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What happens to your liver as a result of drinking

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What is my liver and what does it do?

The liver is the largest organ in the body and lies under your ribs on the right hand side. If the liver fails completely then death within 3-4 days is inevitable unless a new liver is transplanted - there is no such thing as an artificial liver. The liver produces proteins and energy from food. The liver detoxifies waste products and drugs so that they can be excreted safely.

If the body were a country, the liver would be the manufacturing industry, the food industry, the waste disposal industry, and the petro-chemical industry. In other words it's quite important.The liver has a lot of spare capacity and so when it starts to go wrong nothing is noticed until things are really bad.

The liver doesn't have any pain nerves in it, and so liver disease normally does not cause pain.

If you are regularly drinking more than 3-4 units a day, then it is quite likely that you will have developed a fatty liver. If you are regularly drinking more than 5-6 units a day (30-40 units / week) then you will almost certainly have a fatty liver, and may well develop more serious liver problems over time.

Fatty liver

The best way to explain about fatty liver is to show you some pictures. On the top / left below is what a normal liver looks like under the microscope. When you drink too much each individual liver cell develops a little ball of fat inside it. On the bottom / right is a fatty liver under the microscope - the white holes are the fat. If you drink really heavily for more than a few weeks the chances are that your liver will look like this.

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Fatty liver is not in itself a massive problem, if you stop drinking or cut down to safe levels then the fat will go away. There are also other causes of fatty liver for example obese people may also have fatty livers, and some people with diabetes can develop fat in the liver although when the diabetes is well controlled it usually goes away. If you have more than one risk factor for a fatty liver, then you chances of developing more serious liver disease will go up. So for example if you overweight or have diabetes, then you should aim to drink less alcohol.

Many people will be familiar with Pate de Fois Gras. It is made by force-feeding geese to eat maize by putting a funnel down their throats. In french Foie = liver, and Gras = fat and if you looked at a fresh piece of fois gras through the microscope it would look exactly like the picture on the right.

The problem with a fatty liver is that over a long period of time the liver becomes scarred when this is really bad we call this scarring, cirrhosis. The DRINKULATOR can tell you what your risk of liver disease is, and will give you specific advice about what, if anything, you need to do about it.

Liver scarring and cirrhosis

Probably the best way to explain about liver scarring is to show you some more pictures.

Although it doesn't look like it, the liver has a sort of tiny skeleton that can be seen under the microscope. On the top / left is a close up picture of a normal liver skeleton under the microscope - the black lines are the skeleton, and between them lie the liver cells. When the liver becomes scarred the skeleton becomes much thicker, squeezing the liver cells until they can no longer work properly. On the bottom / right is a picture of a scarred liver

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You can see that the liver skeleton is much thicker and is starting to squeeze the liver cells. This degree of damage can develop after as little as 2 or 3 years of very heavy drinking (8 or more units daily), or after 10 or so years of moderately heavy drinking (5 or 6 units daily). At this stage if the patient stops drinking or even cuts down to safe levels of alcohol intake then the liver may be able to keep working.

If the drinking continues then after a few more years the liver looks like this.

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The circles have been drawn around the tiny bits of liver that can still work - the rest is just scar tissue. When the liver gets to this stage there is very little that can be done short of a liver transplant.

Am I likely to develop cirrhosis?

Not everyone who drinks too much will develop cirrhosis; in fact only about a third of even really heavy alcoholics will develop cirrhosis. The reason for this is the same reason that not everyone who smokes will develop cancer or heart disease only around half.

It's something to do with your genes.

If you drink around 5 or 6 units of alcohol (two to three pints of lager) each day for around ten years then your chances of developing cirrhosis double. By the time you are drinking around 8 units every day (1 bottle of wine, or 3 pints of Stella each day) then your chances of developing cirrhosis go up ten times. Approximately 1 in every 20 people in the UK is currently drinking at this level, and about half of them are likely to get serious liver problems at some stage.

Liver disease isn't rare - it is incredibly common, but for some reason people do not seem to be aware of it. The newspapers and magazines never write about liver disease, you never see it on the TV, there are no big liver disease charities - because people will not give money for research into liver disease.

Why is this? Well it seems that as a nation we all love to have a drink, but we don't seem to tolerate anyone who "cannot hold their drink". This even seems to include people who get alcohol related health problems.

The Government is the same - they take 15 billion each year in alcohol taxation, and give back 50 million to treat alcohol related problems. In comparison the budget for illegal drugs is 1200 million, but for every single UK death from drugs there are 28 UK deaths from alcohol (2001 figures).

Since we first wrote this some years ago the newspapers and magazines have written quite a lot about liver disease and alcohol, the civil servants within the Dept of Health are aware of the problem, as is the National Audit Office and many other official bodies. The problem seems to lie with our elected politicians - who at the time of writing have effectively still done absolutely nothing (June 2009).

How can I tell if my liver is damaged?

The answer is that you can't. There are no signs or symptoms of liver scarring until the scarring is so bad that the liver stops working.

In particular:

There is no pain and you will usually feel completely OK even if your liver is developing bad scarring.

The only way that you find out if you are damaging the liver is by tests from the doctor.

If you or any of your friends and relatives are regularly drinking more than 4 or 5 units of alcohol a day (half a bottle of wine, or 2 to 3 pints of lager) then they should either cut down or discuss this with their family doctor.

What will my doctor do?

Your doctor will ask you a series of questions about your life and how much you have been drinking, will examine your tummy and look in your eyes. If the doctor thinks that you have been drinking enough to put your liver at risk then she will probably do some blood tests and a simple liver scan. These tests will probably show if there is any really serious liver damage although they will not show the early stages of scarring.

The doctor will then discuss with you the reasons why you are drinking more than is good for health and will suggest ways that you can cut down on your drinking. If despite this the doctor remains concerned about your drinking then she will probably refer you to a liver specialist at your local hospital. The liver specialist will have access to better tests of the liver and will be able to tell you if you are really into a problem with liver scarring before it is too late.