Limbic 365Alcoholic hepatitis is a serious and potentially life-threatening inflammation of the liver caused by long-term excessive alcohol consumption. This condition can occur in individuals who consume large amounts of alcohol over a period of years, and is often seen in those who have a history of alcoholism.
Case:
A 45-year-old man presents to the hospital with a history of heavy alcohol consumption. He reports that he has been drinking heavily for the past 10 years, with a daily intake of at least a pint of whiskey. He reports feeling increasingly tired and unwell over the past few weeks, with yellowing of his skin and eyes. On examination, he is jaundiced, with an enlarged and tender liver.
Pathophysiology:
Alcohol is metabolized in the liver, and long-term excessive alcohol consumption can lead to damage and inflammation of liver cells, which can progress to alcoholic hepatitis. The exact pathophysiology is not completely understood, but it is thought that chronic alcohol consumption can increase the production of cytokines, which can cause inflammation and damage to the liver cells. Alcohol also increases the production of reactive oxygen species, which can damage liver cells and promote inflammation.
Signs and Symptoms:
The signs and symptoms of alcoholic hepatitis can range from mild to severe and include:
- Jaundice (yellowing of the skin and eyes)
- Fatigue and weakness
- Abdominal pain and tenderness
- Loss of appetite
- Nausea and vomiting
- Fever
- Enlarged and tender liver
- Ascites (fluid accumulation in the abdomen)
Investigations:
Diagnosis of alcoholic hepatitis typically involves a combination of clinical assessment, blood tests, and imaging studies. Blood tests may reveal elevated liver enzymes, and imaging studies such as ultrasound or CT scan may show signs of liver inflammation and scarring. A liver biopsy may be performed to confirm the diagnosis and determine the severity of the liver damage.
Treatment:
The treatment of alcoholic hepatitis involves a combination of lifestyle modifications and medical therapies. The primary goal of treatment is to stop drinking alcohol and to provide supportive care for the liver. Treatment options may include:
- Abstinence from alcohol
- Nutritional support, including a high-protein, low-fat diet and vitamin supplementation
- Medications to reduce inflammation and liver damage, such as corticosteroids and pentoxifylline
- Management of complications, such as ascites and hepatic encephalopathy
- In severe cases, hospitalization may be required, and in some cases, a liver transplant may be necessary.
Dos and Don’ts:
To prevent further liver damage, individuals with alcoholic hepatitis should follow a few dos and don’ts:
Dos:
- Stop drinking alcohol completely.
- Follow a healthy and balanced diet, including high-protein, low-fat foods.
- Take prescribed medications as directed.
- Get regular medical check-ups to monitor liver function.
Don’ts:
- Do not drink alcohol.
- Do not take any medications or supplements without consulting a healthcare provider.
- Avoid exposure to toxins and chemicals that can damage the liver.
- Do not smoke or use tobacco products.
Reference:
Singal AK, Kamath PS, Gores GJ, Shah VH. Alcoholic hepatitis: current challenges and future directions. Clin Gastroenterol Hepatol. 2014;12(4):555-564.
Louvet A, Naveau S. Alcoholic hepatitis: diagnosis and treatment. Clin Liver Dis. 2012;16(4):717-736.
National Institute on Alcohol Abuse and Alcoholism. Alcohol and Liver Disease. Accessed on 25 March 2023.
