In many cases, people with alcohol-related liver disease (ARLD) do not have any noticeable symptoms until their liver is badly damaged.

Early symptoms

If you do experience early symptoms of ARLD, these are often quite vague, such as:

• abdominal pain (stomach ache)
• loss of appetite
• fatigue
• feeling sick
• diarrhoea
• feeling generally unwell

Advanced symptoms

As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as:

• yellowing of the skin or whites of the eyes (jaundice)
• swelling in the legs, ankles and feet caused by a build-up of fluid (oedema)
• swelling in your abdomen caused by a build-up of fluid known as ascites
• a high temperature and shivering attacks
• very itchy skin
• hair loss
• significant weight loss
• confusion and memory problems, trouble sleeping (insomnia) and changes in your personality caused by a build-up of toxins in the brain

When to seek medical advice

ARLD does not often cause symptoms until it's reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of the symptoms above. Contact your GP for advice if you have a history of regular alcohol misuse.

A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4 questions:

• Have you ever thought you should cut down on your drinking?
• Have people annoyed you by criticising your drinking?
• Have you ever felt guilty about your drinking?
• Have you ever drunk an "eye-opener", which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves?

If you answer "yes" to one or more of the questions above, you may have an alcohol problem and are advised to see your GP. See your GP as soon as possible if you have symptoms of ARLD.