Alcoholic Liver Disease

I'm new here, and I was hoping some of you can help me in understanding alcoholic liver disease. My husband had a biopsy done last month, we went to the follow up last week. My husband's hepatologist knows he's an alcoholic, and when we went to the follow up, he asked my husband if he drank the previous night. Husband said yes. Told us he had alcoholic liver disease according to biopsy, abstain from alcohol, eat right and exercise. Said they found diffuse (lots of) macrovesicular and microvesicular fat and pericentral and pericellular fibrosis but no cirrhosis. I asked what stage of ALD was he at. Dr. said there are no stages to ALD, I said yes there are: alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis, dr. said ALD is a broad spectrum and it is what it is. Hubby kept asking if he could drink alcohol twice a week, dr. said that shouldn't be a problem. If anyone could help me understand what stage he is at, or what complications may develop (which the dr. also didn't say), I would really appreciate it. Thanks again in advance.

[cantlivenotknowing]

I would be very careful with drinking at all with ALD. While functionally, your husbands liver may be doing it's job, by the very fact that he is an alcoholic it is likely that he would drink heavily even if it is only 2 nights a week. Once he starts, he probably wouldn't stop until he had his fill, which is when he is ready for his head hit the pillow. Fibrosis is progressive if the insult continues. It can regress to normal tissue if given a break from the insult. He is now living with 2 chronic diseases both which casue the other to degenerate. This is what I mean : When an alcoholic gets fibrosis, their liver is not able to process alcohol as well, therefore the alcohol that hits their brain cells is more concentrated, thus the addiction grows stronger as the liver is able to process less and less. A bad liver as it continues to deteriorate causes al sorts of problems including deep depression because it doesn't produce as many of the good things it is supposed to, so then the depression leads to more drinking which leads to ...... death. He needs to go to a treatment program or AA and stop drinking if he wants to live. These 2 disease are deadly and together catastrophic.

[Kalio1]

The situation is progressive and once fibrosis begins it progresses faster, it's a slippery slope into a worse and worse health situation.He needs to stop drinking and get some support with that if he can't "just stop" He is faced with a "silent killer" disease, they are like their names imply, they quietly go about the business of destroying your body and you have few or no symptoms so you think "hey, Im fine! I feel fine!" but that is temporary. As it progresses it has a whole host of problems it can cause your health. The doctor is an idiot for saying it's OK to drink twice a week! NO ONE with  liver damage should drink AT ALL, I can't believe the doctor would do such a dumb thing, especially to an alcoholic.  He also should not eat processed foods or eat a lot of sugar or animal fat and it sounds like your husband has started down the slippery slope. He also has fat in there and other not so good changes going on, he should feel truly blessed he is aware of the situation and he has some power to try to stop the progression of the fibrosis(or scarring) right nowbefore he becomes cirrhotic.Is he seeing a Heptologist? I'd have him see a good one if he hasn't already.  He has already been diagnosed, he needs to translate that into action. If he can't stop on his own, there is help. If he can't stop and you need support, AlAnon is a lifesaver. Our livers are responsible for an incredible number of functions needed to stay alive, it is an easy organ to ignore but oh so key to our survival. How are his platelets? Was his spleen enlarged?
At this point, it sounds to me like he doesn't have cirrhosis at the moment, so at this point he has a shot at improving his liver histology and hopefully avoid it progressing to cirrhosis. If he stops the booze, makes sure to lose any excess weight and eats right and gets exercise he has a fighting chance at healing his liver. As we enter mid life things start to fall apart. End stage liver disease is a horrible way to go.
Best of luck to you.

[queenteree]

Thank you cantlivenotknowing and kalio1, for taking the time to reply.  It helped me to understand better my husband's condition.  A second opinion is out of the question because 1) we went to one hepatologist last year after my husbands liver enzymes were way out of wack and that hepatologist diagnosed my husband with alcoholic liver disease (without biopsy) and told him he had two choices a) he could stop drinking all together and we'd monitor the situation or b) he could keep drinking and not bother with any of it.  Husband chose to keep drinking (said if dr. thought anything was majorly wrong, he wouldn't have said that).  As liver enzymes kept climbing, I talked hubby into going to another hepatologist (chief of hepatology), he did it only for me.  Now this dr. says drinking twice a week is OK, so hubby loves that - he always just tells me "you just want the dr. to tell me not to drink" and he's right, because it's killing him.  His platelets are low (117 on last labs -normal 150-450) and have been for 6 mos or so, and getting lower and before the biopsy dr. was concered about fibrosis/cirrhosis and portal hypertension (now he doesn't seem concerned- when I asked him what if his platelets keep going lower, he said "well, he'll bleed more" that was it!!!), his MCH was high (33.8 - range 27-33),  AST 110 (3-50 range) ALT 105 (3-60 range), GGT 285 (3-80 range).  The liver enzymes have gotten lower, which I guess is good.  I just don't get why that dr. would not tell me if it was alcoholic fatty liver or alcoholic hepatitis (fatty I believe has no complications while alcoholic hepatitis has complications).  Again, thanks for all your help.  Anything else you can add is very much appreciated.  

[cantlivenotknowing]

A couple more thoughts. When AST is elevated by almost 2x the ALT, it is usually indicative of Alcoholic Hepatitis, when it is elevated just slightly above the ALT, it is usually indicative of cirrhosis being present. AST elevations usually occur when more than just the liver cells are dying, it usually indicates a breakdown of the endothelium and vascular structures and arteries. AST in the liver is more concentrated in these types of liver tissues, so I would say the type of elevation you are seeing with that type of AST is indicative of serious damage to not only the liver cells, but also the base membranes of his veinous and artery systems in his liver. If he keeps it up, he is not long for things. This is no joke. Your husbands #'s are not good especially with the AST and GGT being what they are. He needs to stop drinking or else that vascular breakdown is going to cause portal hypertension. He is in deep trouble then. He has to learn everything he can about this disease so he knows what it does to people. I would suggest starting at www.pubmed.gov to see studies and research of what liver disease does to people. You will notice there are no success stories when people play around with this disease.  

[Kalio1]

I couldn't agree more with cantiliveknowing. It is so unfortunate you have had these doctors say such idiotic things, the last thing he needs is a doctor rubberstamping his drinking! How a doctor can diagnose a patient with alcoholic liver disease and then tell the patient it's ok to drink is beyond me.
We are all in charge of our OWN medical care and seeking out solutions when we are ill. Doctors hopefully can help us, but as you have found they aren't always helpful. He is in a dire situation and in denial and my heart goes out to you. If he doesn't make these lifestyle changes right now things are going to progress faster. I'd get some support from AlAnon and print out all the info I could find on his situation I guess and hope he reads it, what else can you do?

Has he had the Fibrosure blood test? That is a "noninvasive biopsy" that can give you more information.

[queenteree]

No, the dr. just wants to see him in 6 months, and I will not go to that appointment with him.  No sense in doing it since he thinks he is perfectly fine.  He has problems sleeping and doesn't have ambien right now, so he's been having some beer each night (5 or so cause he's "moderating") then takes two Tylenol PM's.  Where is his brain?  I caught him again last night taking them, and when I said something, he flat out lied to me and told me he didn't take them.  He says even when he does I'm making something out of nothing like I did at the liver dr. because (according to him) the liver dr. told him his liver is perfectly fine, he has no liver problems.  I am going to seek help, I have to detach like immediately!!!!  Tylenol is also bad for the liver, right?  I thought alcohol and Tylenol were a bad combination?  

[thistlegirl]

I realize that you posted over two years ago, but am wondering about your husband's status now....

I have lived my whole life without medical insurance & recently saw a doctor for the first time since I was five - for my shots (i am now 38).  I have been battling severe chronic back/muscle pain, fatigue & depression for about five years & strongly suspect that fibromyalgia is the underlying cause.  I also indulge in almost all activities i engage in, excessively -- which includes drinking, which i have done off and on since my early teens.  I was never concerned about alcoholism, per se, since excessive drinking was just par for the course re: my excessive behavior regime re: everything else.  And I was one of those who could stop anytime they wanted to (and had done so numerous times with no problems at all - for years at a time).  But when the suite of (fibromyalgic) symptoms hit - about five years ago, so did the frequency of my drinking binges,,, it provided a (temporary) refuge from my fatigue, pain and depression. first the happy high, and then the hangover -- which btw, is more pleasant than my symptoms untreated!   yeah, a hangover & its symptoms are a rather pleasant distraction.....

ANYWAY, I finally applied (and received) medicaid & saw a doctor - in hope of trying to get legitimate medication - instead of my own self-medication, so to speak... as i think i passed a line b/w voluntary alcohol use & alcohol addiction, about a year ago. ;(  doctors are notorious for discounting fibromyalgia as 'real' -- so i approached my doctor with a list of symptoms only...to see where that led her independently...

she was immediately concerned given my alcohol intake, and said i was jaundiced and had yellowing eyes.  she became even more concerned with my abdominal pain, only when she pressed and not in the liver quadrant, btw. she also noticed i had tremors, which i had attributed to coffee, not alcohol withdrawl (withdrawal)...

OK -- at this point she has every reason to believe that i *may* have liver disease, right? yet, her concern is kidney failure.  so she orders up a bunch of blood tests -- all normal.  and an upper abdomen ultrasound -- all normal.  but it may be an overly acidic stomach, so prescribes 'prevacid'.  lo and behold, a few weeks after taking prevacid, no relaxation of previous symptoms, but an onslaught of new ones.  so i stop (despite her recommendation to continue).  then a few weeks later, i am excessively sleepy (BEYOND my high fatigue), bruising like crazy, not remembering anything (although i typically remember EVERYTHING), bleeding like crazy given the tiniest of scratches, and ITCHING everywhere, and severely so!  hello?  these are all indications of liver failure!

so what now? (1) did she give me any *specific* diagnostic tests of liver failure?  i don't know! and (2) why is it only after i take the medication she prescribed, that i seem to exhibit THE diagnostic features of liver failure?

that asked, i have looked back, and i may have been suffering from liver disease for years.  granted, it is notoriously difficult to diagnose, and i have ignored possible precursors for years (at least not enough to warrant a doctor, with no insurance, no less - and oblivious to boot).  i still think that fibromyalgia is the source of most my (overt) symptoms -- and my doctor concluded that there is nothing wrong with me -based upon symptoms and her tests..

well there it is, my primary symptoms are now more inflamed... but beyond that... i could really be a poster child for liver failure. considering the recent and rapid influx and similarities of NEW symptoms.

so what then? IF i only have a few months to live -- ahem, i have a child and am a single mum!  hello?  

any thoughts? anyone?

ok, the 90 day survival rates really scared me. oh geee, if i have the BEST score on the only diagnostic test, i might expect to live at MOST 3 months?

[NoBooze60]

I know your post was months ago but I just joined today. I'm not a Doctor, I am a 49 yr old male that had a liver transplant 2 yrs ago. I went through tests for years with the same results you are getting. No Diagnosis. I believe my GI did a "Hypatic Panel" on me when he found my issue. I had Hepatitis C which gave me cirrhosis of the liver. Sorry, but I had the same symptoms you are having. There is no cure for Hep C but there are treatments if it's caught early. It's only a blood test. They may have done it already. They also did a liver biopsy. Please do something right away to get a diagnosis because time matters if it's a liver situation. My GI refered me to a liver specialist in Indianapolis at IUPUI his name is Dr.Paul Kwo. The team there saved my life. Remember that if all else fails, that could be an option! Feel free to contact me.