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Alcoholic Hepatitis


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:

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[medlineplus.gov]
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
  • Prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever.[ncbi.nlm.nih.gov]
  • 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]
  • We describe a patient with severe alcoholic hepatitis, markedly elevated white blood cell count, and high fever. After review of the English literature, we discovered reports of other cases similar to our case.[ncbi.nlm.nih.gov]
  • 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]
  • You might also have a fever, stomachache, or liquid buildup in your belly, and you may lose weight. If you’ve been diagnosed with it or think you might have it, here’s what you need to know. How Is It Diagnosed? Medical history.[webmd.com]
Weight Loss
  • 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]
  • 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]
  • 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]
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]
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 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]
  • 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]
  • 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]
  • 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]
  • 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]
  • 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]
  • […] symptoms include: Fever Enlargment of liver (edema) Blood clot impairment Jaunice (yellowing of skin and eyeso Hypertension Abdominal swelling (edema) and pain Abnormal brain function (also associated with fatality) Confusion Swollen veins Weight loss Vomiting[justbelieverecovery.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]
  • 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]
  • 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]
  • 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]
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]
  • 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]
  • 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[medlineplus.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]
Jaundice
  • No single behavioural change occurred before the onset of jaundice, although reductions in alcohol and/or dietary intake were common. Reduction in alcohol use was seen to occur approximately 14 days before the onset of jaundice.[ncbi.nlm.nih.gov]
  • 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]
  • This clinical picture is characterized by: jaundice with a duration of less than three months, jaundice at the first failure event, serum bilirubin greater than 5 mg/dL, ratio AST/ALT 2/1, AST less than 500 IU/L, ALT[ncbi.nlm.nih.gov]
  • Prednisolone administered orally for 10 days produced a slight improvement in the jaundice and fever.[ncbi.nlm.nih.gov]
  • A 49-year-old woman with a history of heavy alcohol drinking was admitted to our hospital due to jaundice and abdominal distention. A blood test showed leukophilia, mild hypoalbuminemia, hyperbilirubinemia, hepatobiliary injury and coagulopathy.[ncbi.nlm.nih.gov]
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]
  • 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]
  • Do a thorough abdominal exam, evaluating for hepatomegaly and/or splenomegaly, hepatic bruit, RUQ tenderness suggesting swelling of liver capsule, ascites.[clinicaladvisor.com]
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]

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:

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.

References

Article

  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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Last updated: 2018-06-22 04:14