The page explains how alcohol affects and damages your liver particularly if you drink a lot of it regularly. This is called alcohol misuse and affects about three in every 10 men and 1 or 2 in every ten women.

The Liver

Your liver is the body’s largest organ and   holds about ½ litre (1 pint) of blood. It is placed just under your ribs on the right side of your stomach. If you place your hand over the lower right hand side of your ribs it will just about cover the area of your liver.

Your liver carries out hundreds of vital jobs. Two thirds of your liver is made up of liver cells. When liver cells become damaged they can sometimes repair themselves. But if the damage is repeated your liver will become scarred and will not repair itself.

What your liver does

A healthy liver has many jobs including:

• Storing vitamins, sugars and iron to help give your body
• Controlling the production and removal of cholesterol
• Processing many of the medicines which you my take
• Helping to remove or process alcohol, poisons and other toxins from your body
• Making proteins that are essential for blood to clot
• Helps you fight infection by removing bacteria from the blood
• Making and storing amino acids, proteins and fats
• Making bile which passes from your liver to your gut and helps to digest

Alcohol and its journey through your liver

When you drink alcohol, it is absorbed into the bloodstream from the stomach and intestines. The highest amount of alcohol is in the blood flowing through the liver. So, if you drink alcohol faster than your liver can process it, the level of alcohol in your bloodstream rises and you become drunk. Each time alcohol passes through the liver, some of your liver cells die. The liver is very good at recovery and can develop new cells but continued alcohol misuse can seriously damage your liver.

Alcohol and Units

Healthy liver cells can process and breakdown about one unit of alcohol per hour.

Units are a way of measuring how much alcohol you are drinking. One unit is 10ml of pure alcohol. The national guidance for alcohol consumption is to not exceed 14 units in a week, spread over 3 or more days, with several non-drinking days each week recommended. You need the measure and strength of a drink to calculate the unit content.

This is a guide
Type of Drink	ABV % (Strength)	Amount	Number of units
Cider or Beer (Ale/Stout/Bitter)	4.5%	1 pint	2.6
Strong Cider (Frosty Jacks)	7.5%	1 can (440ml)/1 litre	4/7.5
Fruit Cider	4%	1 bottle (500ml)	2
Lager	4%	1 pint	2.3
Bottled Lager	4.5%	330ml	2.8
Strong  lager (Tennents Super/ Special Brew)	7.5%	1 Can (500 mls/440ml)	4/3.3
Wine	13%	250ml (large glass)	3.3
Prosecco	12%	125ml	1.5
Spirits	40%	25ml (single measure)	1

Units and Your health

Binge drinking is classed as drinking over 8 units in one session for men or 6 units for women.

NICE Guidance says say drinking 3 to 6 drinks a week can increase the risk of developing certain cancers such as breast or colon cancer. Whilst drinking more than 7 drinks a week can increase the risk of heart disease and stroke.

Harmful drinking is when people regularly drink over 35 units per week. This level of drinking is likely to cause harm- either physical or mental.

Drinks Tracker

If you want to control the amount of alcohol you drink there is a free MyDrinkaware App you can use. It’s available from your app store to download, making it easy to take that first step.

It lets you:

• See how your drinking compares to previous weeks
• Take a quick test to see your risk level
• Check how many units or calories are in each drink
• Set goals to help you drink less over time
• Understand the link between alcohol and sleep quality
• Plan and celebrate drink-free days
• Set manageable, realistic goals to help make those positive changes stick

Alcohol and Parenting

For many years women have been advised not to drink at all if they are or could be pregnant. This is because alcohol is absorbed into your blood which then passes to your baby. Drinking during pregnancy can cause Foetal Alcohol Spectrum Disorders. This group of conditions can include physical, behaviour and learning

problems for your baby. It is also important to limit drinking alcohol whilst breastfeeding as drinking can lead to alcohol related health problems or accidents.

Alcohol Related Liver Disease (ARLD)

Liver disease is caused by damage to the liver. This can develop over a short period of time called acute liver disease. If it develops over several years it is called chronic liver disease.

Alcohol can cause major liver damage without producing any signs or symptoms of liver disease. Drinking too much alcohol can lead to three types of liver condition- fatty liver, hepatitis and cirrhosis. Any or all of these conditions can happen at the same time in the same person.

Fatty liver

A build-up of fat occurs within liver cells in most people who drink heavily. Fatty liver is not usually serious and does not cause symptoms. It is reversible if you stop drinking heavily. But in some people the fatter liver gets worse and this can lead to inflammation and scarring which is called cirrhosis.

Alcohol Related Hepatitis

Hepatitis means inflammation of the liver which can range from mild to severe. Mild hepatitis may not cause any symptoms.

The only sign of inflammation may be an abnormal level of liver enzymes in the blood which can be spotted by a blood test.

In some people the hepatitis becomes long term, which can gradually change the liver and eventually cause cirrhosis. A very severe bout of alcohol related hepatitis can quickly lead to liver failure. This can cause deep jaundice (yellowing of the skin and eyes), blood clotting problems, confusion, bleeding from the oesophagus or coma. A third of people with this condition can die.

Alcohol Related Cirrhosis

This is where normal liver tissue is replaced by scar tissue called fibrosis. The scarring builds up gradually. Scar tissue affects the normal structure and regrowth of liver cells. The liver gradually loses its ability to function. About 1 in 10 excessive drinkers will eventually develop cirrhosis. You increase your risk of cirrhosis  if you drink heavily and also have another form of liver disease. Cirrhosis also increases the risk of liver cancer too.

Complications

When your liver is damaged, it can’t remove chemicals from the blood. A build-up of ammonia can cause other complications such as hepatic encephalopathy, which causes confusion. Cirrhosis can cause portal hypertension, enlarging of important veins who carries blood away from the liver. This can lead to bleeding of the oesophagus, which is a life threatening medical emergency. Regularly drinking too much alcohol use increases the chances  of developing other conditions such as pancreatitis which is very painful and can be fatal.

Symptoms of Alcohol Related Liver Disease

Signs and Symptoms may include:

• Nausea, vomiting, abdominal pains and diarrhoea
• Tiredness
• Yellowing of the skin and whites of eyes
• Swelling in the legs, ankles and feet due to a build- up of fluid
• Abdominal swelling due to a build-up of fluid
• Itchy skin
• Hair loss
• Unusually curved finger tips and nails
• Significant weight loss
• Weakness and muscle wasting
• Confusion and memory problems, problems sleeping and changes in personality due to increased toxin levels in the brain
• Vomiting blood and/or black tarry stools due to internal bleeding
• Blood clotting problems- a tendency to bleed and bruise more easily, such a frequent nose bleeds and bleeding gums
• Increased sensitivity to alcohol and drugs because the liver cannot process them

Diagnosing Alcohol Related Liver Disease

A physical examination by a doctor may identify signs of alcohol related liver disease. Diagnosis will include assessment for the previously listed symptoms and other signs such as enlarged liver or spleen.

A blood test called a Liver Function Test (LFT) can show inflammation and damage to the liver, but the results can vary depending if you have drank alcohol that or previous days.

A special type of ultrasound called a FibroScan may be carried out, or an MRE Scan which combines ultrasound technology with magnetic resonance imaging.

If these tests are positive, a biopsy can be taken to confirm diagnosis. This is when a small sample of the liver is taken so that it can be looked at under a microscope. A doctor may recommend further tests or scans.

Understanding Liver Function Tests (LFTs)

This type of blood test is a snapshot of your liver at any one given time. The best time to have them done is after a period of no alcohol of 4 – 6 weeks.

Albumin is a very important protein that helps keep fluid pressures in the body stable and carries many substances around the body.

Albumin may decrease in chronic liver disease, particularly if the disease is getting worse, but may also be decreased for other reasons such as inflammation.

Bilirubin is the yellow/green substance made by the liver. When the liver is not working properly, levels of this can increase, causing jaundice.

Clotting studies are a measure of the bloods ability to clot  The liver produces most of the proteins that allow this to happen.

Worsening clotting results can indicate failing liver function. When the liver is damaged your blood becomes too thin and takes longer to clot. This may lead to bruising more easily.

Alkaline Phosphate ALP is an enzyme found mainly in the bile ducts of the liver. An increase in ALP and another liver enzyme called Gamma GT can show a form of liver disease where there may be a blockage of the bile duct. This stops bile being moved from the liver.

Platelets measured within the Full Blood Count (FBC) are an important part of the clotting process. Platelet making can be affected by metabolic disorders and vitamin levels in the body, which is made worst by drinking alcohol.

Referral and treatment

You may be referred to a liver specialist who will tell about the tests and treatments you need. Non-severe cases of fatty liver and alcohol related hepatitis can often be treated by stopping drinking, eating a healthy diet and exercising. These things allow the liver to repair itself.

The treatment of cirrhosis depends upon the type and stage of the condition. Treatment aims to stop the cirrhosis getting worse, reverse the damage that has been caused and treat problems that are disabling or life threatening.

If the liver scarring is very severe and your liver is no longer doing what it should, you may need a liver transplant. However, there is a very long waiting list and a very small number of livers available. Patients generally need to have stopped drinking alcohol for 6 months before they are considered for a liver transplant.

Alcohol Dependence

Being dependent on alcohol means a person feels they’re not able to function or survive without it and that drinking becomes an important – or sometimes the most important – factor in their life.

People who are becoming dependent on alcohol notice they need to drink more to get the same effect. They often give priority to drinking over other activities or obligations (such as work or family life), or continue drinking despite harmful consequences – for example, liver disease or depression caused by drinking. Alcohol dependence also causes physical withdrawal symptoms when you stop drinking.

If you are not physically dependent on alcohol it is safe for you to stop drinking. However, if you are physically dependent you are likely to experience withdrawal symptoms, which include shaking, sweating, retching, seizures and Delirium Tremens (DTs). DTs are classed as a medical emergency. They usually start 24-72 hours after alcohol has been reduced or stopped.

The signs are different from usual withdrawal symptoms. They show signs of altered mental state. These can include confusion, hallucinations (where you see, hear or smell things that aren’t really there) and severe agitation. You should seek medical help immediately if you have any of these.

You should NOT suddenly stop drinking unless you have completed alcohol detox or been told by a medical professional that is safe to do so.

There are lots of help and support services available if you find that you are unable to stop drinking. Seek medical professional help around the best course of action for your individual circumstances. There is a list of local services available on the back of this booklet.

Eating Well for your Liver

Alcohol does not provide the body with any nourishment. Food and non-alcohol drinks are important to make sure that your body gets all the nutrients it needs. It is important to include a wide variety of foods in your diet. You should eat something from each of these food groups every day.

Food Group	Why they are important	Types of Food
Carbohydrates	Provide energy and fibre for good gut health	Bread, Chapattis, Rice, Noodles, Pasta, Potatoes, Cereals, Crackers
Proteins	Help growth and repair of body tissues including the liver	Chicken, Meat, Fish, Eggs, Beans, Pulses, Nuts
Fruit & Vegetables	Provide essential vitamins and minerals	Oranges, Apples, Bananas, Grapes, Pears, Broccoli, Sweetcorn, Salad Tinned or frozen are just as good!
Dairy	Provide protein and calcium for healthy bones and teeth	Milk, Cheese, Yoghurt
Fats & Sugars	Provide energy for the body	Crisps, Chocolate, Cake, Biscuits, Bombay Mix, Samosa, Butter, Oil, Fizzy pop

If you do not have the nutrients that your body requires you may feel weak, have difficulty walking and moving as normal, have a low mood and you may lose weight. Many people who drink more alcohol than is recommended, or have existing liver disease may have some degree of malnutrition. This is a serious condition that happens when your diet does not have the right amount of nutrients.

Malnutrition can be caused by a variety of things:

• Poor appetite
• Feeling sick
• Feeling full from alcohol
• Forgetting to eat
• Not thinking food is important
• Low finances

Thiamine (Vitamin B1)

Thiamine is an important vitamin needed to help make new brain cells. People who have a long history of alcohol excess and/or  have a poor diet are at risk of having low levels of Thiamine. Good dietary sources of Thiamine are plant and animal foods. These include beef/yeast extract (Bovril/Marmite), cereals, potatoes with the skin on, bread nuts, seeds, dried fruit, peas, kidney/baked beans, pork and fish.

Symptoms of Thiamine deficiency are fatigue, irritability, drowsiness, poor concentration and memory problems. This can lead to a condition called Wernicke-Korsakoff Syndrome. If untreated, this can lead to permanent brain damage. You may be prescribed Pabrinex or Thiamine if you are admitted to hospital. It is likely you will be advised to continue taking Thiamine tablets when you are discharged. Your GP should then take over the prescription.

Local and National Contacts

Alcohol Care Team

Bradford Royal Infirmary Monday – Friday 08:00 – 16:00
01274 272792
07799917849

New Vision Bradford

Community Drug & Alcohol Team 01274  296023

Project 6

Airedale and Bradford Community Drug & Alcohol Service 01535  610180

MAST (Multi Agency Support Team)

Inpatient signposting team for patients at BRI & Airedale 01535  610180

Alcoholics Anonymous

Find your nearest meeting at: www.alcoholicsanonymous.org.uk/aa-meetings 0800856156

SMART Recovery

Weekly meeting each Friday at Pelican House 13:00 -14:30. 07935856156

Drink Aware

Lots of useful information of cutting down alcohol intake www.drinkaware.co.uk
03001231110