Alcoholic Hepatitis (AH) – Overview
Alcoholic hepatitis is an inflammatory condition of the liver caused by heavy and prolonged alcohol use. It ranges from mild to life-threatening, with symptoms that can develop suddenly after years of drinking. Some people with alcoholic hepatitis may later develop cirrhosis, an irreversible scarring of the liver.
Symptoms
- Jaundice (yellowing of the skin and eyes)
- Loss of appetite
- Nausea and vomiting
- Fever
- Abdominal pain and tenderness (especially in the upper right quadrant)
- Fatigue and weakness
- Swelling of the abdomen (ascites) or legs (edema)
- Confusion, drowsiness, or behavior changes (hepatic encephalopathy)
- Easy bruising or bleeding
Causes
- Excessive alcohol intake: The primary cause; typically heavy drinking for many years.
- Pattern of drinking: Binge drinking or consistent daily intake increases risk.
- Genetics: Some people are more susceptible due to inherited enzyme variations.
- Gender: Women are more vulnerable to alcohol’s toxic effects on the liver.
- Poor nutrition: Alcohol interferes with nutrient absorption, worsening liver injury.
Diagnosis
- Medical history & physical exam: History of alcohol use plus signs like jaundice or enlarged liver.
- Blood tests:
- Elevated liver enzymes (AST often higher than ALT, usually in a 2:1 ratio)
- Increased bilirubin
- Abnormal clotting tests (INR)
- Imaging: Ultrasound, CT, or MRI to check for enlarged liver, fatty infiltration, or cirrhosis.
- Liver biopsy (sometimes): To confirm inflammation and rule out other causes.
Liver function tests (ALT, AST) will usually be elevated in acute hepatitis or active chronic hepatitis, signaling liver inflammation. Doctors may also evaluate liver damage with imaging (ultrasound, FibroScan) or occasionally a liver biopsy if needed, especially in chronic cases to assess fibrosis.
Treatment
- Stop alcohol completely – the most important step.
- Nutritional support: High-protein, high-calorie diet; vitamin supplements (especially thiamine and folate).
- Medications:
- Corticosteroids (like prednisolone) in severe cases to reduce inflammation.
- Pentoxifylline may be used if steroids are contraindicated.
- Treat complications: Ascites, infections, encephalopathy, bleeding.
- Liver transplant: In severe, non-reversible cases where patients remain abstinent.
FAQs
Yes, mild cases can improve with complete alcohol abstinence and proper treatment. Severe cases can lead to permanent damage.
There’s no exact safe threshold, but typically years of heavy drinking (3–4+ drinks daily) raise the risk. Some individuals are more sensitive.
No. Hepatitis is inflammation; cirrhosis is scarring. However, hepatitis can progress to cirrhosis if alcohol use continues.
Long-term heavy drinkers, women, those with poor nutrition, and people with genetic predisposition.
Yes, if diagnosed early and alcohol is stopped permanently. In severe or advanced cases, recovery may be partial, and transplant may be needed.