis). Symptoms and signs relate to development of complications such as portal hypertension (increased resistance to blood flow through the liver), enlarged spleen, ascites (fluid accumulation in the abdominal cavity), confusion (encephalopathy), and liver cancer.

What are the symptoms of alcohol-induced liver disease?

The effects of alcohol on the liver depend on how much and how long a person has been drinking alcohol. The following are the most common symptoms and signs of alcohol-induced liver disease:

  • Enlarged liver

  • Fever

  • Nausea

  • Vomiting

  • Jaundice

  • Spider-like veins in the skin

  • Distended abdomen

  • Confusion

The symptoms of alcohol-induced liver disease may resemble other medical conditions or problems.
Always consult your doctor for a diagnosis.

How is alcohol-induced liver disease diagnosed?

In addition to a complete medical history and physical examination, tests for alcohol-induced liver disease may include the following:

  • Blood tests

    …such as liver function tests to assess if the liver is functioning properly.

  • FibroScan™

    …to assess liver stiffness as a marker for liver scarring (fibrosis)… Read more

  • Liver biopsy

    …procedure that involves removing tissue samples from the liver (with a needle or during surgery) for examination under a microscope.

  • Ultrasound (US) liver scan

    …to assess for ascites, to check patency of the main liver blood vessels and assess for blood clots in the portal vein.

  • Computed tomography (CT) scan

    …shows detailed images of the abdomen and liver, and may be requested if small focal lesions (nodules) are seen on ultrasound images. A CT liver scan may be requested to assess for liver cancer.

What is the treatment for alcohol-induced liver disease?

The goal of treatment is to restore some or all normal functioning to the liver. Treatment usually begins with abstinence from alcohol. The liver has great regenerative capacity and is often able to repair some of the damage caused by alcohol. However, the scarring from cirrhosis is not reversible, and if the liver damage is severe enough to cause liver failure, most of the damage may be irreversible. In some cases, liver transplant may be considered after a period of abstinence has been demonstrated.

In the acute presentation of ALD, treatment options will be determined by:

  • Age, overall health, and medical history of the patient

  • Extent of the disease

  • Tolerance for specific medications, procedures, or therapies

Alcohol guidelines

There are alcohol guidelines in place for alcohol consumption which have been developed by the HSE. is the first HSE website that provides dedicated information about alcohol risk and offers support and guidance to anyone who wants to cut back on their drinking. Using the most up-to- date scientific research and evidence, the guidelines aim to help you make informed choices and help reduce the risk of alcohol-related accidents, injuries, disease and death.

Low risk weekly guidelines for adults are up to 11 standard drinks in a week for women, and up to 17 standard drinks in a week for men. Drinking no more than six standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion. Drinking more than six standard
drinks on any one occasion is regarded as binge drinking.

Keep in mind that alcohol can have varying effects on you depending on; age, gender, mental health, drug use and medical conditions, so balance a glass of your preferred alcoholic beverage with some thought about the associated risks.

If you are concerned about your liver health and would like to book a FibroScan® Liver Assessment (a pain-free, non-invasive examination of liver health and a reliable alternative to liver biopsy), please contact us here.