The First Signs of Alcoholic Liver Damage Are Not in the Liver

7 min readDec 5, 2020


Not enough alcoholics are educated about this

Image: VSRao/Pixabay

Myfather died of alcoholic liver cirrhosis four years ago. It came as a surprise to all of us, even though it was clear he had a severe drinking problem for decades. It was especially surprising to me, as a former nurse and a recovering alcoholic. You would think I’d know more about liver problems and alcohol use than the average person. But the truth is, in the months before his death, I had no idea my father’s liver was struggling at all. Most people know about cirrhosis, but few people know how a liver goes from early damage to end-stage liver cirrhosis.

The combination of my father’s death and my personal background lit a fire in me to know more. He was admitted to the hospital on June 24, 2016, and he died on July 18. Only 24 days passed between the first sign there was a problem and his subsequent death.

Now, hearing that he was in end-stage cirrhosis didn’t surprise me, given his heavy drinking. What did surprise me was that he’d visited several doctors and specialists in the months before his death, and no one knew his liver was struggling either.

So what happened? Does end-stage liver cirrhosis really sneak up that fast? Were there other signs that would have alerted someone to his failing liver?

As for why the doctors and specialists didn’t know what was happening, that mystery resolved reasonably quickly. The plain truth is that alcoholics rarely divulge the amount and frequency of their drinking to their doctors. This was the case for my dad. He had many health issues that he was trying to solve, but he protected his drinking habit fiercely. So he refused to spill the beans, even when it mattered.

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The problem is that liver damage has numerous multifaceted symptoms that are confusing and associated with many other illnesses. Unless a doctor knows that the patient is an alcoholic, they may not know how to interpret what’s happening until it’s too late.

As he was dying, my father told me that he didn’t think to tell the doctors how much he was drinking. He said it was as if he blanked out and “forgot” to mention it. As crazy as that sounds, this strange “forgetting” is a common part of the alcoholic mindset. It may also be due to the metabolic and physical changes of cirrhosis itself.

There are many signs of liver problems, but oddly, none seem to point to the liver at first. And in fact, many of the first signs of liver damage occur in other parts of the body. Knowing these signs may help educate alcoholics and their families if they want to understand their risk of developing liver cirrhosis.

Liver damage has numerous multifaceted symptoms that are confusing and associated with many other illnesses. Unless a doctor knows that the patient is an alcoholic, they may not know how to interpret what’s happening until it’s too late.

Digestive signs

The liver plays a huge part in our digestive process. It filters out all toxins from food as well as helping to break down fats and glucose.

When a liver starts to slow down due to significant damage, it will reduce its digestive work. Instead, it will divert its energy toward vital functions like metabolizing medications and filtering toxins.

This means that symptoms like bloating, nausea, vomiting, gas, and diarrhea will start to increase. Over time, eating becomes more challenging. In the later stages of liver cirrhosis, toxins that can’t be filtered out begin to build in the bloodstream, which causes more nausea.

Cognitive signs

Although confusion and brain fog happen in end-stage liver cirrhosis, they can also be early signs.

The liver is responsible for filtering dangerous substances in the blood. It also helps regulate hormones, blood glucose, and vitamin absorption. In the early stages of liver damage, these processes can be interrupted. Inevitably, this affects our brain and nervous system.

This means that early liver problems can make you feel tired, confused, slow, and foggy. You may have some memory issues as well.

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Neuromuscular signs

The liver stores vitamins required for the functioning of many organs and systems in the body — one of them is vitamin B1 or thiamine. A deficiency in this particular vitamin has been documented in many alcoholics with or without liver damage.

Unfortunately, alcohol inhibits the absorption of thiamine in the intestine. Over time, as the liver becomes damaged, it can no longer store thiamine in enough quantities. Thiamine deficiency is responsible for many neurological issues in people with alcoholism.

Symptoms of thiamine deficiency range from mild to severe and include things like: confusion, mental fog, lack of balance, pain and numbness in hands and feet, muscle weakness, rapid heart rate, digestive problems, flushing, and involuntary eye movements.

Thiamine deficiency happens in almost every alcoholic who consumes frequent and large amounts of alcohol. And if thiamine deficiency due to alcoholism is discovered, you can be sure the liver is suffering damage at the same time.

Many of the first signs of liver damage occur in other parts of the body.

Vascular signs

All alcohol consumption can lead to blood vessel dilation, causing flushing in the face and hands. Over time, this can cause damage leading to permanent redness in the face. Although many alcoholics have rosacea or spider-like veins on their faces, this is often benign.

However, spider angiomas are different from rosacea or spiderlike veins. They’re circular and have a central point called a spider nevus that is darker than the rest of the lesion. Spider angiomas are a sign of liver disease and can be present in the early stages. They often progress to more extensive and more numerous lesions.

Spider angiomas are caused by increased estrogen levels in the blood. When the liver becomes damaged, it can’t properly metabolize estrogens, which causes them to build up in the body.

Many women who are pregnant or taking birth control pills may have a few spider angiomas. However, in alcoholic liver disease, these lesions are often more frequent and accompanied by red palms and varicose veins in the esophagus.

These are a few of the main signs of alcoholic liver damage that happen outside of the liver. It’s important to know this because most of us have no idea how the liver functions and how it communicates distress.

The liver itself doesn’t show signs like pain or swelling in the early stages of liver damage. This contrasts with other organs like the heart or stomach, where any damage will emit pain or symptoms directly from these organs.

What happens with liver damage is that its many diverse functions become interrupted, causing symptoms in other parts of the body. This may explain why most people never think they have a problem with their liver.

Unfortunately, patients with alcoholism are rarely educated about these issues. This is because they often don’t reveal their drinking, to begin with. And even if they do, the symptoms are widespread and complex, which makes patient education challenging.

My goal in writing articles like this is to help educate regular people about alcoholic liver disease to understand their health and make better decisions.

It’s hard to say if my father would have changed his drinking habits if he knew more about his vague and complicated symptoms. But I think having proper education would have certainly helped him understand his risks and health problems better.