Alcoholic Hepatitis

Alcoholic hepatitis occurs when a person drinks excessive amounts of alcohol, causing inflammation of the liver and liver injury. In severe cases, it can lead to liver failure. The exact mechanism by which alcohol causes alcoholic hepatitis is still unclear. Severe cases lead to fever, elevated white blood cell count, swelling of the abdomen and a condition known as hepatic encephalopathy (decreased level of consciousness due to liver disease).

Alcohol abuse is the most common reason behind getting serious liver disease in the US and Canada. The rate is approximately one percent of the total population. It is unknown exactly who has hepatic hepatitis because the disease is under-diagnosed. If the disease is mild, alcoholic hepatitis is a benign condition that has a low mortality rate. If the disease is bad enough to cause hepatic encephalopathy, the mortality rate is much higher. About 15 percent of those hospitalized with alcoholic hepatitis die within 30 days of diagnosis. The one year survival rate after being hospitalized for alcoholic hepatitis is only about forty percent. Alcoholic hepatitis is more common in Native Americans and in non-white populations. Males are more likely to be affected than women because they drink more but women are more sensitive to getting alcoholic hepatitis if they drink. This is a disease that can develop at any age but the peak incidence is between 20 and 60 years of age.

Under the microscope, there is commonly a great deal of fat in the liver along with fibrous tissue or scar tissue. Fatty liver is the earliest sign of alcoholic liver disease. Things that predispose you to developing alcoholic liver disease include genetic factors, malnutrition, and the amount of alcohol you drink. Tylenol interacts badly with those who have alcoholic hepatitis because the individual does not metabolize Tylenol the way they are supposed to due to liver damage.

Symptoms of alcoholic hepatitis include fever and rapid heart rate. The person breathes rapidly and can develop respiratory alkalosis because of that. The liver is enlarged and usually tender. There may be jaundice of the eyes and/or the skin. The spleen can be enlarged. There can be a flapping tremor of the hands due to metabolic problems in the body. Spider veins are common as is gynecomastia (male breast enlargement). The WBC count can be elevated and there can be a mild anemia due to bone marrow suppression by alcohol. There may be an elevation of the number of platelets in the bloodstream. Liver enzyme levels show an elevated AST level with a mildly elevated ALT level. Both of these, however, are not severely elevated, even in bad alcoholic liver disease. The albumin level is often low because it is not made as well in the liver. There is often an elevated bilirubin level, especially in those with jaundice.

You need to screen for other possible causes of hepatitis, including vital hepatitis and hemochromatosis. High AST and ALT levels are more indicative of viral hepatitis than it is of alcoholic hepatitis. Liver cancer can cause rapid deterioration of the liver function tests and should be looked into whenever suspected.

Imaging studies for alcoholic hepatitis can include an ultrasound of the liver that shows fatty liver with scarring of the liver. This is the preferred test because it is cheap and not invasive. CT scan or MRI scan of the liver can show changes specific to liver disease, including alcoholic hepatitis. A transcutaneous biopsy of the liver will show changes in the liver consistent with alcoholic liver disease. Usually this is not necessary, however and it can be diagnosed with less invasive tests.

The treatment of alcoholic liver disease includes stopping drinking and entering alcoholic rehabilitation. Some patients need vitamin K to counteract a coagulopathy. Some people need treatment for alcohol withdrawal symptoms. If a person is rehabilitated and still has an abnormal liver or liver failure, a liver transplant can be undertaken.