Cirrhosis can be caused by multiple issues related to liver injury and disease. Alcoholic cirrhosis is a late-stage form of liver disease caused by extensive heavy drinking. It is the third phase in progressive liver conditions, which starts as fatty liver disease and alcoholic hepatitis.

If not appropriately treated, alcoholic cirrhosis can lead to liver cancer, liver failure, and the need for a liver transplant.1 It is currently one of the most preventable causes of death in the United States.

In this article:

Diagnosis of Cirrhosis

Liver cirrhosis can be diagnosed by your symptoms of alcoholism, blood tests, imaging, or the presence of scarring and irregular tissue on your liver. A liver biopsy can confirm it, but often symptoms of alcoholism and history provide enough evidence to warrant a diagnosis.2,3

Once advanced past a certain point, alcoholic cirrhosis is considered irreversible and can lead to various serious complications, including liver cancer and death.4

Although liver disease and cirrhosis of the liver are not unique to those who overuse alcohol, their prevalence among drinkers is remarkable:

  • In 2018, 43% of liver-related deaths were related to alcohol for people 12 and up.3
  • In 2013, 48% of cirrhosis deaths were related to alcohol.3

Prevalence of Alcoholic Cirrhosis

Alcohol use is the leading cause of death from liver disease.2 For people with alcohol use disorder (AUD), an estimated 10-15% develop cirrhosis. Many more than that have other, less progressive forms of liver disease.1

Cirrhosis was the eighth leading cause of death in the U.S. in 2010. This number includes cirrhosis from all causes, but it is estimated that about half of all cirrhosis deaths are related to alcohol use.5 Death from alcoholic cirrhosis is prevalent among young adults between 25-34.5

Who is At Risk for Alcoholic Cirrhosis

The most significant risk factors for alcoholic cirrhosis have to do with the frequency and duration of your drinking history. Heavy drinking is defined according to an individual’s age, gender, health status, and alcohol serving intake. A serving of alcohol is equivalent to the following:2

  • 12 ounces (oz.), or a regular-size can, of beer
  • 8 oz of malt liquor
  • 5 oz wine
  • 5 oz, or a shot glass, of hard liquor

Although there is no perfect science for predicting your propensity for alcoholic cirrhosis, specific populations are more vulnerable. The people at highest risk for alcoholic-related cirrhosis include:2

  • Men who drink more than 14 servings of alcohol per week, and more than four drinks at a time
  • Women who drink more than seven servings of alcohol per week, and more than three drinks at a time
  • Adults over 65 who have more than seven servings of alcohol per week, and more than three drinks at a time

A long history of drinking alcohol is associated with cirrhosis, more so than a more recent onset of problematic drinking. In a study of heavy drinkers with a variety of liver conditions, including both healthy liver function and cirrhosis, patients with cirrhosis had used alcohol heavily for an average of 17 years, while those with healthy liver function had abused it for an average of 7 years.

As liver function worsened, the average amount of years of drinking increased.1 This tells us as you drink more over time, you increase the likelihood that you will progress through the cirrhosis stages from liver disease to cirrhosis.1

Women are more susceptible than men to cirrhosis,2 although more men than women have cirrhosis and die from it. This is related to gender-specific biochemistry and metabolism and a higher prevalence of heavy drinking among men than women.1 People with diets high in fatty foods are also at greater risk for cirrhosis. Lastly, those with existing compromises in liver function are at higher risk.2

Cirrhosis Symptoms and Signs

Early symptoms of alcoholic cirrhosis include:6

  • Loss of appetite
  • Fatigue
  • Weakness
  • Weight loss
  • Pain in abdomen
  • Stomach upset

As the disease progresses, symptoms become more severe and debilitating. You may experience:

  • Fluid buildup in your abdomen
  • Susceptibility to bruising and bleeding easily
  • Jaundice, or a yellow tinge to your eyes and skin
  • Swelling in extremities
  • Dry, itchy skin
  • Confusion
  • Difficulty sleeping, restlessness

Cirrhosis also causes other symptoms, such as “clubbing” or the thickening and widening of your fingers and nails. You may even notice reddening palms, shortening, and rigidity in the muscles of your fingers.

You can prevent the progression into these more severe signs and symptoms by abstaining from alcohol as soon as you become aware of liver damage. The 5-year survival rate for moderate alcoholic cirrhosis is 90% for people who stop drinking and 70% for those who don’t. Survival rates are significantly lower for those with end-stage cirrhosis.1

Treatment for Cirrhosis

The treatment approach for cirrhosis may vary among individuals, depending on their health history and progressive state of liver disease. In the most extreme cases of cirrhosis, a doctor may recommend a liver transplant. For all patients, the main goals of treatment for alcoholic cirrhosis are generally the same:4

  • Prevent further progression of liver damage.
  • Identify liver tolerance for medications, and manage care accordingly.
  • Manage and prevent complications of cirrhosis.
  • Address symptoms and maintain quality of life.
  • Identify the potential need for a liver transplant, and optimize timing and care.

One of the first steps in managing cirrhosis involves abstaining from alcohol and other liver-toxic substances. Generally, cirrhosis patients who remain abstinent from alcohol have better survival rates and treatment outcomes.4

Your provider will also discuss certain medications, foods, and other substances to avoid that may be toxic to your compromised liver.

To learn more about treatment options for alcohol addiction and abuse, call 800-839-1686Who Answers? to speak to a treatment specialist.

Medical Management of Cirrhosis

Medication management for cirrhosis depends upon your specific symptoms and the extent of damage to your liver. Some cirrhosis patients are given antivirals and blood pressure medications, which have shown to slow cirrhosis progression.

Other types of treatment mostly relate to symptom management.4 They may include:4

  • Placement of a shunt to manage excessive bleeding in your digestive tract
  • Diuretics, salt restriction, and periodic drainage to manage excessive fluid in the abdomen
  • Antibiotics to fight common infections associated with liver disease (pancreas, liver).
  • Blood thinners to manage blood clots blocking blood flow from your liver

Lifestyle Management of Alcoholic Cirrhosis

In addition to medication and procedures, your provider will review lifestyle recommendations with you to optimize your experience with alcoholic cirrhosis.

As mentioned, alcohol abstinence is one of the most important first steps in dealing with cirrhosis. Many people who have alcohol-related liver disease need support to become and stay abstinent from alcohol. You have many options for finding help, including:

  • Inpatient rehabilitation
  • Outpatient rehabilitation
  • Counseling
  • Peer group support, such as AA or SMART Recovery

Call 800-839-1686Who Answers? to speak to a treatment specialist and discuss your rehab options.

These types of programs can support you through any difficulty you may face with abstinence. You will get tools to deal with any stressors or triggers for drinking, as well as any other help you need to optimize your quality of life without alcohol.

You will also receive suggestions on how to change your lifestyle to minimize further damage to your liver. Your doctor may also put you on a low sodium diet to reduce side effects related to abdominal fluid retention.

For many cirrhosis patients, undercooked or raw fish or meat is to be avoided as it can promote bacteria and viruses, which your liver and immune system may not be able to fight.

It is also recommended that liver disease patients avoid foods high in fat because fatty liver disease precedes cirrhosis and can be part of cirrhosis symptoms.6 You may also learn about over-the-counter medications that the liver is sensitive to, such as Tylenol and specific supplements.

Liver Transplant

Treatment of cirrhosis can be tricky because your liver may not be able to tolerate or metabolize many medications. In situations of untreatable cirrhosis complications, a liver transplant is often considered. In liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from an organ donor. It is major surgery with possible complications.

Once your providers have decided to explore liver transplant surgery, there is an extensive workup for you to qualify for surgery. You will be put on a list of liver transplant candidates. Preference for liver recipients is usually focused on the likelihood of a good result. After transplant surgery, patients and providers must work together closely to ensure a safe outcome and survival with a good quality of life.1

Prevention

Alcoholic cirrhosis can be prevented by a reduction or cessation of drinking alcohol. Abstinence from alcohol is essential for those who already have liver dysfunction or susceptibility to disease. If you have any liver damage related to your drinking, it is wise to find the help you need to stay abstinent. Abundant confidential and helpful resources are available for people struggling with alcohol today.

Much of the data on cirrhosis diagnoses related to alcohol is based on autopsies of people who died with cirrhosis. Many don’t even know they have it and, because of that, do not treat it or prevent complications.1

If you think you have a problem with heavy drinking, it is important to discuss it with your doctor. It gives you the chance to learn about signs of liver disease, actions you can take to prevent it, and the resources that can help you. You can also contact 800-839-1686Who Answers? to get help for your addiction or to speak with a treatment advisor.

References

  1. Mann, R., Smart, R., & Govoni, R. (n.d.). The Epidemiology of Alcoholic Liver DiseaseAlcohol Research & Health,27(3), 209-219. Retrieved 2003.
  2. Patel, R., & Mueller, M. (2020, November 18). Alcoholic liver disease. Retrieved February 09, 2021.
  3. National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol Facts and Statistics. Retrieved February 2021.
  4. Goldberg, E. & Chopra, S. (2020). Cirrhosis in adults: Overview of complications, general management, and prognosis. In K. Robson (Ed.) UpToDate.
  5. National Institute on Alcohol Abuse and Alcoholism. (2018). Surveillance Report #111: Liver Cirrhosis Mortality in the United States: National State, and Regional Trends, 2000-2015. Retrieved 2021.
  6. National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Symptoms & causes of cirrhosis. Retrieved 2021.

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