Acute alcoholic hepatitis

Background

Acute alcoholic hepatitis is inflammatory liver disease secondary to alcohol use.

• spectrum from hepatic steatosis to alcoholic hepatitis to cirrhosis
• history of (usually chronic) alcohol abuse (~80 grams of ethanol daily for 5 years (2))
• ranges from subclinical cases to severe multisystem dysfunction

Clinical Features

Symptoms

• abdominal pain
• N/V
• weight loss / fatigue / anorexia

Signs

• RUQ tenderness
• jaundice
• fever
• hepatomegaly
• ascites
• encephalopathy
• spider angioma
• GI bleed/varices
• malnutrition
• symptoms of alcohol withdrawal

Cirrhosis is found in 50-60% of cases of alcoholic hepatitis (2).

Differential Diagnosis

• viral hepatitis
• acetaminophen toxicity
• alcoholic pancreatitis
• gallstones
• Budd-Chiari syndrome

Diagnosis

1. History of significant alcohol intake
2. Clinical evidence of liver disease
3. Supporting laboratory abnormalities

• • May be nondiagnostic in patients with mild disease or early cirrhosis

Diagnosis is difficult and relies on a good history (1). Laboratory analysis may find an AST/ALT ratio of >1.5, elevated GGT, elevated WBC (1).

Management

Abstinence from alcohol, nutritional supplementation (thiamine, folate

References

1. Amini, Maziyar; Runyon, Bruce. "Alcoholic Hepatitis 2010: A clinician's Guide to Diagnosis and Therapy." World of Gatstroenterol 2010 October 21; 16(39):4905-4912
2. Basra, Gurjot,et. al. "Symptoms and Signs of Acute Alcoholic Hepatitis." World J Hepatol. 2011 May 27; 3(5): 118–120.