Fatty liver (steatosis) is the initial and most common consequence of excessive alcohol ingestion. It is potentially reversible. Fatty liver is the accumulation of fat as large droplets of triglyceride. The liver usually enlarges.
Alcoholic hepatitis (steatohepatitis) is a combination of fatty liver, diffuse liver inflammation, and liver necrosis (often focal), all in various degrees of severity. Cirrhosis may be present as well.
Cirrhosis is advanced liver disease characterized by extensive fibrosis that disrupts the normal liver architecture. The amount of fat present varies. Alcoholic hepatitis may coexist.
Iron accumulation in the liver occurs in up to 10% of alcoholics with normal, fatty, or cirrhotic livers. Accumulation is not predicted by iron intake or body iron stores.
Symptoms and Signs
Symptoms match the stage and severity of disease. Symptoms generally become apparent in patients during their 30s; severe problems appear about a decade later.
Fatty liver usually causes no symptoms. In 1⁄3 of patients, the liver is enlarged, smooth, and occasionally tender.
Alcoholic hepatitis ranges from a mild, reversible illness to a life-threatening disease. In moderate cases, patients usually are malnourished and present with fatigue, fever, jaundice, right upper quadrant pain and tenderness. Their condition often deteriorates in the first few weeks of hospitalization.
Severe cases may involve jaundice, ascites, hypoglycemia, electrolyte abnormalities, hepatic insufficiency. Cirrhosis may cause symptoms ranging from minimal to those of alcoholic hepatitis or the complications of end-stage liver disease.
Commonly, portal hypertension (often with esophageal varices and upper GI bleeding, ascites, portal-systemic encephalopathy)
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