Alcohol Abuse: Organ Damage Across Body Systems

Chronic alcohol misuse damages virtually every organ system. Effects are dose- and duration-dependent, with genetic susceptibility.

1. Liver (Primary Site of Metabolism)

• Steatosis (fatty liver) → reversible with abstinence.
• Alcoholic steatohepatitis (ASH) — inflammation, ballooning, Mallory-Denk bodies.
• Fibrosis → Cirrhosis (irreversible architectural distortion, portal hypertension).
• Hepatocellular carcinoma (HCC) — cirrhosis main risk factor.

2. Brain & Nervous System

• Acute: GABA↑/glutamate↓ → sedation, ataxia, disinhibition, blackouts.
• Chronic: Cortical atrophy (frontal), cerebellar degeneration (ataxia), white matter loss.
• Wernicke-Korsakoff Syndrome: Thiamine deficiency → ophthalmoplegia, ataxia, confusion → irreversible amnestic syndrome.
• Peripheral neuropathy (axonal, sensory > motor).
• ↑Stroke risk (hypertension, atrial fibrillation, coagulopathy).

3. Heart & Cardiovascular

• Alcoholic cardiomyopathy (dilated, systolic dysfunction) — dose-related.
• Arrhythmias: "Holiday heart" (AFib after binge), VT.
• Hypertension (dose-dependent).
• ↑Triglycerides, ↑HDL (but dysfunctional).

4. Pancreas

• Acute pancreatitis (trypsinogen activation).
• Chronic pancreatitis → exocrine insufficiency (malabsorption), endocrine insufficiency (diabetes).

5. GI Tract

• Gastritis, erosions, ulcers (↑acid, ↓mucosal defense).
• Esophagitis, Barrett's, Mallory-Weiss tears.
• Malabsorption (villous atrophy, pancreatic insufficiency).
• Diarrhea/constipation.

6. Immune System

• ↓Neutrophil chemotaxis, phagocytosis, oxidative burst.
• ↓T cell function, cytokine production.
• ↑Susceptibility: pneumonia, TB, postoperative infections.

7. Reproductive

• Men: ↓Testosterone, ↓spermatogenesis, erectile dysfunction, gynecomastia.
• Women: Menstrual irregularities, anovulation, ↓fertility, fetal alcohol spectrum disorders (FASD) — no safe level in pregnancy.

8. Cancer (Group 1 Carcinogen)

• Oropharyngeal, esophageal, liver, colorectal, breast (linear dose-response).

9. Bone & Muscle

• Osteoporosis (↓osteoblasts, ↑cortisol, ↓vit D/Ca absorption).
• Myopathy (proximal weakness).

Abstinence or reduction reverses many early changes. Screening (AUDIT-C, LFTs, MCV) enables early intervention.