what is alcoholic hepatitis:
Alcoholic hepatitis is hepatitis (inflammation of the liver) due to excessive intake of alcohol. While distinct from cirrhosis, it is regarded as the earliest stage of alcoholic liver disease.
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.
This will depend on the severity of the alcoholic hepatitis.In mild cases only abstinence from alcohol and nutritional support are required.But in acute severe alcoholic hepatitis – characterised by jaundice, easy bruising, abnormal blood tests and sometimes the presence of extra fluid within the abdomen (ascites) – hospital admission is necessary.Steroids can also help some of these patients, but even with steroids 10 to 15 per cent die within three months of developing the disease.Kidney failure, if it occurs, leads to an almost 100 per cent mortality rate.
2)Nausea and Vomiting
5)Generalized Abdominal Pain
6) Jaundice is usually one of the most common symptom. Some common mode of presentations are: jaundice - 50% of the patients, ascites in 30 - 60% and splenomegaly - 15% of the patients.
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.
1)Tender Hepatomegaly (80-90% of cases)
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.Features of portal hypertension - Ascites, dilated abdominal wall veins, splenomegaly and oesophageal varices are not a prominent features of pure alcoholic hepatitis.Liver is very large and tender on palpation its surface is smooth and consistency is soft to firm.
The ratio of aspartate aminotransferase to alanine aminotransferase is usually 2 or more.In most cases, the liver enzymes do not exceed 500.
Fatty liver is usually diagnosed in the asymptomatic patient who is undergoing evaluation for abnormal liver function tests; typically, aminotransferase levels are less than twice the upper limit of normal. No laboratory test is diagnostic of fatty liver.
Characteristic ultrasonographic findings include a hyperechoic liver with or without hepatomegaly. Liver biopsy is rarely needed to diagnose fatty liver in the appropriate clinical setting, but it may be useful in excluding steatohepatitis or fibrosis.
Clinical practice guidelines by the American College of Gastroenterology recommend corticosteroids.Patients should be risk stratified using a MELD Score or Child-Pugh score.
Hospitalization is indicated to expedite a diagnostic evaluation of patients with jaundice, encephalopathy, or ascites of unknown cause. In addition, patients with known alcoholic liver disease who present with renal failure, fever, inadequate oral intake to maintain hydration, or rapidly deteriorating liver function, as demonstrated by progressive encephalopathy or coagulopathy, should be hospitalized.