I’m a former nurse and recovering alcoholic and have turned my forces over to writing educational health-promoting articles. In particular, ever since my own father died of alcoholic liver disease, I want more people to understand this confusing condition. As it stands, there are far too many stories of surprise alcoholic liver failure with devastating results for families and those suffering from addiction.
The truth is, the signs of alcoholic liver disease are vague, confusing, and may not be serious enough to warrant deep medical investigation — that is until it’s so late in the game and the liver is already failing.
For example, Jules Weldon, a fellow writer, spoke with me recently about her ex-husband’s passing from the disease. She says that she took him to get blood work and a physical exam just before his death since he was clearly showing signs of illness by then. The results showed his blood values that were a bit problematic, but according to the doctor, not enough to be hospitalized. Unfortunately, he died two days later.
A similar thing happened to Barbara, another fellow writer who speaks up about recovering from the heartbreak often inherent in our relationships with alcoholics. Just before her ex-husbands’ liver failed, the only clear signs were a change in personality, sleep habits, and a weakening state. He ended up requiring a liver transplant in order to survive.
Sadly, a similar fate happened to my father. He had been unwell before his admission to the hospital, but his blood work, while disordered, didn’t reveal anything overly concerning. However, there were earlier signs that his liver was likely in trouble, but the health team couldn’t put it together, given they didn’t have an accurate history of my father’s health and lifestyle. And this is often the case for many people with alcoholic liver disease.
Unfortunately, when alcoholics don’t tell their doctors how much they drink, it is difficult to investigate the confusing health issues that liver failure brings. Also, alcoholism still has such a stigma within health care itself that it can be hard to advocate and receive care.
For those who may want to help themselves or another with this debilitating disease, it’s essential to know some crucial signs that may point to severe liver issues. The signs I want to address are the ones that usually happen towards the end of the disease before full liver failure is imminent. These signs can still be confusing to health professionals and patients alike; however, understanding them better may help people advocate for themselves or loved ones reaching the end of their liver functioning.
Most people don’t get all of these signs — although it certainly possible to have all of them. Since these signs are present in many other diseases, the only way to know for sure if they’re caused by the liver is to have evidence that the liver requires investigation. In the case of alcoholism, the only way a doctor can link up all the information and actually check the liver is to know the exact history of heavy drinking. Without that crucial data, many people are sent home without a diagnosis and as such, may die quickly.
High blood pressure
High blood pressure happens for a few reasons in alcoholic liver disease, however, the most important reason is due to portal hypertension. The portal vein carries blood from the digestive system into the liver. When the liver becomes too diseased to function properly, this blood can’t make it’s way into the hardened cells of the liver. The result is a build up of blood outside of the liver and into the thoracic region. This causes swollen vessels in the gut and esophagus that can easily burst. Also, the person with portal hypertension is at an increased risk of spontaneous heart attack.
Disordered blood clotting and spontaneous bleeding
One of the important functions of the liver is to create blood clotting products. As the liver loses function, these products decrease causing a lowered platelet count as well as a decrease in other clotting factors. On top of that, as we talked about above, the blood pressure raises in the portal vein which pushes blood up into the thoracic area causing an increase risk of bleeding.
One lab test to ask the doctor about is called an INR — prothrombin time — which captures the time it takes for a blood clot to form. People in late-stage alcoholic liver disease may have a much higher INR than usual.
The liver also helps manage red blood cells as well. Chronic alcoholism often causes a wide variety of nutritent deficiencies and as such, anemia could result from these deficiencies. But also, the toxic effect of alcohol on the body and bone marrow can suppress the development of healthy red blood cells. Lastly, late-stage alcoholic liver disease can cause internal bleeding, (as we discussed above) which can also contribute to anemia.
There are a few reasons for heart-related problems in late stage alcoholic liver disease. One is the direct result of portal hypertension; an increased pressure in the vascular system can directly stress the heart. If there is already underlying heart disease, then portal hypertension can greatly increase the risk of heart attack.Also, nutrient deficiencies and electrical issues caused by alcohol use can also stress the heart in the late stage of the disease.
The kidneys and liver do tend to work alongside each other even though they each have very different functions. The problem is that when the liver is beginning to fail, the toxins and lack of blood flow in the body can directly injure the kidneys.Hepatorenal syndrome is a complication of advanced cirrhosis of the liver and as such, it can show up in people who have a serious decrease in healthy liver cells. Often, it doesn’t show up at all. But for those who have it, hepatorenal syndrome is unfortunately a sign of poor prognosis.
Serious cognitive and mobility issues
Advanced alcoholic liver disease causes severe malnutrition as well as nervous system and brain damage due to a build up of toxins. These issues work together to cause a major decrease in cognitive skills and mobility. Many people with advanced liver disease, especially just before the liver fails, show signs of poor balance, personality changes, sleep disruption, and problems with memory and executive functioning.
The most dangerous nervous system problem due to liver failure is hepatic encephalopathy. This is usually a sign that the liver is in imminent failure. The person can often be seen walking with a shuffling gait and suffer from poor balance, confusion, mood and sleep changes, slurred speech, disorientation, and flapping hand movements when holding hands out straight.
Having a swollen belly in late-stage alcoholic liver disease is actually called ascites; a medical term for fluid accumulating in between the visceral layers of the abdomen. One thing to check alongside a swollen belly is the level of albumin in a persons blood. Albumin is a protein that requires the liver to keep in balance. The exact mechanism is complicated but all we need to understand is that once the liver begins to fail, blood albumin levels decrease causing water to leak out into the abdominal visceral area.
Inability to digest food and metabolize medications
The liver is a key player in the digestions, elimination of toxins, and absorption of nutrients. Once the liver begins to fail, it has to divert all of its attention to the most pressing functions of the liver. This means that food digestions and absorption of nutrients goes on the back burner.
People with alcoholic liver disease show signs of digestive issues early on in the disease. However, once it reaches the late stages and the liver is functioning at a minimal capacity, the person may not be able to eat at all. Also, they are likely to vomit or have diarrhea in response to eating. Another sign is a sudden decrease in ability to metabolize medications. This means some people have weird reactions to their medications that they otherwise may not have.
Disordered blood sugar
The liver is also a key player in blood sugar management in the body — it works together with the pancreas to maintain blood sugar levels. Once the liver becomes stressed, the blood sugar management system may become disordered. Often, even in the earlier stages of the disease, some alcoholics and heavy drinkers may develop diabetes. However, once the liver begins to fail, blood sugar levels often become dangerously disordered, even in people with no prior history of diabetes.
These are some signs that happen in the late-stages of alcoholic liver disease, usually as the liver is in active failure. Remember that liver failure happens gradually, until one day the cascade of various problems associated with liver failure causes a a tip in the balance, and the organ fails suddenly. The more people understand these common signs, the more they can be empowered to act earlier or to advocate for further investigation.
If you or someone you know is a heavy drinker and shows these signs, it’s imperative that medical assistance be accessed. The most important detail that can help doctors link up the information is to let them know the frequency and amount of alcohol consumption. Also, a complete list of important symptoms can help medical professional clue in to what may be happening. The list of signs I provided above can be a good starting point in conversing with doctors and health professionals.