— AGOA

Dear AGOA,

Unfortunately for your grandmother, long-term alcohol use is known to have a damaging affect on the liver. For someone who drinks alcohol in excess, the following factors may increase the chances of developing liver damage:

• Being female. Females develop alcoholic hepatitis (hepatitis = inflammation of the liver) 2-3 times more often than males.
• Advanced age.
• Genetic factors (like a family history of liver problems) can increase someone's risk of liver disease.
• Obesity can make liver problems worse.
• Chronic alcoholics tend to replace calories from foods/nutrients with calories from alcohol and they can develop malnutrition and associated risks and problems.
• Having other diseases like diabetes or hemochromatosis (iron overload) may compound liver troubles.

Because the liver fulfills so many responsibilities within the body, liver damage can have a wide range of effects. Signs and symptoms of liver damage include:

• Loss of appetite.
• Nausea and vomiting, sometimes with blood.
• Fever.
• Mental confusion.
• Fatigue.
• Yellowing of the skin and whites of the eyes (also known as Jaundice).
• Abdominal pain/tenderness (because the liver will become enlarged and feel sensitive).
• Abdominal swelling due to fluid accumulation (also known as Ascites).

There are over 100 different liver diseases with a wide range of factors that cause them (including viral infections, drugs/alcohol, and environmental toxins). When someone's liver enzymes are elevated, this can indicate to a health care professional that that person may have some type of liver disease. Blood tests are commonly used to assess the level of different liver enzymes (gamma-glutamyltransferase, aspartate aminotransferase, and alanine aminotransferase). It sounds like this is the point where your grandmother is; she had a blood test and does not know what type of liver problem she may have.

Since you said the liver problem is from long-term drinking, your grandmother may have some degree of alcoholic hepatitis. This is a condition where the liver is inflamed and this inflammation can negatively impact the liver's ability to function properly. If the person continues to drink and if the alcoholic hepatitis goes untreated, it can progress into cirrhosis of the liver (an irreversible condition where scar tissue replaces normal liver tissue). This scar tissue cannot perform liver functions and the more scar tissue there is, the more difficulty the liver will have performing its normal functions. When the damage from cirrhosis becomes so severe that liver function is seriously impaired, a liver transplant may be the only option.

Happily, damage from alcoholic hepatitis can often be reversed if the person stops drinking alcohol. But, your grandmother has to make that decision for herself as she is ultimately the only one in control of her own body and her behaviors. If the moment feels right, you can sincerely tell your grandmother that you are concerned for her health and you can mention that you think the best thing for her liver would be for her to avoid or limit her alcohol consumption before the liver damage progresses to cirrhosis. If you are still concerned you may want to see a counselor to help deal with these strong feelings. If you are at Columbia, you may call Counseling and Psychological Services at x4-2878 to speak with someone about helping your grandmother and taking care of yourself.

Of course, your grandmother may be diagnosed with a different type of liver problem unrelated to alcohol. If this is the case her health care provider will give her suggestions of actions she can take to improve her health. You can support your grandmother by encouraging any efforts she takes to improve her liver and her health.

Best wishes for your grandmother.

Alice

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