Mason Delacroix
Alcoholic hepatitis is a severe syndrome related to alcoholic liver disease. It is caused by heavy drinking over many years, which damages the liver. Alcoholic hepatitis is characterised by a number of symptoms, including jaundice, malaise, tender hepatomegaly, and subtle features of systemic inflammatory response. The condition can be treated by quitting drinking, preferably under medical supervision. Here is a closer look at the signs and symptoms of alcoholic hepatitis.
| Characteristics | Values |
|---|---|
| Cause | Excessive alcohol intake |
| Duration of excessive drinking before onset | 3 months to 36 years |
| Average daily consumption | Over 80g of ethanol for over 5 years |
| Racial distribution | 70%-80% of cases are among whites, 20%-30% among blacks |
| Clinical features | Jaundice, ascites, hepatic encephalopathy, coagulopathy, tachycardia, tachypnea, fever, enlarged liver, signs of portal hypertension, spider angiomas, proximal muscle wasting, gynecomastia, malaise, fatigue, confusion, decreased levels of consciousness, asterixis, obtundation |
| Treatment | No medicine to treat alcoholic hepatitis directly; quitting drinking is the only effective treatment, preferably under medical supervision |
| Survival rate | 40-50% mortality rate within 30 days of onset |
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What You'll Learn
Jaundice, malaise, and other signs of liver damage
Alcoholic hepatitis is a severe syndrome related to alcoholic liver disease. It is caused by inflammation of the liver due to excessive alcohol intake. Typically, patients have a history of at least 8–10 drinks per day for 5–10 years. However, some patients develop alcoholic hepatitis from seemingly insignificant quantities of alcohol.
Jaundice is a common symptom of alcoholic hepatitis, occurring in 40% to 60% of cases. It is characterised by yellowing of the skin and eyes, which indicates liver damage. Jaundice is caused by elevated levels of bilirubin, a yellow compound produced during the breakdown of old or damaged red blood cells. In a healthy liver, bilirubin is processed and excreted as bile, but in alcoholic hepatitis, the liver's ability to process bilirubin is impaired, leading to its accumulation in the body and resulting in jaundice.
Malaise, a general feeling of being unwell, is another common symptom of alcoholic hepatitis. This can include fatigue, weakness, and a lack of energy. Malaise is often accompanied by other symptoms such as loss of appetite and weight loss, which can further contribute to a person's overall feeling of unwellness. Malaise and fatigue are indicative of the body's struggle to cope with the toxic effects of excessive alcohol consumption and the resulting liver damage.
In addition to jaundice and malaise, other signs of liver damage in alcoholic hepatitis include an enlarged liver, fluid accumulation in the abdomen (ascites), and elevated liver enzyme levels. Severe cases of alcoholic hepatitis may also present with profound jaundice, obtundation (ranging from drowsiness to unconsciousness), and progressive critical illness. The mortality rate for severe alcoholic hepatitis is high, with up to 50% of patients dying within 30 days of onset despite receiving the best care.
The only effective treatment for alcoholic hepatitis is to quit drinking alcohol, preferably under medical supervision. Quitting alcohol allows the liver to regenerate and recover, reducing the risk of further damage and improving the chances of recovery. However, it is important to note that simply quitting alcohol may not be sufficient for everyone, and some people may require additional medical interventions such as nutritional therapy or, in severe cases, a liver transplant.
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Hepatic encephalopathy and brain dysfunction
Hepatic encephalopathy is a brain dysfunction caused by liver dysfunction. The word "encephalopathy" refers to brain dysfunction, while "hepatic" means related to the liver. It is a serious and potentially fatal brain disorder that can develop as a result of prolonged liver dysfunction caused by excessive alcohol consumption.
Hepatic encephalopathy affects the central nervous system, including how a person thinks, feels, and acts. It can manifest as confusion, disorientation, erratic behaviour, and
The development of hepatic encephalopathy is associated with the liver's inability to effectively remove neurotoxins from the blood. These neurotoxins, including ammonia and manganese, are ordinarily filtered by the liver to prevent them from reaching the brain. However, when the liver is dysfunctional, these neurotoxins continue to circulate in the bloodstream and can accumulate to toxic levels. As a result, they can enter the brain and exert harmful effects, leading to the symptoms of hepatic encephalopathy.
Diagnosis of hepatic encephalopathy typically involves a hepatologist or gastroenterologist evaluating a patient's symptoms, vital signs, and underlying conditions. Blood tests to assess liver function and ammonia levels, as well as imaging techniques like CT scans and MRIs, are employed to confirm the presence of hepatic encephalopathy and its associated complications.
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Ascites and fluid accumulation in the abdomen
Alcoholic hepatitis is a condition caused by alcohol misuse over a long period. It can also be caused by binge drinking, which is classified as drinking more than five drinks in a night for men or four for women. Even seemingly insignificant quantities of alcohol can lead to alcoholic hepatitis. Heavy drinking over the years can cause liver damage, and in some cases, this damage may only be discovered when the condition has progressed to a severe stage.
Ascites is a symptom of alcoholic hepatitis. It refers to the buildup of fluid in the abdomen, causing a swollen belly. This fluid buildup is most commonly due to cirrhosis, which is the scarring of the liver. Ascites can lead to weight gain, abdominal pain and discomfort, and difficulty breathing. In some cases, the fluid can become infected, leading to a fever and requiring antibiotic treatment. The buildup of fluid can also leak into the chest and lungs, causing shortness of breath, cough, and a lack of oxygen in the blood.
The treatment options for ascites include water tablets (diuretics) to remove the fluid. If the condition progresses, paracentesis may be required, which involves inserting a long, thin tube to drain the fluid. Preventative measures for ascites include avoiding alcohol, reducing salt intake, engaging in physical activity, and maintaining a healthy weight.
It is important to note that there is no specific medicine to treat alcoholic hepatitis directly. The most effective treatment is to quit drinking under medical supervision. Nutritional therapy and liver transplantation may also be considered as treatment options.
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Nutritional deficiencies and weight loss
Alcoholic hepatitis is inflammation of the liver caused by alcohol use. Alcoholic hepatitis is unrelated to infectious hepatitis and is caused by alcohol misuse over a long period. Binge drinking large amounts of alcohol in a short period can also cause alcoholic hepatitis.
Malnutrition is common in alcoholic hepatitis, with almost all patients with severe alcoholic hepatitis having some component of malnutrition. Patients with alcoholic hepatitis are often drinking 10 to 15 standard drinks per day, which amounts to about 2000 empty calories. These are considered "empty" calories because they contain little nutritional value. Patients with alcoholic hepatitis often have inadequate protein intake and may have nutritionally imbalanced fat intake, with excess omega-6 and low omega-3 intake. Their diets are also often deficient in micronutrients such as zinc.
The classic phenotype of malnutrition in alcoholic hepatitis is sarcopenia, but this has become more difficult to discern clinically as patients have become more obese. Nutritional deficiencies are more severe in patients with advanced disease. Patients with alcoholic hepatitis are frequently malnourished at baseline and are at risk of worsening malnutrition during hospitalization, especially in the intensive care unit.
Several diagnostic tests can be used to diagnose malnutrition in alcoholic hepatitis, although many of them have accuracy limitations in liver disease. Anthropometry, which includes body mass index (BMI), change in body weight, and triceps skin fold (TSF), is widely used to evaluate nutritional status. However, if patients have fluid retention with edema or ascites, this can overestimate BMI or underestimate weight loss. Biological parameters, such as visceral proteins, are also used to indicate prognosis and nutritional status. These visceral proteins most commonly include albumin, pre-albumin, and retinol-binding protein.
Nutrition support can improve nutritional status and reduce complications. Nutritional therapy in inpatients with alcoholic hepatitis is challenging due to pre-existing nutritional deficiencies, a high risk of refeeding syndrome, poor appetite, altered taste, nausea, early satiety, and the development of alcohol withdrawal syndrome.
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Treatments: abstinence, steroids, and liver transplantation
Alcoholic hepatitis is a condition that arises in individuals with a history of prolonged and heavy alcohol consumption. It is characterised by jaundice and liver impairment, with short-term mortality exceeding 30%. The severity of the condition is typically assessed using Maddrey's discriminant function, and a value of 32 or higher indicates severe alcoholic hepatitis.
The treatment for alcoholic hepatitis primarily involves abstaining from alcohol. For individuals with fatty liver disease, abstaining from alcohol for an extended period, ranging from months to years, may reverse the damage. However, in cases of alcoholic hepatitis or cirrhosis, lifelong abstinence is recommended. This is because refraining from alcohol consumption is the only way to prevent further liver damage and potentially save the patient from dying of liver disease. It is important to note that achieving abstinence can be challenging, especially considering that a significant proportion of individuals with alcoholic hepatitis have an alcohol dependency problem. Seeking professional help and support is crucial in this journey.
In addition to abstinence, specific treatments with corticosteroids may be administered to reduce liver inflammation in some patients with severe alcoholic hepatitis. Nutritional support is also an integral part of the treatment process. Glucocorticoids, such as prednisolone, are often recommended for severe alcoholic hepatitis, as they can help improve survival rates. However, the benefits of these treatments are still being evaluated in clinical trials.
In the most severe cases of alcoholic hepatitis, where the liver loses its function, leading to liver failure, a liver transplant may be necessary. Liver transplantation for alcoholic liver disease has generally shown favourable outcomes, but it remains a controversial topic. Some believe that patients with alcoholism are responsible for their illness and may resume alcohol use after transplantation. To address this concern, most transplantation programs require a 6-month abstinence period before considering patients for liver transplantation. However, the effectiveness of the 6-month rule as a predictor of long-term sobriety is still a subject of debate.
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Frequently asked questions
Alcoholic hepatitis is inflammation of the liver caused by alcohol use. It is a severe syndrome related to alcoholic liver disease.
Symptoms of alcoholic hepatitis vary depending on the severity of the disease. In mild cases, patients may experience tenderness or soreness in their upper right abdomen, a swollen or enlarged liver, a distended abdomen, loss of appetite and weight loss, light-coloured stools, and a fast heart rate. In more severe cases, patients may experience jaundice, hepatic encephalopathy, renal failure, ascites, and bleeding tendencies due to coagulopathy and/or thrombocytopenia.
Alcoholic hepatitis is typically diagnosed in patients with a history of significant alcohol intake (more than 5 years) who develop worsening liver function tests, including elevated bilirubin and aminotransferase levels, and the onset of jaundice. Imaging tests such as ultrasounds, CT scans, or MRIs may be used to visualise the liver and look for signs of inflammation and damage. In uncertain cases, a liver biopsy may be performed to confirm the diagnosis.
The only effective treatment for alcoholic hepatitis is to quit drinking alcohol, preferably under medical supervision. Nutritional therapy and supportive care during alcohol withdrawal can also help treat complications and improve outcomes. In severe cases, liver transplantation may be required if the liver has stopped functioning and does not improve with abstinence.
