saudigastro.com/patients/alcohol-related-liver-disease
Category
Serious
Red flags
6
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Alcohol-related liver disease (ARLD) is damage to the liver caused by alcohol. It includes alcoholic fatty liver (fat building up in liver cells), alcoholic hepatitis (inflammation, which can be severe), and cirrhosis (permanent scarring that stops the liver working well). A person may have more than one stage at once. This is a medical condition, and seeking help is a sign of strength.
How common is it?
The risk rises with the amount and length of drinking. Not everyone who drinks heavily develops advanced liver disease, and some people are affected at lower levels of drinking than others. Women are generally more vulnerable than men. Obesity, diabetes and other liver diseases such as hepatitis B or C increase the damage.
Why does it happen?
The liver breaks down alcohol, and in the process makes harmful by-products that injure liver cells and cause inflammation. Over years, repeated injury leads to scar tissue. Genetics, nutrition and other conditions affect who is most at risk. Safe limits are hard to define for an individual, and for people with liver disease, no alcohol is the safest choice.
Symptoms
- Often no symptoms in early stages
- Tiredness, weakness and loss of appetite
- Nausea, weight loss and muscle wasting
- Pain or discomfort in the upper right abdomen
- Jaundice (yellow skin and eyes), dark urine
- Swollen abdomen or legs from fluid
- Easy bruising or bleeding
Red flags — seek urgent medical care
Vomiting blood or passing black stools
Possible bleeding from swollen veins. Go to the emergency department now.
Confusion, drowsiness, shaking hands or trouble thinking
Could be hepatic encephalopathy (brain effect of liver failure). Emergency care is needed.
Seizures, hallucinations, severe shaking or sweating after stopping drinking
Alcohol withdrawal can be dangerous. Do not stop suddenly alone if you drink heavily; get medical help or go to the emergency department.
Fever with abdominal pain or a rapidly swelling belly
May be infection of the abdominal fluid. Seek urgent care.
Worsening jaundice with fever and weakness
May be severe alcoholic hepatitis, which needs hospital care.
Thoughts of harming yourself
Seek help immediately from emergency services or a trusted person.
How is it diagnosed?
The doctor asks about drinking in a non-judgmental way, as honest answers lead to better care. Blood tests check liver enzymes, bilirubin, clotting and blood counts. Ultrasound or other scans look at the liver, and FibroScan or blood scores estimate scarring. Other causes of liver disease, such as viral hepatitis, are excluded. A liver biopsy is sometimes needed.
Outlook — what to expect
Stopping alcohol is the single most important step. Fatty liver can often recover fully, and inflammation and early scarring can improve. Even with cirrhosis, stopping alcohol improves survival and lowers the chance of complications. Continued drinking carries the risk of liver failure. Support for stopping, including medical and counselling services, makes success more likely.
Treatment
Habits & Lifestyle
Stopping alcohol is the key treatment. Heavy drinkers should get medical advice before stopping, because withdrawal can be dangerous.
- Tell your doctor honestly how much you drink so withdrawal can be managed safely
- Ask for counselling, support groups or addiction services
- Involve family or a trusted friend for support
- Stop smoking and keep a healthy weight
- Get vaccinated against hepatitis A and B as advised
Diet
Good nutrition matters because liver disease and alcohol often cause malnutrition.
- Eat regular meals, including a bedtime snack if your doctor advises
- Eat enough protein; do not cut protein unless your doctor tells you to
- Reduce salt if you have fluid build-up
- Ask about vitamin supplements; deficiencies are common
- Avoid raw shellfish in advanced disease
Medications
Medicines are chosen by your doctor, depending on the stage of disease.
- Medicines can help with alcohol withdrawal and cravings under medical supervision
- Severe alcoholic hepatitis may be treated in hospital, sometimes with steroids, if suitable
- Water tablets (diuretics) and other medicines for fluid, bleeding risk or confusion in cirrhosis
- Check with your doctor before taking painkillers or herbal products
Procedures & Surgery
Procedures are used for complications and for monitoring.
- Endoscopy to look for and treat swollen veins at risk of bleeding
- Draining abdominal fluid (paracentesis) when it causes discomfort or needs testing
- Ultrasound surveillance for liver cancer if you have cirrhosis
- Liver transplant assessment may be considered in selected people with advanced disease
Living with the condition
- Relapse can happen; it is not a failure. Contact your care team early
- Support from family and counselling improves long-term success
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- What stage of liver disease do I have?
- Can my liver recover if I stop drinking?
- How can I stop safely, and what support is available?
- Which tests and scans do I need and how often?
- Which medicines and supplements are safe for me?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide