Hi Rintin,
I?ll answer the last part of your question first. You say the
tests your husband had run were ?lipid panel, basic metabolic panel,
ALT, UA, TSH, and PSA.?. Was an LFT, or Liver Function Tests panel
run? This would include the ALT along with an AST, ALP, Total
Bilirubin, GGT, Total protein, and Albumin. Some doctors and labs may
toss in an SEP (Serum electrophoresis) and a Protime (to detect
clotting disorders).
A relatively new test that is more specific to alcohol consumption
could be ordered, if the doctor suspected your husband had a problem
with alcohol. This test is called CDT, carbohydrate-deficient
transferrin. (There?s more about this test further on in the answer).
None of these tests are completely specific for diagnosing liver
problems, meaning one can have early liver disease that the tests may
not reveal. Considering the volume of alcohol your husband consumes,
his doctor should be apprised of this fact. You can call the doctor?s
office and ask the nurse to make a chart note to discuss alcoholism
with your husband at his next visit.
I don?t want to sound hard-nosed, but drinking 12 ounces minimum of
vodka a day, is a considerably large amount of alcohol. Twelve ounces
of vodka is comparable to 8 drinks a day, and this is classified as
heavy drinking. While some people may tolerate alcohol better than
others, this does not mean there is no systemic damage going on. (This
is covered further down in the answer too). Let?s not forget the
?other? dangers of alcohol; car accidents and their related injury,
death and expense, falls and physical injury, increased depression,
violence and aggression, the impact on family dynamics and quality of
life, and the expense of the alcohol itself.
?Most adults can drink moderate amounts of alcohol -- up to two drinks
per day for men and one drink per day for women and older people --
and avoid alcohol-related problems. (One drink equals one 12-ounce
bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5
ounces of 80-proof distilled spirits.)?? As a person ages, certain
mental and physical functions tend to decline, including vision,
hearing, and reaction time. Moreover, other physical changes
associated with aging can make older people feel "high" after drinking
fairly small amounts of alcohol. These combined factors make older
people more likely to have alcohol- related falls, automobile crashes,
and other kinds of accidents.
?In addition, older people tend to take more medicines than younger
persons, and mixing alcohol with many over-the-counter and
prescription drugs can be dangerous, even fatal. Further, many medical
conditions common to older people, including high blood pressure and
ulcers, can be worsened by drinking. Even if there is no medical
reason to avoid alcohol, older men and women should limit their intake
to one drink per day.?
http://www.medicinenet.com/alcohol_abuse_and_alcoholism/page5.htm#27whatis
It would be impossible to say your husband will or will not develop
any serious effects of his drinking. No one escapes all of the
negative effects of heavy drinking. All of the ravages of alcohol that
are included in this answer take time to develop, and may not appear
until it is too late to reverse the damage. At 55, he is gambling with
his life. I have seen thousands of patients in the hospital with
alcohol related diseases; it is a miserable way to die.
As far as high blood pressure, you are correct. Even limited
alcohol consumption can elevate blood pressure. ?Alcohol affects every
body system, causing a wide range of health problems. Some such
problems include poor nutrition, memory disorders, difficulty with
balance and walking, liver disease (including cirrhosis and
hepatitis), high blood pressure, muscle weakness (including the
heart), heart rhythm disturbances, anemia, clotting disorders,
decreased immunity to infections, gastrointestinal inflammation and
irritation, acute and chronic problems with the pancreas, low blood
sugar, high blood fat content, interference with reproductive
fertility, and weakened bones?
http://www.healthatoz.com/healthatoz/Atoz/ency/alcoholism.jsp
?People who drink alcohol excessively (over two drinks per day) have a
one and a half to two times increase in the prevalence of
hypertension. The association between alcohol and high blood pressure
is particularly noticeable when the alcohol intake exceeds 5 drinks
per day. Moreover, the connection is a dose-related phenomenon. In
other words, the more alcohol that is consumed, the stronger is the
link with hypertension.?
http://www.medicinenet.com/high_blood_pressure/page8.htm
?Even modest alcohol consumption can cause blood pressure to increase,
according to two recent studies conducted in Japan.
Dr. Noriyuki Nakanishi, from the department of social and
environmental medicine at Osaka University Graduate School of Medicine
in Japan, lead author of the first study, concluded that "Alcohol use
represents an important modifiable risk factor for hypertension."
http://alcoholism.about.com/cs/heal/a/aa020722a.htm
?Alcohol exerts a depressive effect on the brain. The blood-brain
barrier does not prevent alcohol from entering the brain, so the brain
alcohol level will quickly become equivalent to the blood alcohol
level. Alcohol's depressive effects result in difficulty walking, poor
balance, slurring of speech, and generally poor coordination
(accounting in part for the increased likelihood of injury). At higher
alcohol levels, a person's breathing and heart rate will be slowed.
Vomiting may occur, with a high risk of the vomit being breathed into
the lungs, which often results in severe problems, including the
possibility of pneumonia. Still higher alcohol levels may result in
coma and death.?
http://www.findarticles.com/p/articles/mi_g2603/is_0001/ai_2603000147
=====================
Diagnosing Alcoholism
=====================
It?s not surprising your doctor did not realize your husband has a
drinking problem.
?The great majority of alcoholics go unrecognized by physicians and
health care professionals. This is largely because of the alcoholic?s
ability to conceal the amount and frequency of drinking, denial of
problems caused by or made worse by drinking, the gradual onset of the
disease, and the body's ability to adapt to increasing alcohol
amounts.?
http://www.emedicinehealth.com/articles/18863-3.asp
?Alcohol can make some medical concerns hard for doctors to find and
treat. For example, alcohol causes changes in the heart and blood
vessels. These changes can dull pain that might be a warning sign of a
heart attack. Drinking also can make older people forgetful and
confused. These symptoms could be mistaken for signs of Alzheimer's
disease. For people with diabetes, drinking affects blood sugar
levels. Ulcers also may become worse with alcohol use.
People who drink more than a little alcohol also may be putting
themselves at risk for serious conflicts with family, friends, and
coworkers. The more heavily they drink, the greater the chance for
trouble at home, at work, with friends, and even with strangers.?
http://www.abletochangerecovery.net/alcoholism_aging.html
?Alcoholism is difficult to define, and is easily missed by
clinicians. Investigators explored the value of different screening
questions for alcoholism in 232 new patients in a university-based
primary-care unit.?
http://general-medicine.jwatch.org/cgi/content/full/1988/108/1
?Family members cannot always rely on a physician to make an initial
diagnosis. Although 15% to 30% of people who are hospitalized suffer
from alcoholism or alcohol dependence, physicians often fail to screen
for the problem. In addition, doctors themselves often cannot
recognize the symptoms. In one study, alcohol problems were detected
by the physician in less than half of patients who had them. Even when
physicians identify an alcohol problem, however, they are frequently
reluctant to confront the patient with a diagnosis that might lead to
treatment for addiction.?
http://www.reutershealth.com/wellconnected/doc56.html
(Are your husbands palms red? Many people that drink too much have red
palms, and ER doctors look for this when a patient comes in with
alcohol related problems.)
?A person is generally considered to be dependent on alcohol when they
have experienced three or more of the following symptoms during a
year:
a strong urge to drink,
difficulty controlling drinking,
physical withdrawal symptoms, such as sweating, shaking, agitation and
nausea when they try to reduce drinking,
a growing tolerance to alcohol (needing larger quantities to get the same effect),
gradual neglect of other activities,
persistent drinking even though it is obviously causing harm.
http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/alcohol_abuse.html
===================
Alcohol Tolerance:
===================
?About alcohol tolerance: even though alcohol passes through all of
our bodies the same way, drinking has very different effects on
people. Even when an individual drinks exactly the same amount of
alcohol on two different occasions, it can have different effects.
Physiologically, the following factors affect the body's response to alcohol:
Speed of consumption
Body weight
Type of beverage consumed
Whether your stomach is full or empty
Psychologically, these factors influence a person's reaction to alcohol:
Why you are drinking
Drinking history: Drinking regularly develops tolerance
Body chemistry: How rapidly the stomach empties into the small
intestine can be slowed or increased by anger, fear, stress, euphoria,
state of relaxation, etc.
Drinking environment: Think about the various environments you have
been in when drinking, when the change seemed to occur regarding
getting drunk easier, and see if there are any parallels with the
particular influences on your drinking.?
http://www.goaskalice.columbia.edu/0482.html
?In order to determine if you do have a problem, I would need to know
if there were any "red flags" present in your life. These "red flags"
are potential symptoms of alcohol abuse or dependence. A list of "red
flags" include a high alcohol tolerance (a person can drink a lot of
alcohol and not feel drunk), social and/or work problems related to
alcohol, health problems related to alcohol use, alcohol-induced
relationship problems and withdrawal symptoms, i.e., irritability,
anxiety, etc. when not drinking. There are too many red flags to list
here but if a person has more than one or two of these red flags, I
typically would suggest that they see a mental health professional for
a substance abuse evaluation.?
?Dear Dr. Wes: I have recently noticed that my tolerance for alcohol
seems higher. I can drink a whole bottle of wine over 2-3 hours and
feel perfectly sober. What is up with that? Do I just think I'm sober,
or can I really be able to handle more than I used to?
Yes, tolerance is the hallmark feature of a drinking problem in
development. Your body attempts to tolerate the amount of alcohol you
drink. The more you drink the more your body attempts to handle the
volume. However, your liver will have to work overtime. That is why
the first organ to be damaged with drinking is your liver.?
http://www.whatsdrivingyou.org/resources/ask_experts/alcohol_tolerance.html
?Developing a tolerance to alcohol is your body's way of adapting to
alcohol use. The intoxicating effect of alcohol decreases as a result
of continuous consumption. Your system adapts to alcohol very quickly,
as the fact that it has accustomed itself to alcohol is evident even
during a single occasion of intoxication. The tolerance is not
permanent; it decreases with time as you stop using alcohol or cut
down on your consumption.
Your body has several means of neutralizing the effect of alcohol. The
best known of these is metabolic tolerance, where the body aims at
neutralizing the effects of alcohol by accelerating the rate with
which it metabolizes alcohol. Metabolic tolerance slowly develops as a
result of prolonged, high-scale consumption of alcohol.
The most important means is the neural tolerance where the tolerance
of the brain and the rest of the nervous system increases. The nervous
system tries to function normally in spite of the alcohol. This is why
it will before long adapt itself to the alcohol in the body. The
intoxicating effect of alcohol decreases. Prolonged, high-scale
consumption of alcohol is not needed in order for neural tolerance to
develop: occasional, repeated drinking is enough.?
http://www.paihdelinkki.fi/english/infobank/300_a_line/314e.htm
======
Tests
======
Tests for alcohol levels in the blood are not useful for diagnosing
alcoholism because they reflect consumption at only one point in time
and not long-term usage. Certain blood tests, however may provide
biologic markers that suggest medical problems associated with
alcoholism or indications of alcohol abuse:
A test for a factor known as carbohydrate-deficient transferrin (CDT)
has been approved as a marker for heavy drinking. It can be helpful in
monitoring patients for progress towards abstinence and may also be an
indicator for a higher risk for suicide in people with alcoholism.
Gamma-glutamyltransferase (GGT). This liver enzyme is very sensitive
to alcohol and can be elevated after moderate alcohol intake and in
chronic alcoholism.
Aspartate and alanine aminotransaminases (AST,ALT) are tests for
enzymes and factors that can help identify liver damage.
Tests of testosterone levels in men with alcoholism may be low. (This
result sometimes persuades men with alcoholism to seek help.)
A mean corpuscular volume (MCV) blood test is sometimes used to
measure the size of red blood cells, which increase with alcohol use
over time.
There is quite a bit of useful information on this Reuter?s Health
page, from which I gathered the above information.
http://www.reutershealth.com/wellconnected/doc56.html
?No single laboratory test or combination of tests has been shown to
be optimal in screening for or diagnosing alcoholism. There are,
however, several tests that are useful in evaluating patients:
Carbohydrate-deficient form of transferrin (CDT), a molecule involved
in iron transport in blood. CDT is a newer test that can be used to
help in screening and diagnosis of alcoholism. It may also help in the
monitoring of patients in treatment to learn whether they have
relapsed.
Gamma-glutamyl transferase (GGT), a liver enzyme that is increased by
heavy alcohol intake
Mean corpuscular volume (MCV), which measure the size of red blood cells
The GGT result is more useful than the MCV result as a ?red flag? to
raise the suspicion that the person is drinking too much. Both of
these tests are relatively poor as either a screening or diagnostic
test because conditions other than alcohol abuse or alcoholism can
cause elevated levels.
Physical examination also may reveal signs suggestive of alcoholism,
such as evidence of injuries, a visible network of enlarged veins just
under the skin around the navel (called caput medusae), fluid in the
abdomen (ascites), yellowish-tone to the skin, decreased testicular
size in men, and poor nutritional status.?
http://www.labtestsonline.org/understanding/conditions/alcoholism-2.html
"There are very few conditions that can elevate CDT other than
excessive drinking, and those conditions are rare," said John Allen,
PhD, associate director of treatment studies at the National Institute
on Alcohol Abuse and Alcoholism.? For a CDT test to be positive, a
patient would have to consume at least 3.5 standard drinks a day --
roughly five glasses of beer or four glasses of wine -- for one to two
weeks. There is also evidence that long-time abusers who relapse will
show up positive after much less drinking. Experts say that people can
be alcoholics and drink much less than that.
http://www.ama-assn.org/amednews/2000/08/28/hlsc0828.htm
=====================================
Complications of Alcohol Consumption:
=====================================
?When drunk frequently or in large quantities, alcohol is addictive.
Doctors use a number of techniques to identify patients with drink
problems, and there are screening questions drinkers may be asked to
explore issues such as the amount and frequency of drinking, whether
it damages the drinker?s relationships, or whether they have a drink
to "get going" in the morning.
A person is generally considered to be dependent on alcohol when they
have experienced three or more of the following symptoms during a
year:
a strong urge to drink,
difficulty controlling drinking,
physical withdrawal symptoms, such as sweating, shaking, agitation and
nausea when they try to reduce drinking,
a growing tolerance to alcohol (needing larger quantities to get the same effect),
gradual neglect of other activities,
persistent drinking even though it is obviously causing harm.
Problem drinking occurs when a person is not dependent on alcohol, but
drinks enough to cause actual physical or psychological harm.
Short-term effects
Alcohol suppresses the part of the brain that controls judgement,
resulting in a loss of inhibitions. It also affects physical
co-ordination, causing blurred vision, slurred speech and loss of
balance. Drinking a very large amount at one time (binge drinking) can
lead to unconsciousness, coma, and even death. Vomiting while
unconscious can lead to death by asphyxiation (suffocation). Alcohol
is implicated in a large proportion of fatal road accidents, assaults
and incidents of domestic violence.
Long-term effects
Alcohol can be a dangerous drug. Drinking too much too often will
cause physical damage, increase the risk of getting some diseases, and
make other diseases worse. Excessive drinking over time is associated
with:
loss of brain cells,
liver failure,
irritated stomach lining and bleeding from stomach ulcers,
high blood pressure (which can lead to stroke),
certain types of cancer,
nerve damage,
heart failure,
epilepsy.
Excessive drinking has also been linked to:
vitamin deficiency,
obesity,
sexual problems,
infertility,
muscle disease,
skin problems,
inflammation of the pancreas.
http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/alcohol_abuse.html
Hangover
--------
One study found that not only does drinking cause significant
problems, but the subsequent hangover causes changes in liver
function, hormones, the heart, and mental and emotional imbalances.
?Alcohol is absorbed in the small intestine and passes directly into
the liver, where it becomes the preferred energy source. The liver,
then, is particularly endangered by alcoholism. In the liver, alcohol
converts to toxic chemicals, notably acetaldehyde, which trigger the
production of immune factors called cytokines. In large amounts, these
agents cause inflammation and tissue injury?
From the Merck Manual ?Alcohol can affect the body in so many ways
that researchers are having a hard time determining exactly what the
consequences are from drinking. It is well known, however, that
chronic consumption leads to many problems, some of them deadly.
As people age, it takes fewer drinks to become intoxicated, and organs
can be damaged by smaller amounts of alcohol than in younger people.
Also, up to one-half of the 100 most prescribed drugs for older people
react adversely with alcohol.
Alcohol abusers who require surgery also have an increased risk of
postoperative complications, including infections, bleeding,
insufficient heart and lung functions, and problems with wound
healing. Alcohol withdrawal symptoms after surgery may impose further
stress on the patient and hinder recuperation.?
Gastrointestinal Problems
Alcoholism can cause many problems in the gastrointestinal tract.
Violent vomiting can produce tears in the junction between the stomach
and esophagus. Alcoholism poses a high risk for diarrhea, hemorrhoids,
and increases the risk for ulcers, particularly in people taking the
painkillers known as nonsteroidal anti-inflammatory drugs (such as
aspirin or ibuprofen). Alcohol can contribute to serious and chronic
inflammation of the pancreas (pancreatitis) in people who are
susceptible to this condition. It can also cause inflammation of the
esophagus (esophagitis), which can lead to bleeding in heavy drinkers.
Effect on Heart Disease and Stroke
----------------------------------
Adverse Effects of Heavy Drinking. On the other hand, cardiovascular
disease is the leading cause of death in alcoholics. The following are
negative effects on the heart and circulation from high alcohol
consumption.
Evidence suggests that people who consume more than three drinks a day
have abnormal blood clotting factors.
Heavy alcohol consumption can raise blood pressure even in people with
no history of heart disease. The more alcohol someone drank, the
greater the increase in blood pressure, with binge drinkers (people
who have nine or more drinks once or twice a week) being at greatest
risk. One study found that binge drinkers had a risk for a cardiac
emergency that was two and a half times that of nondrinkers.
Heavy drinking, and particularly binge drinking, may also increase the
risk for hemorrhagic stroke (caused by bleeding in the brain).
Large doses of alcohol can trigger irregular heartbeats, which can be
dangerous in people with existing heart disease.
Alcohol abuse has also been associated with and may actually be one
cause of idiopathic dilated cardiomyopathy, a condition in which the
heart enlarges and its muscles weaken, putting the patient at risk for
heart failure.
Cancer
------
Cancer, however, is the second leading cause of death in alcoholics
(after cardiovascular disease), and alcoholics have a rate of
carcinoma 10 times higher than that of the general population. Alcohol
is probably not the direct cause of cancer, but evidence suggests that
it increase the effects of factors that can contribute to certain
cancers.
Effects on the Lung
Pneumonia. Acute alcoholism is strongly associated with very serious
pneumonia. (Chronic alcoholism also causes changes in the immune
system, although in people without any existing medical problems these
changes do not appear to be significant.)
Acute Respiratory Distress Syndrome
------------------------------------
One study indicated that intensive care patients with a history of
alcohol abuse have a significantly higher risk for developing acute
respiratory distress syndrome (ARDS) during hospitalization. ARDS is a
form of lung failure that can be fatal.
Skin, Muscle, and Bone Disorders
--------------------------------
Severe alcoholism is associated with osteoporosis (loss of bone
density), muscular deterioration, skin sores, and itching. Peripheral
neuropathy, damage to the nerves in the limbs, occurs in 5% to 15% of
people with alcoholism. Such injuries cause tingling, pain, and
numbness in the hands, feet, arms and legs.
Fatty Liver
-----------
?Fatty liver or steatosis appears to be the initial change and is the
most common response to alcohol ingestion. The liver is large; the cut
surface, yellow. The increased liver fat is derived from the diet,
from free fatty acids mobilized from adipose tissue, and from lipid
synthesized in the liver and inadequately degraded or excreted.
Alcoholic Hepatitis/Cirrhosis
-----------------------------
Alcoholic hepatitis, Alcoholic cirrhosis represents end-stage disease,
developing in 10 to 20% of those who are chronically heavy drinkers.
Patients with a fatty liver are usually asymptomatic ? meaning it
shows no sympstoms. Routine biochemical studies are often within
normal limits; GGT is often elevated. Vascular spiders and features of
hyperestrogenism and hypoandrogenism from the alcoholism per se may be
evident.
Alcoholic hepatitis can be suspected clinically, but the diagnosis
depends on examination of a biopsy sample. Cirrhosis may also be
relatively asymptomatic, have features of alcoholic hepatitis, or be
dominated by complications: portal hypertension with splenomegaly,
ascites, hepatorenal syndrome, hepatic encephalopathy, or even
hepatocellular carcinoma.?
http://www.merck.com/mrkshared/mmanual/section4/chapter40/40a.jsp
?Alcohol Metabolism. Most of the alcohol a person drinks is eventually
broken down by the liver. However, some products generated during
alcohol metabolism (e.g., acetaldehyde) are more toxic than alcohol
itself. In addition, a group of metabolic products called free
radicals can damage liver cells and promote inflammation, impairing
vital functions such as energy production. The body's natural defenses
against free radicals (e.g., antioxidants) can be inhibited by alcohol
consumption, leading to increased liver damage.
Bacteria that live in the human intestine play a key role in the
initiation of ALD. Alcohol consumption increases the passage of a
noxious bacterial product called endotoxin through the intestinal wall
into the bloodstream. Upon reaching the liver, endotoxin activates
specialized cells that monitor the blood for signs of infection. These
cells respond to the presence of endotoxin by releasing substances
called cytokines that regulate the inflammatory process.
Scar Formation. Normal scar formation is part of the wound-healing
process. Alcohol-induced cell death and inflammation can result in
scarring that distorts the liver's internal structure and impairs its
function. This scarring is the hallmark of cirrhosis. The process by
which cirrhosis develops involves the interaction of certain cytokines
and specialized liver cells (i.e., stellate cells).?
http://www.niaaa.nih.gov/publications/aa42.htm
Ulcers and Reflux
------------------
?Alcohol relaxes the lower esophageal sphincter, allowing the reflux
of stomach contents into the esophagus. It also increases the
production of stomach acid.?
http://heartburn.about.com/cs/emailcourses/qt/heartburntip16.htm
?What happens is the liver begins to harden. Scar tissue develops in
the body's largest organ which hinders its ability to filter blood.
When the scar tissue develops to a certain point, the liver can no
longer do its work.
The problem is the liver performs more than 1,500 functions for the
body, including more than 300 life-saving procedures. If the liver
stops doing its job, all kinds of health problems develop quickly and
death can come rapidly.
The liver detoxifies poisons, both those produced by the body and
those from outside; filters bacteria from the blood; regulates fat
metabolism; stores and manufactures vitamins; regulates and
manufactures cholesterol and fats; synthesizes proteins; maintains the
body's water and salt balance; secretes bile for the digestion of fat;
stores energy (in the form of glycogen) helps regulate overall body
metabolism; transforms the highly toxic ammonia (produced by exercise
and by metabolism of proteins) into urea which is eliminated in the
urine; manufactures lipoproteins for fat and cholesterol transport;
and metabolizes alcohol. If the liver stops doing any of these jobs,
or numerous others it does constantly, the result is fatal.?
http://alcoholism.about.com/cs/liver/a/aa072397.htm
?Alcoholism is a life-threatening problem that often ends in death,
particularly through liver, pancreatic, or kidney disease, internal
bleeding, brain deterioration, alcohol poisoning and suicide. As well,
alcoholism is a major contributing factor for head injuries, motor
vehicle accidents (MVA), violence and assaults, as well as a leading
cause of neurological and other medical problems (e.g., cirrhosis,
etc.).?
http://en.wikipedia.org/wiki/Alcoholism
Cancer
-------
?Two more research studies have emphasized the serious health effects
of long-term heavy drinking, from an increased risk for having
accidents to developing liver cancer.
Heavy drinking has long be associated with other liver problems, such
as cirrhosis, and now a new Italian study links heavy drinking to the
development of liver cancer.
Dr. Francesco Donato, a professor of epidemiology and public health at
the University of Brescia in Italy, studied 464 Italian men and women
diagnosed with hepatocellular carcinoma, the most common form of liver
cancer, and 824 patients with no liver damage.
Donato's researchers found that drinking more than 60 grams of alcohol
a day, equivalent to four to five glasses of wine, was associated with
an elevated risk of developing liver cancer for both men and women.
They also found that the risk of developing liver cancer was even
greater for patients They also found that the risk of developing liver
cancer was even greater for patients who had been diagnosed with
either hepatitis C or hepatitis B. The study was published in the
American Journal of Epidemiology.?
http://alcoholism.about.com/cs/liver/a/aa020225a.htm
?Usually alcoholic cirrhosis develops after more than a decade of
heavy drinking, but that is not always the case.
Due to genetic factors some heavy drinkers can develop cirrhosis much
sooner. Some people have livers that are much more sensitive to
alcohol.
Likewise, the amount of alcohol that can injure the liver varies
greatly from person to person. In women, as few as two to three drinks
per day have been linked with cirrhosis and in men, as few as three to
four drinks per day. Alcohol attacks the liver by blocking the normal
metabolism of protein, fats, and carbohydrates.
Cannot Be Reversed
?A damaged liver cannot remove toxins from the blood, causing them to
accumulate in the blood and eventually the brain. There, toxins can
dull mental functioning and can cause personality changes, coma, and
even death.
Loss of liver function affects the body in many ways. Here is a list
of common problems, or complications, caused by cirrhosis. One of the
well-known symptoms of cirrhosis is jaundice, which causing a
yellowing of the skin and eyes. Generally by the time jaundice
develops, the liver has been severely damaged.
Liver damage from cirrhosis cannot be reversed, but treatment can stop
or delay further progression and reduce complications. If the
cirrhosis is caused by long-time heavy drinking, the treatment is
simply: abstain from any further alcohol. A healthy diet and avoiding
alcohol are essential because the body needs all the nutrients it can
get, and alcohol will only lead to more liver damage.?
http://alcoholism.about.com/cs/liver/a/aa001016a.htm
?A linear correlation generally exists between the dose and duration
of alcohol abuse and the development of liver disease, although not
all who overuse alcohol develop significant liver damage. The alcohol
equivalent to 10 g is 30 mL of 40-proof whiskey, 100 mL of 12% wine,
or 250 mL of 5% beer. As little as 20 g of alcohol in women or 60 g in
men can produce liver injury when consumed daily for years. For
example, ingestion of 150 to 200 g of alcohol for 10 to 12 days
produces fatty liver even in otherwise healthy men.
For alcoholic hepatitis, patients consume 80 g of alcohol daily for
almost a decade, whereas the average threshold to develop cirrhosis is
160 g daily over 8 to 10 yr. Duration is important.? ?genetic factors
may also be involved in alcohol metabolism: some people may be
deficient in oxidizing alcohol. Certain HLA histocompatibility types
have also been associated with alcohol-induced liver disease.
Immunologic status does not appear to help determine susceptibility to
alcohol, but immunologic mechanisms (particularly cytokine mediators)
may be important in the inflammatory response and in liver injury.?
?Whether alcoholics metabolize alcohol differently from nonalcoholics
is unknown. Clearly, chronic ingestion of alcohol leads to hepatic
adaptation with hypertrophy of the smooth endoplasmic reticulum and
increased activity of the hepatic drug-metabolizing enzymes. Alcohol
induces the microsomal ethanol oxidizing system, which is responsible
in part for alcohol metabolism. Alcohol also induces microsomal P-450,
which is involved in drug metabolism. Thus, the alcohol abuser
acquires an increased tolerance to alcohol and drugs (eg, sedatives,
tranquilizers, antibiotics), and neurologic adaptation develops. The
result is a complex interaction between drugs, other chemicals, and
alcohol.?
http://www.merck.com/mrkshared/mmanual/section4/chapter40/40a.jsp
Esophageal Varices/Variceal Hemorrhage
---------------------------------------
?When the liver is damaged (most commonly by Cirrhosis), fluid backs
up in the portal veins, blocking the veins of the esophagus. The
esophageal veins then dilate (distended much beyond their normal
size); the walls weaken and burst like a balloon. When this occurs,
there may be massive bleeding in the esophagus.?
http://www.ecureme.com/emyhealth/data/Esophageal_Varices.asp
?In Western countries, alcoholic and viral cirrhosis are the leading
causes of portal hypertension and esophageal varices. Patients who
have bled once from esophageal varices have a 70% chance of
rebleeding, and approximately one third of further bleeding episodes
are fatal. The risk of death is maximal during the first few days
after the bleeding episode and decreases slowly over the first 6
weeks. Mortality rates in the setting of surgical intervention for
acute variceal bleeding are high.?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7982318&dopt=Abstract
Alcohol Boosts Effects of Smoking
-----------------------------------
?In tests on human volunteers, Duke University Medical Center
researchers have found that even small amounts of alcohol boost the
pleasurable effects of nicotine, inducing people to smoke more when
drinking alcoholic beverages. The findings provide a physiological
explanation for the common observation that people smoke more in bars.
The findings also explain statistics showing that alcoholics tend to
smoke more than non-alcoholics, and that smokers are more likely to be
alcoholics.?
http://alcoholism.about.com/b/a/2004_03_22.htm
I urge your husband to seek treatment for alcoholism now, before he
shows symptoms of irreversible damage. This is not what you were
asking, but I feel a truly responsible answer would include a plea
that your husband make every attempt to become sober, in order to save
his life.
?The key to the treatment of alcohol dependence is to stop drinking
alcohol permanently. The first step in this process is detoxification
(immediate withdrawal from alcohol). Depending on your symptoms,
detoxification can be done as an outpatient, or as an inpatient in a
hospital or drug treatment facility. During the withdrawal process,
your doctor probably will prescribe tranquilizers called
benzodiazepines for a few days to lessen withdrawal symptoms. After
that, a medication called naltrexone (ReVia) may be used to help
lessen the craving for alcohol. As an alternative to naltrexone, an
older medication called disulfiram (Antabuse) may be prescribed.
Drinking alcohol while taking disulfiram causes nausea and vomiting.
This is meant to be an incentive not to drink impulsively in response
to craving.
After detoxification, most alcoholics need some form of long-term
support or counseling to remain sober. Recovery programs focus on
teaching a person with alcoholism about the disease, and helping him
or her to learn new coping strategies to deal with the stresses of
everyday life without turning to alcohol. Many patients benefit from
self-help groups such as Alcoholics Anonymous (AA).
If your doctor suspects that you have any alcohol-related damage to
your liver, stomach or other organs, you may need additional tests and
treatments for these problems. Your doctor also will suggest a healthy
diet with vitamin supplements, especially B vitamins.?
http://www.intelihealth.com/IH/ihtIH/WSAZR000/9339/9422.html
?Confidential advice and support is available through GPs, and may
involve a community alcohol team or specialist consultant care. There
are also organisations such as Alcohol Concern and Alcoholics
Anonymous that help many people (see below).
Treatment
To prevent withdrawal symptoms, a chronic heavy drinker may be
prescribed medication such as diazepam (Valium) for a few days after
stopping drinking.
There are two drug treatments that may be used to help someone stop drinking:
ˇDisulfiram, which causes very unpleasant effects if even a small
amount of alcohol is consumed (and severe, occasionally
life-threatening effects with large amounts of alcohol).
ˇAcamprosate, which influences transmitters in the brain and reduces
the craving for alcohol. It may have side-effects such as headache,
diarrhoea and rash.
People with chronic alcohol dependence are often malnourished, and
vitamin supplements are essential.?
http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/alcohol_abuse.html
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
6000 Executive Blvd.
Willco Building
Bethesda, MD 20892-7003
E-Mail: niaaaweb-r@exchange.nih.gov
http://www.niaaa.nih.gov/
National Clearinghouse for Alcohol and Drug Abuse Information (NCADI)
P.O. Box 2345
Rockville, MD 20847-2345
Phone: (301) 468-2600
Toll-Free: (800) 729-6686
Fax: (301) 468-6433
TDD: (800) 487-4889
E-Mail: info@health.org
http://www.health.org/
Alcoholics Anonymous World Services
475 Riverside Dr.
11th Floor
New York, NY 10115
Phone: (212) 870-3400
http://www.alcoholicsanonymous.net/
Al-Anon/Alateen
Al-Anon Family Group Headquarters, Inc.
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
Toll-Free: (888) 425-2666
E-Mail: wso@al-anon.com
http://www.al-anon.alateen.org/
More information
================
Lots of good information on this site:
http://www.niaaa.nih.gov/publications/aa28.htm
Forum
http://ehealthforum.com/health/topic12134.html
?Cirrhosis of the liver is irreversible but treatment of the
underlying liver disease may slow or stop the progression. Such
treatment depends upon the underlying etiology. Termination of alcohol
intake will stop the progression in alcoholic cirrhosis and for this
reason, it is important to make the diagnosis early in a chronic
alcohol abuser. Similarly, discontinuation of a hepatotoxic drug or
removal of an environmental toxin will stop progression. Treatment of
metabolic diseases, such as treatment of iron overload in
hemochromatosis or copper overload in Wilson disease, are also
effective therapies. Chronic viral hepatitis B and C may respond to
treatment with interferon and autoimmune hepatitis may improve with
prednisone and azathioprine (Imuran). Drugs such as ursodiol
(Actigall) may slow the progression of primary biliary cirrhosis and
possibly sclerosing cholangitis.
In patients with cirrhosis of the liver, treatment must also be
directed at the complications. Bleeding esophageal varices can be
treated with endoscopic sclerotherapy or rubber band ligation. Ascites
and edema are often responsive to a low sodium diet and such a diet
must be emphasized in patients with these symptoms. More advanced
ascites and edema can respond to diuretic therapy. A low protein diet
and agents such as lactulose may help hepatic encephalopathy.
Infections such as spontaneous bacterial peritonitis must be rapidly
treated with appropriate antibiotics. Drugs metabolized in the liver
must be given with caution. Coagulation disorders will sometimes
respond to vitamin K.?
http://cpmcnet.columbia.edu/dept/gi/cirrhosis.html
There you go, Rintin! I hope this information is what you were
seeking. Please request an Answer Clarification, before rating, if any
part of this answer is unclear. I wish you and your husband the best!
Sincerely, Crabcakes
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