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Liver damage, alcoholic

Alcoholic liver damage(alcohol-toxic liver disease): Progressive damage to the liver cells as a result of years of alcohol consumption, mostly in the context of alcohol dependence. Typically, alcoholic fatty liver disease occurs initially, followed by alcohol-related cirrhosis of the liver with continued heavy consumption of alcohol. The main complaints are a feeling of pressure in the upper abdomen, fatigue, poor performance; but all complaints can also be absent. If a fatty liver already exists, alcohol or fatty liver hepatitis can occur as a secondary disease. The most important therapy principle for alcoholic liver damage is the immediate and complete renunciation of alcohol.

Leading complaints

With fatty liver

  • Often no symptoms
  • Sometimes upper abdominal discomfort, e.g. B. slight feeling of pressure

For fatty liver hepatitis

  • Upper abdominal pain
  • Jaundice, fever
  • Nausea, loss of appetite, weight loss
  • Ascites
  • Impaired consciousness
  • With cirrhosis of the liver
  • Jaundice, weight loss, tiredness (see cirrhosis of the liver)
  • Impaired consciousness
  • Vomiting blood.

When to the doctor

Immediately at

  • Vomiting blood, impaired consciousness

In the next few days if

  • symptoms mentioned above occur
  • the person concerned notices that he has got used to regular alcohol consumption and can no longer take countermeasures on his own.
  • a decrease in performance, constant feeling of pressure in the upper abdomen and yellowish discoloration of the skin are observed.
  • the CAGE test shows that the person has an alcohol problem.

The illness

Disease emergence

Regular alcohol consumption changes the liver metabolism: The substances produced during alcohol breakdown, such as acetaldehyde, damage the liver cells and lead to fatty liver formation (reduced fat breakdown, increased fatty acid production) and then to connective tissue shrinkage of the liver (cirrhosis) after years of intensive alcohol consumption. As Threshold dose for triggering this liver damage For healthy women, the amount of 20 g of alcohol per day, corresponding to 0.2 l of wine or 0.5 l of beer; for men the threshold dose is twice as high.

Note: Alcohol not only damages the liver, but also the brain. Men who drink 110 to 170 g of pure alcohol per week (e.g. 5–7 bottles of beer) are 2–3 times more likely than abstainers to have their brains shrinking. That concerns v. a. the hippocampus, i.e. the area that is responsible for memory and spatial orientation. Recommendations for risk-free alcohol consumption are therefore lower than the threshold dose for alcohol-toxic liver damage. As risk-free threshold dose 10–12 g of pure alcohol per day apply for healthy, non-pregnant women and 20–24 g for men.

There is so much alcohol in it: 10 to 12 g of alcohol correspond to approx

  • 0.25 l beer (5 vol%)
  • 0.1 l wine / sparkling wine (11 vol%)
  • 0.2 l long drink with 4 cl vodka (38% vol)
  • 0.04 l spirit (38 vol%)

Risk factors

Obesity, some lipid metabolism disorders and diabetes also lead to fatty liver disease. In addition, they significantly reduce the threshold dose, i. H. these diseases make the liver even more sensitive to alcohol.

Complication: alcoholic hepatitis or fatty liver hepatitis

If someone is already suffering from fatty liver, the further destruction of the liver cells often leads to fatty liver hepatitis (Alcohol hepatitis) There are two forms:

  • Chronic-active fatty liver hepatitis is the severe form of fatty liver hepatitis; it was also called the chronic-aggressive form in the past. It is often dramatic and acute with vomiting of blood, rapid development of unconsciousness due to liver failure and kidney failure. 30% of the patients die.
  • In other people, on the other hand, the disease is quite inconspicuous as chronic, persistent fatty liver hepatitis. Sometimes jaundice occurs. Cirrhosis of the liver, which develops with continued alcohol abuse, also goes on for a long time without symptoms in many people.

Diagnostic assurance

As with other liver diseases, the diagnosis of alcohol-toxic liver damage is made through clinical examination, blood tests, and imaging tests such as ultrasound. If in doubt, the doctor will also perform a liver puncture including a biopsy and have the tissue examined.

Typical findings in Fatty liver are:

  • Physical Exam: Soft, enlarged liver
  • Blood values:
    • increased gamma GT
    • increased iron storage level ferritin
    • enlarged red blood cells (MCV)
    • CDT (carbohydrate-deficient transferrin as an expression of alcohol abuse)
  • Ultrasound: typically bright (hyperechoic) liver tissue (lighter than the tissue of the kidney)
  • Typical findings in Fatty liver hepatitis
  • Physical Exam: Enlarged, tender liver
  • Blood values:
  • Ultrasound: light (hyperechoic) tissue as in fatty liver
  • Typical findings in cirrhosis of the liver see there.

Diagnosing Problem Alcohol Use - CAGE Test

Based on the CAGE tests is easy to tell if you have a drinking problem. If you answered yes to more than two of the following questions, you are likely to be addicted to alcohol:

  • C: Question about reducing consumption (Cut down): Have you ever felt that you should reduce your alcohol consumption?
  • A: Ask about excitement (Annoyed): Have you ever been upset when other people criticize your drinking habits?
  • G: Ask about guilt (Guilty): Have you ever had a remorse about your alcohol consumption?
  • E: Ask about a pick-me-up (Eye-opener): Have you ever drank alcohol as the first thing in the morning when you woke up to calm your nerves or to get rid of the hangover?


If the doctor determines that the liver is fatty, he urges you to give up alcohol immediately and permanently. If the patient is already addicted to alcohol, usually only withdrawal with subsequent long-term therapy will help (see alcohol addiction).

In addition to avoiding alcohol, the doctor recommends careful weight reduction, plenty of exercise and a high-fiber, low-fat diet if you are overweight. Regular liver tests and ultrasound examinations of the liver are important in order to detect any progression of obesity at an early stage.

Treatment of cirrhosis of the liver see there.


The prognosis depends heavily on the extent of the liver damage and on whether the patient can change their drinking habits. In the case of fatty liver and fatty liver hepatitis, the liver can regain its functionality by completely avoiding alcohol. In the case of connective tissue remodeling processes, the prognosis is worse (see cirrhosis of the liver).

Your pharmacy recommends

There are numerous offers of help for people with alcohol problems on the way to a life without alcohol. One of the best-known and oldest self-help groups are the Alcoholics Anonymous, which were founded in the USA in 1936 and are now represented in every major city in Germany. Alcoholics Anonymous assumes that the "drinker" will remain addicted and endangered by alcohol for life. It is also believed that alcohol is stronger than willpower, that it is difficult to get rid of on your own, and that only alcoholics can help other alcoholics. Only drinkers, no healthy "helpers" are accepted. The concept also includes the principle of taking small steps with the help of a 12-step program so as not to overwhelm those affected.

Church organizations and health authorities also offer support groups and hotline helplines, as well as associations such as the Guttempler or the Blue Cross.

Further information

Website with offers of help including telephone numbers, e.g. B. the nationwide addiction and drug hotline, the telephone counseling and the information phone for addiction prevention of the BZgA at

Internet offer of the Blue Cross:


Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 14:20

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.