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Alcohol Liver Diseases

Home > Patients & Visitors > Diseases & Conditions > Alcohol Liver Diseases

What is alcohol?

Alcohol is derived from the fermentation of sugar by yeast. The main psychoactive ingredient in alcoholic drinks is ethanol, or ethyl alcohol.

Ethanol dissolves quickly in water and is quickly absorbed into the bloodstream. In the short term, in small doses, it acts on the receptors in the brain to make people feel uninhibited and provides a general sense of well-being. Drinking more alcohol starts to affect the balance and the speech centre of the brain. If you drink regularly, the brain's receptors adapt to the alcohol and higher doses are needed to cause the same effect.


What happens when you drink alcohol?

Alcohol is quickly soaked up through the lining of the stomach and the upper part of the intestine and into your blood stream. The higher the concentration of alcohol, the faster it will be absorbed (e.g. whisky will be faster than beer).

From there, the alcohol is carried to your liver as well as the other organs, such as the brain, and may alter your physical coordination and mental judgement.

Your liver cannot store alcohol. It processes about 90 per cent of the alcohol you drink to eliminate it from your body.


What happens to the liver if you drink too much?

Along with the central nervous system, the liver suffers the most from alcohol consumption.

Your liver can only handle a certain amount of alcohol in any given time (one unit an hour). If you are drinking quickly, your liver cells will have to work overtime to process the alcohol. When this is more than what the liver can deal with, the excess is transported to the rest of your organs.

Regular and heavy drinking over time can lead to alcoholic liver disease.

The first stage of the disease may not seem all that significant but it must be acted upon. The later stages are very serious and can threaten your life.


Fatty liver

When the liver breaks down alcohol, it stores the fat in your liver. There should be little or no fat in a healthy liver. Too much of this fat can build up if you drink more than the liver can cope with, leading to fatty liver disease.

Fatty livers return to normal if you drink within the sensible limit. If you carry on drinking above that limit, you are running the risk of more serious damage.


Alcoholic hepatitis

If you have a fatty liver and continue to drink, you have up to a one in three chance of getting alcoholic hepatitis. This is a condition where your liver becomes puffy, swollen and tender. It can affect you suddenly (e.g. after a weekend of heavy drinking) and if your liver fails, it can kill you. Alcoholic hepatitis can happen to you at an early stage or after many years of excessive drinking.



The final stage of any chronic liver disease is cirrhosis. This is usually the result of long-term and continuous damage to the liver. The odds are that one in ten will develop cirrhosis if you drink too much over a long period of time. The complications of liver cirrhosis include liver failure, bleeding problems and liver cancer.

All these complications are potentially life threatening.


What is sensible drinking?

Women are more susceptible to liver damage than men, even if they drink less.


The following guidelines are for sensible drinking:


  • Women should not regularly drink more than 2 to 3 units of alcohol in a single day (no more
    than 14 units in a week)
  • Men should not regularly drink more than 3 to 4 units of alcohol in a single day (no more than 21 units in a week)


These are guidelines for Caucasian patients. Asian patients may be more susceptible to alcohol.


Calculating units

An accurate way of calculating the number of units you are drinking is to multiply the alcohol content figure (abv) by the size of your drink in millilitres and divide by 1,000.


For example, a typical can of beer these days is 440ml, at 5% abv strength. Therefore: 440 x 5 = 2,200; divide this by 1,000 = 2.2 units.



Average units in the following drinks

  • A standard glass of wine (175ml) at 12% abv is 2.1 units and a large glass (250ml) is 3 units
  • A measure (35ml) of whisky/brandy spirits (40% abv) is 1.4 units
  • A can of beer (330ml) at 5% abv is 1.6 units
  • A large bottle of beer at 5% is 3 units
  • A jug (1000ml) of regular strength (5% abv) beer or stout is 5 units
  • A 750ml bottle of spirits (whisky, brandy, vodka, etc) is 30 units 



When to seek medical advice

An individual should consider seeking help if the alcohol is affecting his/her work or family life. The four screening questions that we use to assess if drinking is an issue are as follows:

1) Have you ever felt that you needed to cut down on your drinking?
2) Have people annoyed you by criticising your drinking habits?
3) Have you ever felt guilty about drinking?
4) Have you ever felt like you needed a drink the first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?


If you have answered 'Yes' to two or more of the above questions, you should be investigated for alcohol dependence.


Alcohol related liver disease is rather silent and is usually picked up during routine screening of the liver function.


Appointment and Enquiry

University Digestive Centre
Kent Ridge Wing Level 4
National University Hospital


Appointment Lines:
(65) 6772 2505 / (65) 6773 3380
Fax : (65) 6774 1075
Email: udc@nuhs.edu.sg

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