Alcoholic liver disease (ALD) is a spectrum of liver injury caused by long-term excessive alcohol consumption. It progresses from simple steatosis to alcoholic hepatitis, fibrosis, and ultimately cirrhosis. Symptoms vary depending on the stage of liver damage.
In the early stage—alcoholic fatty liver—most patients have no obvious symptoms. Some may feel mild fatigue or a sense of heaviness in the right upper abdomen, and physical examination may reveal a slightly enlarged, soft liver without tenderness .
When the disease progresses to alcoholic hepatitis, symptoms become more prominent. Patients often develop jaundice, which is the yellowing of the skin and sclera due to bilirubin accumulation. Other common symptoms include loss of appetite, nausea, vomiting, low-grade fever, fatigue, and tenderness in the upper right quadrant of the abdomen. In severe cases, complications such as ascites (fluid buildup in the abdomen), hepatic encephalopathy (confusion or altered behavior due to toxin buildup), and even liver or kidney failure may occur .
In the cirrhotic stage, patients may present with signs of chronic liver disease and portal hypertension, such as spider angiomas, palmar erythema, gynecomastia, splenomegaly, ascites, and esophageal varices. Additional symptoms include weight loss, muscle wasting, and endocrine disturbances like testicular atrophy in men. Laboratory findings often show elevated AST and ALT levels (typically with an AST/ALT ratio ≥2), hyperbilirubinemia, prolonged prothrombin time, hypoalbuminemia, and thrombocytopenia .
Summary Table: Symptoms and Manifestations of Alcoholic Liver Disease by Stage
| Stage | Common Symptoms | Physical Signs | Possible Complications |
|---|---|---|---|
| Alcoholic fatty liver | Often asymptomatic; mild fatigue | Slight hepatomegaly, soft liver | Reversible with abstinence |
| Alcoholic hepatitis | Jaundice, nausea, vomiting, fever, fatigue, anorexia | Tender hepatomegaly, low-grade fever | Ascites, encephalopathy, liver failure |
| Alcoholic cirrhosis | Weight loss, pruritus, bleeding tendency | Spider angiomas, ascites, splenomegaly, gynecomastia | Variceal bleeding, hepatorenal syndrome, hepatic encephalopathy, liver cancer |