Alcoholic Hepatitis

The disease originates from this process: Poison.

Presentation

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:

Workup

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.

Treatment

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].

Prognosis

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]

Etiology

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]

Epidemiology

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.

Sex distribution
Age distribution

Pathophysiology

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.

Prevention

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.

Summary

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.

Patient Information

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.

Self-assessment

References

  1. Mueller S, Millonig G, Seitz HK. Alcoholic liver disease and hepatitis C: a frequently underestimated combination. World J Gastroenterol. Jul 28 2009; 15(28):3462-71.
  2. Zintzaras E, Stefanidis I, Santos M, Vidal F. Do alcohol-metabolizing enzyme gene polymorphisms increase the risk of alcoholism and alcoholic liver disease? Hepatology. Feb 2006; 43(2):352-61.
  3. Zimmerman HJ, Maddrey WC. Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure. Hepatology. Sep 1995; 22(3):767-73.
  4. Horie Y, Ishii H, Hibi T. Severe alcoholic hepatitis in Japan: prognosis and therapy. Alcohol Clin Exp Res. Dec 2005; 29(12 Suppl):251S-8S.
  5. Forrest EH, Evans CD, Stewart S, et al. Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glascow alcoholic hepatitis score. Gut. Aug 2005; 54:14-5.
  6. Testino G, Sumberaz A, Ancarani AO, Borro P, Ravetti G, Ansaldi F, et al. Influence of body mass index, cholesterol, triglycerides and steatosis on pegylated interferon alfa-2a and ribavirin treatment for recurrent hepatitis C in patients transplanted for HCV and alcoholic cirrhosis. Hepatogastroenterology. Mar-Apr 2009; 56(90):501-3.
  7. Lieber CS, DeCarli LM. An experimental model of alcohol feeding and liver injury in the baboon. J Med Primatol. 1974; 3(3):153-63.
  8. Vanbiervliet G, Le Breton F, Rosenthal-Allieri MA, Gelsi E, Marine-Barjoan E, Anty R, et al. serum C-reactive protein: A non-invasive marker of alcoholic hepatitis. Scand J Gastroenterol. Dec 2006; 41:1473-9.
  9. Immordino G, Gelli M, Ferrante R, et al. Alcohol abstinence and orthotopic liver transplantation in alcoholic liver cirrhosis. Transplant Proc. May 2009; 41(4):1253-5.
  10. O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. Jan 2010; 51(1):307-28.

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Self-assessment