Mild cases of alcoholic hepatitis usually are asymptomatic. As the disease progresses, the damage to the liver increases and the following signs and symptoms are evident:

• Weight loss
• Appetite changes
• Nausea accompanied by vomiting
• Inflammation along with pain
• Undue fatigue
• Jaundice
• Fever
• Confusion
• Excessive feeling of thirst
• Dryness of mouth
• Ascites

• Splenomegaly

  Image studies showed an extremely enlarged fatty liver and splenomegaly. The Japan alcoholic hepatitis score and Maddrey's discriminant function were 10 and 54 points, respectively. [ncbi.nlm.nih.gov]

  Splenomegaly is uncommon. Ascites and hepatic encepalopathy are common in severe disease but varices are not common. [euroliver.org]

  […] characteristics Demographics: Male: 71% Age: 42.4 years Medical data: Days of treatment: 21.5 Days before randomization: 3.9 Previous decompensation: 24% Hepatic encephalopathy: 8% Creatinine above 2.4 mg/dL: 6.1% Ascites: 76% Edema: 59% Varices: 80% Splenomegaly [wikijournalclub.org]

  Does the patient have a nodular contour to the liver, or splenomegaly, even after the acute event has resolved? That question remains unanswered. [hepatitis.va.gov]

• Fever

  Slight clouding of consciousness, fever, and jaundice were evident on his admission to our hospital. Laboratory data showed leukocytosis with a predominance of polymorphonuclear leukocytes, and a decline in coagulability. [ncbi.nlm.nih.gov]

  These trigger a local and systemic inflammatory response which leads to hepatocellular injury and systemic effects such as fever, anorexia and weight loss. [ddxof.com]

  Other common signs and symptoms include fever, ascites, and proximal muscle loss. Patients with severe alcoholic hepatitis may have encephalopathy. Typically, the liver is enlarged and tender. [ncra.org]

• Ascites

  Convert to ICD-10-CM : 571.1 converts approximately to: 2015/16 ICD-10-CM K70.10 Alcoholic hepatitis without ascites Approximate Synonyms Acute alcoholic liver disease Alcoholic hepatitis Alcoholic hepatitis w ascites Alcoholic hepatitis with ascites [icd9data.com]

  Improvement was also seen in coagulability, ascites, icterus and consciousness. Case 2: The patient was a 49-year-old man. He was a heavy drinker whose alcohol intake had increased for 1 month. [ncbi.nlm.nih.gov]

• Weight Loss

  When the condition takes a severe turn, the symptoms include loss of appetite, undue fatigue, weight loss due to malnutrition, nausea accompanied by vomiting, fever, confusion, and jaundice, swelling in abdomen due to accumulation of fluid and abdominal [symptoma.com]

  Other symptoms include: Heavy fluid retention Confusion Liver and Kidney failure Tender abdominal region Weight loss Vomiting Nausea Treatment for Alcoholic Hepatitis Treatment for alcoholic hepatitis means stopping drinking alcohol immediately. [alcoholmastery.com]

  Hand-related deformities Anorexia and/or unwanted weight loss A long list of other less common symptoms of cirrhosis is available on Wikipedia. [alcoholawareness.org]

  These are the most common symptoms of alcoholic hepatitis: Belly (abdomen) tenderness or pain over the liver Nausea Vomiting blood or material that looks like coffee grounds Poor appetite Yellowing of the skin and eyes (jaundice) Weight loss Tiredness [uchealth.org]

• Anemia

  In addition, the following diagnostic procedures are employed for detecting liver damage: Complete blood count to determine presence of anemia and other abnormalities. [symptoma.com]

  Signs and Tests: A CBC may show anemia and other abnormalities. Liver function tests such as ALP are abnormal. Liver biopsy shows alcoholic liver disease. [ihv.org]

  These results suggest that the patients with markedly elevated white blood cell counts, prolonged prothrombin time, anemia, renal failure, infection, or gastrointestinal bleeding should be treated at an earlier stage with plasma exchange, hemodialysis [ci.nii.ac.jp]

  […] used to establish diagnosis, probable when the clinical and laboratory features were present without potential confounding problems, and possible when confounding problems were present. 16 Other common and nonspecific laboratory abnormalities include anemia [clevelandclinicmeded.com]

• Malaise

  Wernicke-Korskoff syndrome Cardiovascular Hypertension Cardiomyopathy Hyperdynamic circulation Bone Rib fractures on CXR Spinal osteoporosis (particularly in men) Generally, patients with fatty liver have few symptoms, however they may notice nausea and malaise [almostadoctor.co.uk]

• Easy Bruising

  bruising Dupuytren’s contracture Neuromuscular Tremor Memory loss / cognitive impairment Peripheral myopathy- degradation of muscle Epilepsy Wernicke-Korskoff syndrome Cardiovascular Hypertension Cardiomyopathy Hyperdynamic circulation Bone Rib fractures [almostadoctor.co.uk]

  […] symptoms may include: Fluid buildup of the legs (edema) and in the abdomen ( ascites ) Yellow color in the skin, mucous membranes, or eyes ( jaundice ) Redness on the palms of the hands In men, impotence, shrinking of the testicles, and breast swelling Easy [nlm.nih.gov]

• Nausea

  As the disease progresses, the damage to the liver increases and the following signs and symptoms are evident: Weight loss Appetite changes Nausea accompanied by vomiting Inflammation along with pain Undue fatigue Jaundice Fever Confusion Excessive feeling [symptoma.com]

  The patient was well until two weeks ago when she noted increasing fatigue associated with morning nausea/vomiting (non-bloody) as well as yellowing of skin and eyes. [ddxof.com]

  The symptoms of mild alcoholic hepatitis tend to be more severe: Anorexia Nausea Abdominal pain Weight loss Drugs Related Articles Tags: Gastroenterology Liver Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department [almostadoctor.co.uk]

  Other symptoms include: Heavy fluid retention Confusion Liver and Kidney failure Tender abdominal region Weight loss Vomiting Nausea Treatment for Alcoholic Hepatitis Treatment for alcoholic hepatitis means stopping drinking alcohol immediately. [alcoholmastery.com]

  These are the most common symptoms of alcoholic hepatitis: Belly (abdomen) tenderness or pain over the liver Nausea Vomiting blood or material that looks like coffee grounds Poor appetite Yellowing of the skin and eyes (jaundice) Weight loss Tiredness [uchealth.org]

• Vomiting

  As the disease progresses, the damage to the liver increases and the following signs and symptoms are evident: Weight loss Appetite changes Nausea accompanied by vomiting Inflammation along with pain Undue fatigue Jaundice Fever Confusion Excessive feeling [symptoma.com]

  You vomit several times in a row. Contact your healthcare provider if: You feel more tired than usual. You lose weight without trying, lose your appetite, or feel too nauseated to eat. [drugs.com]

  […] blood, or blood in the urine Shortness of breath Vomiting more than once a day Yellowing skin or eyes (jaundice) that is new or gets worse quickly Talk openly to your provider about your alcohol intake. [nlm.nih.gov]

  Other symptoms include: Heavy fluid retention Confusion Liver and Kidney failure Tender abdominal region Weight loss Vomiting Nausea Treatment for Alcoholic Hepatitis Treatment for alcoholic hepatitis means stopping drinking alcohol immediately. [alcoholmastery.com]

• Abdominal Pain

  […] loss of appetite nausea swollen abdomen or increased abdominal circumference (from enlarged liver) jaundice abdominal pain and tenderness fever ascites (fluid collection in the abdomen) unintentional weight gain (because of fluid collection) mental confusion [ihv.org]

  Symptoms include abdominal pain, fatigue, and weight loss. Fatty liver disease cannot be cured. Symptoms can last an entire lifetime. More than 3 million Americans suffer from it every year. [alcoholawareness.org]

  She also denies fevers/chills, increased abdominal girth, abdominal pain, changes in bowel habits or bloody/dark stools. She reports drinking 1 pint of vodka daily for the past 15 years, and perhaps more in the past 3 weeks. [ddxof.com]

  The symptoms of mild alcoholic hepatitis tend to be more severe: Anorexia Nausea Abdominal pain Weight loss Drugs Related Articles Tags: Gastroenterology Liver Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department [almostadoctor.co.uk]

• Loss of Appetite

  loss of appetite nausea swollen abdomen or increased abdominal circumference (from enlarged liver) jaundice abdominal pain and tenderness fever ascites (fluid collection in the abdomen) unintentional weight gain (because of fluid collection) mental confusion [ihv.org]

  Alcoholic Hepatitis Symptoms In the stage of acute alcoholic hepatitis, there may be nausea, loss of appetite, gradual loss of weight, jaundice and other symptoms of liver dysfunction (prolonged prothrombin time, hypoalbuminemia, ascites, and hepatic [quitalcohol.com]

  When the condition takes a severe turn, the symptoms include loss of appetite, undue fatigue, weight loss due to malnutrition, nausea accompanied by vomiting, fever, confusion, and jaundice, swelling in abdomen due to accumulation of fluid and abdominal [symptoma.com]

  Diagnosis Hepatitis of all kinds causes notable discomfort, loss of appetite, nausea, pain in the liver, and usually jaundice (turning yellow). [medical-dictionary.thefreedictionary.com]

  Among which may include: Loss of appetite Nausea and vomiting Abdominal pain and tenderness Yellowing of the skin and whites of the eyes (jaundice) Fever Abdominal swelling due to fluid accumulation (ascites) Mental confusion Fatigue Alcohol-induced hepatitis [the-alcoholism-guide.org]

• Diarrhea

  […] drinking Are worried that drinking may be harming your health Get emergency medical help right away if you have: Abdominal or chest pain Abdominal swelling or ascites that is new or suddenly becomes worse A fever (temperature greater than 101°F, or 38.3°C) Diarrhea [nlm.nih.gov]

  Common symptoms are weakness, anorexia, weight loss, nausea, vomiting and diarrhea. Patients with alcoholic hepatitis are often malnourished and pyrexial. [euroliver.org]

  The more damage there is, the more you’ll experience these initial symptoms: A loss of appetite Fatigue Diarrhea Nausea/vomiting Dry mouth Pain/swelling in the abdomen Fever Jaundice or icterus which is the yellowing of skin or eyes Negative changes in [northpointrecovery.com]

• Tachycardia

  […] vomiting blood or material that looks like coffee grounds bloody or dark black or tarry bowel movements (melena) abnormally dark or light skin redness on feet or hands paleness light-headedness or fainting, especially with upright posture rapid heart rate (tachycardia [ihv.org]

  Physical Exam: VS: T 98.9 HR 104 RR 19 BP 117/67 O2 99% RA Gen: Well-appearing obese female in no acute distress HEENT: PERRL, marked scleral icterus, sublingual icterus, MMM, no lesions CV: Tachycardia, regular rhythm, normal S1/S2, no M/R/G Lungs: CTAB [ddxof.com]

  Alcoholic hepatitis can also lead to intensified hangovers and withdrawals… Symptoms Of Alcoholic Hepatitis And Alcohol Withdrawals Mild to moderate symptoms include: Irritability Anxiety Headache Sweating Tachycardia Hand tremors with clammy skin Severe [drugrehab.org]

  Fever, tachycardia and tachypnea, leukocytosis (sometimes extreme with a white blood cell count >50,000), altered mental status, abdominal pain, and distension may accompany severe AH. [gastroenterologyandhepatology.net]

• Jaundice

  Slight clouding of consciousness, fever, and jaundice were evident on his admission to our hospital. Laboratory data showed leukocytosis with a predominance of polymorphonuclear leukocytes, and a decline in coagulability. [ncbi.nlm.nih.gov]

  Within several weeks after discontinuation of alcohol intake, jaundice and fever may resolve, but ascites and hepatic encephalopathy may persist for months to years. Either continued jaundice or the onset of renal failure signifies a poor prognosis. [ncra.org]

• Hepatomegaly

  Jaundice was present in all patients with fever and tender hepatomegaly also being common. On histopathological evaluation, 33.3% (n = 10) suspected clinically to have alcoholic hepatitis had underlying cirrhosis. [ncbi.nlm.nih.gov]

  # Alcoholic hepatitis: Rapid onset of jaundice, tender hepatomegaly, and elevation of transaminases (AST > ALTx2) in the setting of chronic alcohol use suggestive of alcoholic hepatitis. [ddxof.com]

  Physical examination: Bp 140/80mmHg, Ultrasound of Abdomen showed hepatomegaly with enlarged liver measuring 19.1 cm in the midclavicular line and hepatic steatosis and gallbladder sludge without evidence of wall thickening or pericystic fluid. [bloodjournal.org]

  Do a thorough abdominal exam, evaluating for hepatomegaly and/or splenomegaly, hepatic bruit, RUQ tenderness suggesting swelling of liver capsule, ascites. [clinicaladvisor.com]

  Patients 102 patients (mean age 42 y, 74% men) with severe alcoholic hepatitis (Maddrey discriminant factor ≥ 32), jaundice, and ≥ 1 of the following findings: palpable tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic [acpjc.org]

• Scleral Icterus

  Physical Exam: VS: T 98.9 HR 104 RR 19 BP 117/67 O2 99% RA Gen: Well-appearing obese female in no acute distress HEENT: PERRL, marked scleral icterus, sublingual icterus, MMM, no lesions CV: Tachycardia, regular rhythm, normal S1/S2, no M/R/G Lungs: CTAB [ddxof.com]

  icterus, skin and sublingual jaundice). [clinicaladvisor.com]

• Liver Tenderness

  tenderness Pancreatic pain Skin rash All of the above In alcoholic hepatitis, the liver is usually enlarged. [ncra.org]

• Pruritus

  Patients may present with jaundice, pruritus, abnormal laboratory findings (eg, thrombocytopenia, hypoalbuminemia, coagulopathy), or complications of portal hypertension, such as variceal bleeding, ascites, or hepatic encephalopathy. [clevelandclinicmeded.com]

Diagnosis of alcoholic hepatitis begins with a detailed history about alcohol consumption. This is one of the most important evidence suggesting the development of alcoholic liver disease. In addition, the following diagnostic procedures are employed for detecting liver damage:

• Complete blood count to determine presence of anemia and other abnormalities.
• Tests such as total albumin, bilirubin and international normalized ratio to assess liver function.
• C-reactive protein serum determination has 99% specificity rating [8].
• Imaging studies such as CT scan and MRI of the liver to study the extent of damage to the organ.
• Blood tests to rule out other causes of liver damage.

When the above mentioned tests fail to draw out a confirmed diagnosis then liver biopsy may be done.

• Hypoalbuminemia

  A blood test showed leukophilia, mild hypoalbuminemia, hyperbilirubinemia, hepatobiliary injury and coagulopathy. Image studies showed an extremely enlarged fatty liver and splenomegaly. [ncbi.nlm.nih.gov]

  Hypoalbuminemia is a medical condition where levels of albumin in blood serum are abnormally low. It is a specific form of hypoproteinemia. Acites is the accumulation of fluid in the peritoneal cavity, causing abdominal swelling. [quitalcohol.com]

  – Mild elevation in alkaline phosphatase Albumin (frequent hypoalbuminemia) Prothrombin time/international normalized ratio (INR) (frequent coagulopathy) Complete blood count (CBC) with differential (frequent leukocytosis with neutrophilia, often occult [clinicaladvisor.com]

  - Prolongation of the prothrombin time and hypoalbuminemia reflect poor hepatic synthetic function. - Leukocytosis is common and a count of polymorphonuclear leukocytes greater than 5500/mm3 could be associated with a better response to the corticotherapy [euroliver.org]

  Patients may present with jaundice, pruritus, abnormal laboratory findings (eg, thrombocytopenia, hypoalbuminemia, coagulopathy), or complications of portal hypertension, such as variceal bleeding, ascites, or hepatic encephalopathy. [clevelandclinicmeded.com]

• Hypoglycemia

  Follow for hypoglycemia if fulminant hepatic liver failure. No change in standard management. Consider converting prednisone to prednisolone. [clinicaladvisor.com]

• Prothrombin Time Prolonged

  Serum albumin may be decreased, prothrombin time prolonged and the international normalized ratio (INR) may be elevated; however, these values depend on the severity of the episode. [elsevier.es]

• Leukocytosis

  A trial of intravenous antibiotics had no impact on the leukocytosis. Methylprednisolone at a dose of 40 mg IV daily was started on postoperative day 9. [ncbi.nlm.nih.gov]

The following methods are carried out for treating alcoholic hepatitis:

• Discontinuing alcohol consumption forms the basis of treatment regime. 
• A diet that is rich in carbohydrates and calories is given to minimize the protein breakdown and reverse the effects of malnutrition. If the patient is not in a condition to take food by mouth then tube feeding is employed. In such cases, high nutrient liquid diet is prepared for patients on tube feeding. 
• Along with this, medications are given to reduce the liver inflammation and also reverse the effects of liver damage.
• Liver transplant is done in severe cases for patients who have attained end stage liver disease [9].

The prognosis of the disease would depend on extent of damage to the liver and the severity of the symptoms. If the disease has been diagnosed in the initial stages and the individual stops intake of alcohol, then with proper treatment plan the result would certainly be favorable.

However, if individuals continue to abuse their body with alcohol intake then recovery process would slow down and individuals will gradually develop end stage liver disease. In such situations, the toxins would no longer be filtered from the body causing coma and finally leading to death. Severe alcoholic hepatitis carries a general mortality rate of up to 66% [4]. The Glasgow Alcoholic Hepatitis Scoring (GAHS) is currently being used as a prognostic tool which deems to be up to 81% accurate in predicting a 28 day outcome [5].

Complications

Complications of alcoholic hepatitis occur when individuals do not stop drinking alcohol. The following are the secondary conditions noticed amongst individuals with alcoholic liver disease:

• High blood pressure
• Varices 
• Fluid retention such as ascites wherein large amounts of fluid accumulate in the abdomen
• Jaundice 
• Hepatic encephalopathy due to incapacity of the liver to filter off the toxins from the body
• Hepatosteatosis [6]
• Renal failure
• Cirrhosis due to scarring of the liver tissues [7]

Excessive alcohol consumption causes alcoholic hepatitis. When the alcohol is broken down by the liver, it produces various toxic compounds that cause scarring of the liver tissues. This in turn causes the liver to swell giving rise to alcoholic hepatitis. In addition, other factors are also known to participate in causation of this liver disease. These include:

• Genetic factors [2]
• Live disorders like hepatitis C can pave way for development of alcoholic hepatitis.
• Malnutrition
• Acetaminophen intake [3]

In the US, alcoholic hepatitis is known to affect about 2 million individuals. Women are more affected by this condition as compared to male, essentially because of the difference in the way body breaks down alcohol in both sexes. The incidence of alcoholic hepatitis strikes about 25 to 30% of the total population.

The exact physiology behind the association of alcohol and liver disease is not completely understood. With the little information that is available; it can be postulated that the byproduct of alcohol breakdown produces toxic compounds such as acetaldehyde that is injurious to the liver. The toxicogenic components cause irreversible scaring of the liver tissues leading to inflammation of the organ. This further leads to destruction of the liver cells and gradually the healthy cells of the liver are replaced by knots or web-like scars. This eventually causes loss of liver functioning paving way for development of liver cirrhosis.

The only way to prevent alcoholic hepatitis is to limit alcohol intake as far as possible [10]. It is also necessary to stay away from infectious diseases such as hepatitis C which increases chances of developing alcoholic hepatitis.

Alcoholic hepatitis is a condition characterized by inflammation of the liver due to excessive alcohol consumption [1]. Individuals who consume moderate to excess alcohol fall easy prey to this liver disease. It is necessary to avoid alcohol consumption once the disease has developed; failure to do so can cause serious life threatening complications. Malnutrition and malabsorption of nutrients contribute towards development of alcoholic hepatitis amongst the drinker’s population.

Definition

Alcoholic hepatitis is a liver disease characterized by inflammation of the liver amongst the population who excessively drink alcohol, and have been doing so for several years. Once individuals develop this disease they are advised against alcohol consumption. Failure to adhere to this can cause liver cirrhosis, followed by coma and death.

Cause

Excessive alcohol consumption is the major factor contributing to alcoholic hepatitis. The breakdown of alcohol by the liver causes production of toxin compounds which are not eliminated from the body. Such series of events causes alcoholic hepatitis.

Symptoms

In mild cases of alcoholic hepatitis, the individuals usually experience no signs and symptoms. When the condition takes a severe turn, the symptoms include loss of appetite, undue fatigue, weight loss due to malnutrition, nausea accompanied by vomiting, fever, confusion, and jaundice, swelling in abdomen due to accumulation of fluid and abdominal pain. 

Diagnosis

Diagnosis of alcoholic hepatitis begins with a history of alcohol intake. An array of medical tests is ordered to diagnose the condition. These include blood tests to determine presence of anemia, liver function tests, CT scan and MRI of the liver and liver biopsy.

Treatment

The individuals are advised against alcohol intake to arrest further liver damage. Medications are employed to reduce liver inflammation and correct malnutrition. In addition, nutrient rich food along with nutrimental supplements should be provided. Efforts should be channelized to avoid alcohol intake and individuals should be constantly monitored in this aspect.

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