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Q. Whilst we are talking of liver disorders, who not mention the long-term effects of alcohol on the liver?

A. A good idea, especially as alcohol intake is increasing in Australia and serious liver diseases causing considerable health impairment are also on the upswing.

Q. How much alcohol is needed to produce serious liver damage?

A. It varies, and women are more susceptible to the adverse effects. Severe liver damage may result after ten years (sooner in females), where there has been a daily consumption in excess of 100 g. In practical terms this is roughly equivalent to ten 300 ml (10 oz) glasses of beer, 960 ml (32 oz) of wine or 10 to 13 oz of distilled spirits. About 10 per cent of alcoholics develop cirrhosis, severe liver destruction, but less severe damage is common. All degrees of liver damage occur, from a simple kind called fatty liver, to an acute alcoholic hepatitis, to cirrhosis.

Q. What symptoms take place?

A. In the early stages there may be few if any. A fatty liver tends to enlarge in size. Alcoholic hepatitis may show up as vomiting, diarrhoea, a fever with an enlarged, tender liver, probably felt in the upper left side of the abdomen as it juts down under the ribs. It is much like Hepatitis A. In cirrhosis, it depends on the extent and the capacity of the liver to cope. The liver is enlarged and the surface covered with hard, raised nodules of fibrous tissue indicating the liver cells are destroyed. General health deteriorates, there is fatigue and weight loss. Blood vessels on the skin of the face, arms and trunk appear, the palms become red, body hair decreases, the testes decrease in size and the breasts often develop lumps called gynaecomastia. Fluid may accumulate in the abdominal cavity. Drowsiness occurs.

As greater pressure is exerted on the blood vessels taking blood to the liver, this backs up, and swollen vessels called varices may occur in the oesophagus. These may haemorrhage causing life endangering bleeding. As the brain is gradually affected, mental confusion, slurred speech, shaky hands may occur which may lead on to coma.

Q. This all sounds a gloomy story. Is there treatment?

A. If the patient immediately stops taking alcohol, many cases show an amazing comeback in general health. This is often very difficult and convincing a patient of his health needs, whilst accepted, is often difficult to police. Psychiatric assessment is often necessary. This plus medical treatment under expert guidance can often provide a great deal of help.

Q. What are the current views on drugs and liver damage?

A. Quite apart from alcohol causing destruction of the liver cells, many known drugs if taken in large quantities may similarly produce adverse effects. Many doctor-prescribed drugs, if given in overdose, may cause serious liver disease. The more of the drug that is taken, the greater the degree of liver damage. The range is extensive, including the tetracyclines, corticosteroids, paracetamol (a drug commonly taken in overdose), salicylates, anabolic steroids (often taken by athletes to increase their muscularity), methotrexate (an anti-cancer drug). Many other drugs, in certain individuals, may also damage the liver in certain cases. Fortunately, in view of the enormous amounts of medicinal drugs taken, the adverse liver effects are relatively numerically small.

Q. Is liver cancer common?

A. Cancer which arises primarily in the liver is uncommon, except in some African and Asian countries where Hepatitis B is endemic, and this seems to predispose to it. In western lands, it may follow on from Hepatitis B infection but is much less common.

The liver is a very common site for metastases or secondary cancers which spread there “from another primary source.

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