Excessive alcohol use has consequences for nearly every part of the body, and one of the most crucial organs affected is the liver. Chronic excessive alcohol use is the single most important cause of illness and death from liver disease (alcoholic hepatitis and cirrhosis).

Liver diseases claim about 25,000 Americans each year, making these conditions the country's 11th-leading cause of death. Preventing liver disease is the focus of Liver Awareness Month, sponsored by the American Liver Foundation throughout October.

Liver function is essential to life. The liver filters our blood, removing and destroying toxic substances, secretes bile into the small intestine to help digest and absorb fats, and is involved in many metabolic processes of the body.

While alcohol is a major nemesis of the liver, it is one of many causes of more than 100 liver diseases. Viruses, genetic defects, and reactions to chemicals can also promote liver damage. Other causes are under investigation.

It is not known exactly how alcohol leads to liver disease. At one time, researchers thought that the poor nutrition common to heavy drinkers was the main factor in alcoholic liver cirrhosis. But now we know that alcohol can be toxic to the liver even when a drinker's nutrition is adequate.

Alcohol abuse generally leads to three pathologically distinct liver diseases -- fatty liver, hepatitis, and cirrhosis, notes Howard J. Worman, MD, an expert on liver disease from the College of Physicians and Surgeons at Columbia University in New York City. Traditionally, the three have been considered sequentially related, progressing from fatty liver to hepatitis to cirrhosis. However, alcoholics may progress to cirrhosis without passing through any visible signs of hepatitis.

Fatty liver is the earliest stage of alcohol-induced liver disease. Anyone who drinks heavily for a few days can develop the defining sign of this condition -- liver cells that swell with fat globules and water. Fatty liver caused by excessive alcohol use is reversible with abstinence.

With alcoholic hepatitis, the liver becomes inflamed, often leading to fever, loss of appetite, nausea, vomiting, abdominal pain, and jaundice. Some people with alcoholic hepatitis experience mental confusion as well. In people who've had previous liver damage, alcoholic hepatitis can be fatal. It is reversible if the patient stops drinking.

Cirrhosis is the most advanced form of liver disease. It permanently damages liver cells, replacing those cells with scar tissue. When this happens, the liver cannot carry out its normal functions. Among Americans, the leading cause of liver cirrhosis remains alcohol abuse.

Despite the life-threatening nature of cirrhosis, this disease can run silent at first and even evade blood tests. "Some patients with cirrhosis, especially early in the course of the disease, will have no overt clinical signs or symptoms," says Worman. As cell destruction and scar tissue increase, however, symptoms can include nausea, jaundice, vomiting of blood, abdominal swelling, increased drug sensitivity, and coma.

In general, patients with alcoholic liver cirrhosis have been drinking heavily for 10 to 20 years, according to the Eighth Special Report to the U.S. Congress on Alcohol. About 90 percent of heavy alcohol users develop fatty liver, 40 percent have signs of alcoholic hepatitis, and 15 to 30 percent develop liver cirrhosis.

"Abstinence from alcohol is the single most important component of treatment for alcoholic liver disease," said Enoch Gordis, MD, former director of the National Institute on Alcohol Abuse and Alcoholism. Controlling diet to correct for vitamin deficiencies is another form of treatment. When a drinker becomes terminally ill with cirrhosis, then a liver transplant is the only treatment.

"Because many alcohol abusers and most alcoholics require some form of treatment to remain abstinent, simply giving advice to quit drinking often is not sufficient," said Gordis. "Physicians who choose not to manage their patients alcohol problems may refer these patients to specialized alcohol treatment providers for evaluation and appropriate treatment. Physicians should keep informed of their patients progress, as relapse may further complicate management of the alcoholic liver disease."

For more information on preventing and treating liver disease, contact the American Liver Foundation, 1425 Pompton Avenue, Cedar Grove, NJ 07009; (800) 465-4837; http://www.liverfoundation.org/.

--Published October 16, 1998