Alcoholic hepatitis

What is Alcoholic hepatitis?

Alcoholic hepatitis is an inflammation of the liver occurring after years of moderate to severe alcohol abuse. It is the most common cause of liver scarring or cirrhosis in the US with the severity of symptoms varying from virtually none to a life threatening progression to liver failure.

How is it diagnosed?

History: Individuals may complain of flu-like symptoms such as fatigue, abdominal pain, low grade fever, lack of appetite, and nausea and vomiting, or a yellowing of the skin and whites of the eyes (jaundice). Individuals presenting with a severe case of alcoholic hepatitis may develop an enlarged liver and a high fever. As the disease progresses, the patient may report or exhibit difficulty concentrating, indicating the possibility of impending liver failure. When asked, most individuals will report a history of excessive alcohol consumption.

Physical exam: Depending upon the severity of the disease, the physician may detect an enlarged liver and spleen, abdominal tenderness, yellowing (jaundice) of the skin or the white of the eye (sclera), spider veins, an enlarged abdomen indicating fluid retention (ascites), an enlarged parotid gland, breast development in a male (gynecomastia), and decreased testicle size upon physical examination.

Tests: Blood tests will be performed, including measurements of key liver enzymes (GGT, AST, ALT), bilirubin, hematocrit, and mean corpuscle volume. MRI and diagnostic ultrasound procedures may aid in the diagnosis; however, definitive diagnosis requires a liver biopsy. A liver biopsy is a diagnostic procedure in which a small piece of liver tissue is removed with a needle and examined microscopically.

How is alcoholic hepatitis treated?

The treatment of hepatitis is generally designed to stop further inflammation and to allow the liver sufficient time to heal. Individuals are instructed to stop drinking alcohol permanently and temporarily stop taking certain medications that may make their condition worse, due to the inability of the liver to metabolize and excrete certain compounds during the illness. Additionally, nutritional advice and supplementation is provided. During the acute stage of the illness, the liver is also unable to break down protein, and so protein must be avoided in the diet. As a result, in many cases, the patient receives intravenous nutrients and fluids to prevent dehydration. In severe cases, anti-inflammatory drugs (corticosteroids) may be administered.

Medications

Trental (Pentoxifylline)

What might complicate it?

Complications associated with alcoholic hepatitis can include bleeding, liver failure, brain injury (hepatic encephalopathy), inflammation of the pancreas (pancreatitis), liver scarring (cirrhosis), delirium tremens, and fluid retention in the abdomen (ascites).

Predicted outcome

Individuals with mild or moderate disease usually recover, although recovery may be slow. Those individuals with less serious alcoholic hepatitis typically have a lower mortality rate in the range of seven to eighteen percent. Approximately 40% of individuals with severe disease die within one month of hospitalization.

Alternatives

Differential diagnoses include biliary tract obstruction, idiopathic hemochromatosis, nonalcoholic steatohepatitis, viral hepatitis, and primary biliary cirrhosis.

Appropriate specialists

Gastroenterologist, radiologist, and neurologist.

Last updated 4 April 2018