Hello Enlarges and fatty liver is because of your drinking habits .You had no choice but to stop it Great you have done so Smoking affects every part of respiratory system; lungs; tracheas; other organ associated with breathing and It causes bad cough Lumps in palm may be the burn as result of holding what you smoke cigarette or any other thing .Some time we recognize with these marks that patent is true in denying that he is smoking or not .Such burns are more common in cannabis smoking Contact with chemicals during firefighting and holding of heavy firefighting appliances may also caused damage to your palm I would have advised to such patient in my clinic to stop drinks and smoking for ever and if he can not do of own take the help of de-addiction hospitals .I would have told my patients that to remain free of substance abuse he will need regulator cancelling .I would have told him that cough will take some time to go. Use gloves when handling fire fighting appliances to protect palm and hands I make my patient to be positive for future and take counseling seasons if required For fatty live I would have told my patient to get complete Liver function including SGOT & SGOT done and take the help of a gastro doctor. Take care and I trust you will remain healthy Dr Lal Psychiatrist