Alcohol abuse is an issue of growing concern as it is a major cause of death in the United States. In 2000, alcohol abuse and its related disorders were evaluated as the 12th leading cause of death. Alcohol is known to affect the largest organ in the human body, the liver.
The function of the liver is to store vital energy and nutrients, manufacture proteins and enzymes necessary for good health, protect the body from disease and break down or metabolize harmful toxins, like alcohol, from the body. Being the key organ responsible for the metabolism of alcohol, it is especially susceptible to alcohol related injury.
The term alcoholic liver disease or ALD includes three conditions; fatty liver, alcoholic hepatitis and cirrhosis. Fatty liver, also known as steatosis may be a consequence of excessive drinking for a few days. This signifies the first stage of alcoholic liver disease and is marked by an extra build up of fat inside the liver cells. However, this condition can be rectified by abstinence from alcohol. The second disorder, alcohol hepatitis is a more severe condition caused by heavy drinking for longer periods of time. It leads to the inflammation of the liver and unless precautions are taken in due course of time, this inflammation eventually leads to alcoholic cirrhosis. During cirrhosis, the healthy liver cells are replaced by scar tissue, which inhibits the liver to perform its vital functions. It has been observed that women are at higher risk than men for developing cirrhosis. This vulnerability is a result of the differences in the way alcohol is absorbed and broken down in the body of a man versus a woman.
The diagnosis of alcoholic liver diseases is a challenge in itself as most patients of alcohol abuse are in denial. However, a history of heavy intake of alcohol accompanied by certain physical signs and positive laboratory tests are the best indicators of the disease. The laboratory tests involve three liver enzymes; aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma–glutamyltransferase (GGT). These hepatic enzymes are protein molecules acting as catalysts that regulate metabolism within cells. AST is found in large amounts in hepatocyte and in lesser quantity in circulation due to hepatic growth and repair. AST has a circulatory half-life of approximately 12 to 24 hours. Thus, its level rises in response to hepatic damage but normalizes quickly once damage ceases. ALT is more specific to the liver with limited concentration in other organs. This enzyme has a longer half-life of 37 to 57 hours. Due to this, the increase in its level persists longer after hepatic damage has ceased. ALT is seen to rise drastically in hepatitis caused by infection or inflammation. GGT is present in many organs and shows an increase in its normal level by alcohol abuse and other drugs as well.
Alcohol abuse in terms of liver disease is indicated in the levels of these liver enzymes. More than 80 percent alcoholic liver disease patients show AST levels twice more that of ALT. An elevated level of the liver enzyme GGT is another gauge of heavy alcohol use and liver injury. In fact, it is believed that out of the three enzymes, GGT is the best indicator of excessive alcohol consumption.
Once the condition of the liver is revealed by testing of hepatic enzymes, the treatment may commence. Any liver disease calls for changes in one’s lifestyle marked by reduction in the consumption of alcohol, cigarette smoking and obesity. Nutritional therapy, pharmacological therapy and liver transplantation are the other possible remedies. Of course as they say, prevention is always better than cure. Therefore, it is prudent to enjoy drinking within safe limits.
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