Chapter 6 - The Late Deteriorative Stage of Alcoholism - pages 81 - 94
Fatty Liver, Hepatitis, and Cirrhosis
The body needs fuel to continue functioning, and its major fuel sources are carbohydrates and fat. The liver is the major organ for converting these substances into energy. When alcohol is in the body, however, the liver has a choice. It can either use alcohol or the fat and carbohydrates for fuel. Because alcohol requires less time and effort to oxidize than these other sources of fuel, and the calories available from its breakdown provide a rich and potent energy "kick," the choice is quickly made. The liver uses the alcohol as a fuel, the carbohydrates are stored as glycogen or converted to fat, and the fat is kept in storage.
Thus, whenever alcohol is in the body, the liver uses it for fuel rather than the more difficult and time-consuming fat. This substitution of alcohol for fat as a fuel is not restricted to the alcoholic but, in fact, occurs in everyone who drinks a significant amount of alcohol. The nonalcoholic drinker, however, usually drinks only for short periods, with relatively long periods of abstention in between. When there is no alcohol in the body, the fat is pulled out of storage and converted by the liver into energy to fulfill the body's needs. Alcoholics, on the other hand, keep a fairly constant supply of alcohol in the liver, and as a result, fat accumulates.
Alcohol contributes to the buildup of fat in the liver in another major and potentially disastrous way. Large amounts of alcohol trigger various hormonal discharges which mobilize the fat stored and deposited in other body tissues and move it toward the liver, which must then make room to store it. Surplus fat also circulates in the blood stream as triglycerides.
As the fat accumulates, it begins to crowd the highly specialized liver cells, many of which suffiocate and die. This condition is termed fatty infiltration of the liver. As more and more liver cells are injured, the fatty deposits enlarge, causing the liver to swell. A healthy liver is normally neatly tucked away behind the rib cage on the right side and cannot be felt at all. But as the fat and swelling increase, the inflamed liver can be felt by pressing up under the bottom rib. In advanced cases, the swelling can extend down to the pelvis on the right side. The typical person with a severe case of alcoholic fatty liver has been drinking heavily for weeks or months, has no appetite, and suffers from nausea and jaundice.
In some alcoholics, large numbers of cells are sick and begin to die, and the liver becomes inflammed, swollen, and extremely tender. This condition is known as alcoholic hepatitis. The alcoholic with hepatitis is nauseated, feverish, jaundiced, and complains of abdominal pain. Both fatty liver and hepatitis are reversible with abstinence from alcohol and good nutrition to promote healing. But if the alcoholic continues to drink, so many of his liver cells may be destroyed that scar tissue begins to form, signifying the condition known as cirrhosis of the liver. Cirrhosis occurs in an estimated 8 percent of alcoholics, about seven times as often as in nonalcoholics.
A cirrhotic liver is a plugged up liver, something like a drain that is clogged. Blood cannot flow smoothly through the congested organ; it backs up and is gradually saturated with toxic materials. As the poisoned blood flow reaches the brain, the cells become poisoned and sick, profoundly affecting the alcoholic's behavior and emotions. The toxic alcoholic is confused, his thought processes jumbled and rambling, and memory and judgment muddled. Even his balance and equilibrium may be affected.
As the scar tissue in the liver accumulates and ages, it also constricts, choking the blood vessels and cutting off the blood supply to the remaining liver cells, which causes further cell death. If the alcoholic continues to drink, the combined effects of fatty liver, hepatitis, and cirrhosis have additional serious consequences. When the blood can no longer circulate freely through the congested liver, the pressure created causes the small blood vessels in the head, face, and chest to rupture, resulting in tiny, spiderlike patterns of broken blood vessels called spider angioma.
As the body's blood vessels become constricted, alternate routes to the heart must be found. One route is through the thin-walled and delicate veins of the esophagus. The increased blood flow through these veins can cause them to dilate and, like a bicycle tire blown up with too much air, rupture and hemorrhage. Bleeding from the esophageal vessels (or varices) is evident when the alcoholic vomits up fresh blood. These hemorrhages are obviously dangerous and one of the major causes of death of cirrhosis victims.
Ascites is another complication of the pressure created by a cirrhotic liver. Specifically, ascites is a symptom of pressure in the lymphatic system. When the pressure grows too great, hymph leaks out of the vessels, accumulating in the abdomen, which then swells. Ascites is sometimes mistaken for the common and relatively harmless beer belly, but a swollen stomach in a heavy drinker should be a clear warning of serious trouble in the liver.
Many other serious and sometimes fatal complications occur as a result of cirrhosis. Because so many of its cells are dead or injured, the liver's ability to detoxify poisons is greatly reduced, and potentially dangerous chemicals build up in the blood stream. One of these is ammonia, which can cause personality changes, lethargy, coma, and death. Bilirubin is another chemical which builds up in the blood when the liver is plugged up with scar tissue. This orange bile pigment is a breakdown product of hemoglobin, and its accumulation causes yellowing of the skin, or jaundice.
As liver damage progresses, other essential chemical and hormonal substances are produced at a slower rate because the liver is simply not functioning normally. Among these is prothrombin, an incredient necessary for clotting blood. As the prothrombin level decreases, the alcoholic may bruise easily and blood excessively from a small cut or scratch. He may have bleeding bums, frequent and severe nosbleeds, or bleeding under the skin. If the prothrombin levels gets too low, the alcoholic is in danger of dying from internal hemorrhage.
Up to the point of scar tissue development, the liver has extrordinary regenerative powers, and amazing transformations take place when the liver is given proper food and nutrients, rest, and no alcohol. The body slowly eliminates the accumulated fatty tissue, the liver rebuilds itself, the blood is cleansed of its impurities, and the chemical balance in the brain is gradually restored.
If the alcoholic continues to drink and if scar tissue begins to form, however, the blood vessels will be gradually choked off and the liver cells will sicken and die until the formerly mighty and complex factory of the liver is reduced to a decrepit, fragile structure clogged with poisons, wastes, and dead cells and incapable of sustaining life.
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