Alcoholic Hepatitis

Definition

Definition of Alcoholic Hepatitis
Alcoholic hepatitis is hepatitis (inflammation of the liver) due to excessive intake of alcohol. It is usually found in association with hepatosteatosis, an early stage of alcoholic liver disease, and may contribute to the progression of fibrosis, leading to cirrhosis. Symptoms are jaundice, ascites (fluid accumulation in the abdominal cavity), fatigue and hepatic encephalopathy (brain dysfunction due to liver failure). Mild cases are self-limiting, but severe cases have a high risk of death. Severe cases may be treated with glucocorticoids.

Symptoms

Symptoms of Alcoholic Hepatitis
Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen (ascites), and modest elevation of liver enzyme levels (as determined by liver function tests). Alcoholic hepatitis can vary from mild with only liver enzyme elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and even liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both severe categories is 50% within 30 days of onset.

Alcoholic hepatitis is distinct from cirrhosis caused by long-term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Some alcoholics develop acute hepatitis as an inflammatory reaction to the cells affected by fatty change. This is not directly related to the dose of alcohol. Some people seem more prone to this reaction than others. This is called alcoholic steatonecrosis and the inflammation probably predisposes to liver fibrosis.

Causes

Causes of Alcoholic Hepatitis
Alcoholic hepatitis occurs when the liver is damaged by alcohol you drink. Just how alcohol damages the liver - and why it does so only in a minority of heavy drinkers - isn't entirely clear. What is known is that the process of breaking down ethanol - the alcohol in beer, wine and liquor - produces highly toxic chemicals, such as acetaldehyde. These chemicals trigger inflammation that destroys liver cells. In time, web-like scars and small knots of tissue replace healthy liver tissue, interfering with the liver's ability to function. This irreversible scarring, called cirrhosis, is the final stage of alcoholic liver disease.

Diagnosis

Diagnosis of Alcoholic Hepatitis
The diagnosis is made in a patient with history of significant alcohol intake who develops worsening liver function tests, including elevated bilirubin and aminotransferases. The ratio of aspartate aminotransferase to alanine aminotransferase is usually 2 or more. In most cases, the liver enzymes do not exceed 500. The changes on liver biopsy are important in comfirming a clinical diagnosis.

Treatment

Treatment of Alcoholic Hepatitis
Clinical practice guidelines by the American College of Gastroenterology recommend corticosteroids. Patients should be risk stratified using a MELD Score or Child-Pugh score.

1. Corticosteroids: Patients with a modified Maddrey's discriminant function score > 32 or hepatic encephalopathy should be considered for treatment with prednisolone 40 mg daily for four weeks followed by a taper.
2. Pentoxifylline: A randomized controlled trial found that among patients with a discriminant function score > 32 and at least one of the following symptoms (palpable tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic bruit), 4.6 patients must be treated with pentoxifylline 400 mg orally 3 times daily for 4 weeks to prevent one patient from dying.

Prognosis

Prognosis of Alcoholic Hepatitis
Consult with your doctor.

Prevention

Prevention of Alcoholic Hepatitis
You may reduce your risk of alcoholic hepatitis if you:

1. Drink alcohol in moderation, if at all. If you choose to drink, limit yourself to no more than one drink a day if you're a woman or two drinks a day if you're a man. The only certain way to prevent alcoholic hepatitis is to avoid all alcohol. If you've ever been diagnosed with alcoholic hepatitis, don't drink alcohol.
2. Check the label before mixing medications with alcohol. Check the label of over-the-counter medications for warnings about drinking alcohol. Ask your doctor if it's safe to drink alcohol when taking your prescription medications. Don't drink alcohol when taking medications that warn of complications when combined with alcohol. This includes over-the-counter pain relievers such as acetaminophen (Tylenol, others).
3. Protect yourself from hepatitis C. Hepatitis C is a highly infectious liver disease caused by the hepatitis C virus. Untreated, it can lead to cirrhosis. If you have hepatitis C and drink alcohol, you're far more likely to develop cirrhosis than is someone who doesn't drink. Because there's no vaccine to prevent hepatitis C, the only way to protect yourself is to avoid exposure to the virus.