The Early Signs of Alcoholic Liver Disease are Hard to Detect

Gillian May
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My father died of alcoholic liver disease (ALD) in 2016. We had no idea he was suffering from the condition until he got very sick. The time between when he started showing serious symptoms to the time of his death, was only one month.

Looking back, he had early signs, but he thought they were from other conditions. We were also confused as well and sometimes had no idea he wasn’t feeling well. The truth is, ALD can mimic other illnesses and conditions, so it can be tough to detect the early signs of alcoholic liver disease. Also, the chronic and insidious nature of the disease may make it difficult to notice the slow decline in health and quality of life over time.

This article will discuss three critical reasons why early signs of ALD can be hard to detect.

Denial in alcoholism.

Denial is an important issue in the detection and treatment of alcoholic liver disease. Because the symptoms can be vague, doctors simply don’t know what to look for until the patient divulges the truth about their drinking. If a doctor doesn’t know that the patient is a heavy drinker, they can’t narrow down the cause of the symptoms.

Most of the time, an alcoholic will go to the doctor not feeling well but won’t tell the doctor how much they drink. Denial in alcoholism is a serious issue — sometimes the alcoholic believes their own lies and honestly doesn’t think they drink too much. The way that alcohol can interact with the brain and cognition can often make alcoholics oblivious to their health issues.

The other issue is that even if an alcoholic is aware of their alcoholism, they still may not divulge the amount they drink to the doctor for fear of having to quit drinking. Addiction has such a strong pull that sometimes the person who has the addiction will forgo their health to keep their addiction.

The first signs of ALD are not in the liver.

The liver is a fascinating organ. It has no pain signals, so the person doesn’t feel anything from the liver even when it’s swollen or scarred. They may feel a dull ache from the surrounding organs if the liver is swollen enough to displace other organs and connective tissue. However, the liver itself won’t register pain or distress. Instead, the only way to tell if the liver is in distress is how it affects other organs.

Essentially, the first signs of liver issues are outside the liver. Often, the earliest signs will disrupt digestive functioning as well as cause some nervous system issues.

The person may feel indigestion, bloating, and problems digesting protein and fats. The liver and pancreas work together to aid in digestion — heavy drinking that begins to stress the liver will impact this process. The liver also works to filter toxins from food and medications. If heavy drinking disrupts liver functioning, this process can slow down, causing digestive issues and problems processing medications. Sometimes medications will either stop working, or they build up in the blood. Both problems can cause symptoms that are not associated with the liver.

Also, when the liver isn’t functioning optimally, it can cause issues with the nervous system. Alcohol itself is neurotoxic, but the liver has a part to play in maintaining the nervous system. The liver processes vitamins that help the nervous system do its job, and it also removes toxins that can affect the functioning of the nervous system. This can cause vague problems such as nerve pain, numbness or tingling, issues with balance, foggy brain, and sleep difficulties.

However, because the first signs of liver issues are not in the liver, it can be challenging to know something is wrong. This is why it’s so imperative that the doctor knows how much a person drinks.

The liver functions well until it hits a tipping point.

The liver is one of the strongest and most forgiving organs in the human body. When liver cells are damaged, other liver cells often step up and do the work for the damaged cells. The liver is also one of the only organs in the body that can regenerate when damaged. But only if there are no further assaults.

In the beginning stages of alcoholic liver disease, the liver can function for the most part because of how well it can withstand damaged cells. The liver can be receiving damage with multiple areas of scarring, fatty deposits, and hardening of the tissues, but still manage all of its functions.

When the liver is damaged but working well, it means that it’s compensating. The liver compensates for the damage for the most part, even though there are some vague signs that things aren’t quite right. This is often why liver disease is hard to detect because the liver functions well until it can’t function anymore.

Eventually, as in the case of my father, liver disease can suddenly decompensate. This process can happen quickly and can cause significant disability and eventual death. Once a liver reaches a tipping point and decompensates, the person’s 5-year survival rate lowers significantly. Unfortunately, it’s hard to know exactly when this tipping point will be reached, or how severe it will be, which is why early prevention is so important.

These three factors explain why the early signs of alcoholic liver disease are hard to detect. Denial in alcoholism is one of the biggest reasons why the condition often gets diagnosed late. Also, most signs of liver issues occur outside of the liver, which can be confusing. Lastly, the liver functions well until it hits a tipping point and begins to decompensate. So a person with the disease may not know there’s a problem until it’s too late.

To prevent this condition, let your doctor know exactly how much you drink daily. This way, the doctor can adequately monitor the liver over time. The best way to prevent ALD is to stop drinking, but often that’s easier said than done, so the best way to reduce harm is to divulge drinking patterns to the doctor.

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I'm a former nurse turned freelance writer. I have extensive experience in administration, frontline care, and education in mental health, public health, and geriatrics. However, after 20 years, I needed a change and always wanted to write. I have personal and family experience in mental health and addictions, so I'm passionate about advocacy and education in those areas. I'm also a traveler, photographer, and artist. I funnel all my various expertise into my writing and hope to provide valuable content that is entertaining and educational.


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