Alcoholic Hepatitis


Alcoholic hepatitis is a condition in which the liver is damaged because of the increased consumption of alcohol for a longer duration of time. Alcohol is metabolized through the liver. The intermediate product of the alcohol acetaldehyde combines with the protein and forms a complex that damages the cells of the liver, the damaged cells attract the immune cells causing hepatitis. alcohol damages the liver progressively presenting in stages of fatty liver, alcoholic hepatitis, and lastly results in cirrhosis of the liver.

In recent times the number of people consuming alcohol has increased. Alcohol has become an important cause of liver-related deaths in many countries. Drinking alcohol for a longer duration and excessive consumption results in damage to the liver. Patients with alcoholic liver disease present with no symptoms in the early stage of the disease which later can lead to severe complications affecting the brain leading to death. Individuals suffering from hepatitis infection, fatty liver because of other causes are more prone to develop alcoholic hepatitis

When the individual has developed a fatty liver complete cessation of alcohol can reverse the condition if continued consuming the alcohol patient develops hepatitis and cirrhosis. since alcoholic hepatitis is life-threatening if neglected should be diagnosed, treated, and prevented in its early stages itself.

Alcoholic Hepatitis: Causes

Alcoholic hepatitis as the name indicates is damage to them because of alcohol. Increased consumption and drinking for longer duration cause damage to the liver.

  • Liver is the main center for the metabolism of alcohol. Ethanol(alcohol) when consumed is converted into acetaldehyde by alcohol dehydrogenase. Acetaldehyde formed is converted into acetic acid by acetaldehyde dehydrogenase then it is formed into acetyl-CoA which enters the citric acid cycle.

  • Acetaldehyde the intermediate product is toxic and causes damage to the liver cells. Accumulation of fat occurs within the hepatocytes because of the enzyme alcohol dehydrogenase and distorts the normal liver cell structure. Further, these damaged cells attract the immune cells neutrophils, lymphocytes, etc causing alcoholic hepatitis and later fibrosis of the liver happens leading to alcoholic cirrhosis.

  • Women tend to get affected more than men. Patients suffering from hepatitis infection and fatty liver because of non-alcoholic causes are more prone to develop the disease.

The following image shows the image of the progression of the liver damage caused by alcohol.

Alcoholic Hepatitis: Symptoms

Patients suffering from alcoholic hepatitis initially present with no symptoms. As the disease progresses the individual presents the following symptoms which include −

  • Mild pain or discomfort present in the right upper part of the abdomen

  • Sensation of vomiting

  • Yellowish discoloration of the body

  • Fever

  • Weakness and fatigue

  • Enlarged liver

  • Itching

  • Decreased body hair

  • Fluid collection in the abdomen

  • Loss of appetite

  • Loss of weight

  • Drying of the mouth and increased thirst

  • Bleeding from the enlarged veins in the walls of the lower part of the esophagus

  • Small, reddish spider-like veins

  • Redness on the hands and feet

When brain involvement is present, the patient presents with

  • Problems in thinking, memory, mood

  • Giddiness and light-headedness

  • The feeling of numbness in the legs and feet

Alcoholic Hepatitis: Risk Factors

The important risk factor for the development of alcoholic hepatitis include −

  • Alcohol − As the name indicates alcohol hepatitis is caused by excessive drinking of alcohol. Alcohol when consumed more than a daily dose for a longer duration is more at higher risk. drinking on empty stomach also increases the risk.

  • Gender − Women are more susceptible than men

  • Hepatitis C infection − Patients suffering from hepatitis C infection have a higher risk

  • Genetic factors − Genetic alteration of the enzymes which help in the metabolism of alcohol can increase the risk. patatin like phospholipase domain-containing protein 3 is associated with liver cirrhosis

  • Fatty liver − Obesity and non-alcoholic fatty liver are at increased risk.

  • Increased iron load in the body

  • Diet − Malnutrition, particularly vitamin A and E deficiencies, which increase alcohol-induced liver damage.

Alcoholic Hepatitis: Diagnosis

The diagnosis of alcohol depends on the history, clinical presentation, and laboratory investigations.

  • Liver function tests − Shows increased AST to ALT ratio, ALT is usually less than 100IU/L, Increased Gamma-GT, increased alkaline phosphatase

  • Renal function − Renal factors are altered

  • Haematological − Shows decreased hemoglobin, and decreased platelet count

  • Other abnormalities − The patient shows other abnormalities such as increased uric acid, increased triglycerides, raised IgA, increased sugar levels

  • Ultrasonography − This is the preferred method as it is non-invasive and easily accessible. USG shows enlarged liver and also it is used to exclude other similar conditions

  • Liver biopsy − This is used to assess the severity of liver damage

Alcoholic Hepatitis: Treatment

Management of alcoholic hepatitis is very important as it can become life-threatening. Treatment of alcoholic hepatitis includes −

General Measures

  • The mainstay of the treatment is completely avoided drinking

  • Treat the symptoms of withdrawal

  • Thiamine and multivitamin supplementation

  • Bed rest

  • High protein diet

Therapeutic Agents

  • Corticosteroids − Are given to reduce inflammation, and immune-mediated injury, and also act by inhibiting cytokine production and production

  • Pentoxifylline − Acts by inhibiting the tumor necrosis factor production

  • Treatment of complications such as variceal bleeding, encephalopathy, and ascites.

  • Liver transplantation − It is the Final mode of treatment when other treatment modalities do not help.

Alcoholic Hepatitis: Prevention

Prevention of alcoholic hepatitis is important as it can cause severe complications and if left untreated can involve the central nervous system also. some of the measures sure taken to avoid the occurrence of alcoholic hepatitis are −

  • As alcohol is the main cause it should be avoided completely or should be taken in limited amounts. Alcohol should not be consumed on empty stomach. Women, old age people, and younger people should drink alcohol in limited amounts as they are at more risk. alcohol should not be mixed with other medicines

  • HepatitisC infection should be treated otherwise it increases the risk of developing alcoholic hepatitis.

Conclusion

Alcoholic hepatitis is a condition in which the liver is damaged because of the excess consumption of alcohol. The damage is mainly because of the intermediate product formed which damages the liver cells. Alcoholic hepatitis is a slowly progressive condition that n initially presents with no symptoms and s later presents with yellowish discoloration of the body, nausea, vomiting, pain in the abdomen, weakness, etc. If not diagnosed and treated can involve the central nervous system and become life-threatening.

Drinking in excess amounts for a longer duration, older age people and women, and patients suffering from hepatitis C infection who have a habit of drinking alcohol are at increased risk of developing alcoholic hepatitis. This condition is diagnosed based on altered liver functions, USG showing enlarged liver with fatty changes, and a liver biopsy to assess the amount of liver damage.

Alcohol hepatitis is mainly prevented by avoiding the cause that is by avoiding alcohol. Ones if it has developed corticosteroids, pentoxifylline is shown to improve the condition. the last measure of treatment involves liver transplantation.

Dr. Durgesh Kumar Sinha
Dr. Durgesh Kumar Sinha

MBBS MS [ OPHTHALMOLOGY ]

Updated on: 02-Mar-2023

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