II. Epidemiology
- Alcoholic Hepatitis seen in 33% of chronic Alcoholics
III. Precautions
- Acute Alcoholic Hepatitis, although often asymptomatic, may be severe and life threatening
IV. Pathophysiology
- Chronic Alcoholic Hepatitis is a precursor to Cirrhosis
- Characteristics
- Hepatocyte Inflammation, degeneration, and necrosis
- Neutrophil and Lymphocyte infiltration
V. Symptoms: Acute Alcoholic Hepatitis
- Anorexia
- Nausea and Vomiting
- Weight loss
- Fever
- Generalized Abdominal Pain or Right Upper Quadrant Abdominal Pain
VI. Signs: Acute Alcoholic Hepatitis
- Tender Hepatomegaly (80-90% of cases)
- Jaundice
- Ascites
- Splenomegaly
- Other chronic stigmata may be present (Spider angioma)
VII. Labs
-
Liver Function Tests
- Aspartate Aminotransferase (AST) increased to 100-300 U/L
- AST to ALT ratio = 2:1
- Alkaline Phosphatase elevated
- Gamma glutamyl transferase (GGT) markedly elevated
- Serum Bilirubin elevated
- Hypoalbuminemia
- Aspartate Aminotransferase (AST) increased to 100-300 U/L
-
Complete Blood Count
- White Blood Cell Count increased (mean 12.4k, but may range up to 20k)
- Mean Corpuscular Volume (MCV) elevated
- Other labs
- Prolonged INR (or ProTime)
VIII. Management
- See Prevention of Liver Disease Progression
- Alcohol Cessation
- Alcohol Withdrawal protocol
- Increased caloric and protein intake
- Vitamin Supplementation
-
Corticosteroids (Prednisolone)
- Efficacy: Improves survival (n=61)
- Two month survival 88% versus 45% with Placebo
- Improved survival persists for 1 year
- No advantage after 1 year
- References
- Efficacy: Improves survival (n=61)
IX. Prognosis
- Acute Alcoholic Hepatitis
- Maddrey Discriminant Function predicts patients at highest risk of death
- Mortality 10-15% from Acute Hepatitis
- Chronic Alcholic Hepatitis
- Cirrhosis develops in 50% of chronic Alcoholic Hepatitis patients
X. References
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 571.1 |
| SnomedCT | 155810001, 9953008 |
| Dutch | acute alcoholische hepatitis, acuut; hepatitis, alcoholisch, hepatitis; acuut, alcoholisch |
| French | Hépatite alcoolique aiguë |
| German | akute alkoholische Hepatitis |
| Italian | Epatite acuta alcolica |
| Portuguese | Hepatite alcoólica aguda |
| Spanish | Hepatitis aguda alcohólica, daño hepático agudo por alcohol, hepatitis alcohólica aguda (trastorno), hepatitis alcohólica aguda |
| Japanese | 急性アルコール性肝炎, ｷｭｳｾｲｱﾙｺｰﾙｾｲｶﾝｴﾝ |
| Czech | Akutní alkoholická hepatitida |
| English | Ac alcoholic hepatitis, acute alcoholic hepatitis, Acute alcoholic hepatitis (disorder), Acute alcoholic hepatitis, Acute alcoholic liver disease, Acute alcoholic liver disease (disorder), hepatitis; acute, alcoholic, acute; hepatitis, alcoholic, Acute Alcoholic Hepatitis |
| Hungarian | Acut alkoholos hepatitis |
Ontology: Hepatitis, Alcoholic (C0019187)
| Definition (MSH) | INFLAMMATION of the LIVER due to ALCOHOL ABUSE. It is characterized by NECROSIS of HEPATOCYTES, infiltration by NEUTROPHILS, and deposit of MALLORY BODIES. Depending on its severity, the inflammatory lesion may be reversible or progress to LIVER CIRRHOSIS. |
| Definition (MSHCZE) | Jaterní poškození způsobené alkoholem, zejm. excesem v rámci dlouhodobého alkoholismu; další prognózu výrazně ovlivňuje další konzumace alkoholu či úplná abstinence. Kromě známek zánětu bývá i steatóza.(cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (CSP) | acute or chronic degenerative and inflammatory lesion of the liver in the alcoholic which is potentially progressive though sometimes reversible; it does not necessarily include steatosis, fibrosis, or cirrhosis of the liver, although it is frequently associated with these conditions; it is characterized by liver cell necrosis, infiltration by polymorphonuclear leukocytes and lymphocytes, and Mallory bodies. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D006519 |
| ICD10 | K70.1 |
| SnomedCT | 197312006, 235875008 |
| English | Alcoholic Hepatitis, Hepatitis, Alcoholic, alcoholic hepatitis (diagnosis), alcoholic hepatitis, Hepatitis alcoholic, Hepatitis, Alcoholic [Disease/Finding], Hepatitis;alcoholic, hepatitis alcohol, alcoholics hepatitis, alcohol hepatitis, hepatitis alcoholic, Alcoholic hepatitis, AH - Alcoholic hepatitis, Alcoholic hepatitis (disorder), ethanol; hepatitis, hepatitis; alcoholic, hepatitis; ethanol, alcohol; hepatitis |
| Italian | Epatite alcoolica, Epatite alcolica |
| Dutch | alcoholische hepatitis, alcohol; hepatitis, ethanol; hepatitis, hepatitis; alcoholisch, hepatitis; ethanol, hepatitis door alcoholgebruik, Alcoholhepatitis, Alcoholische hepatitis, Hepatitis, alcoholische |
| Swedish | Hepatit, alkoholbetingad |
| Japanese | ｱﾙｺｰﾙｾｲｶﾝｴﾝ, アルコール性肝炎, 肝炎-アルコール性 |
| Czech | hepatitida alkoholická, Alkoholická hepatitida |
| Finnish | Alkoholimaksatulehdus |
| Russian | ALKOGOL'NYI GEPATIT, GEPATIT ALKOGOL'NYI KHRONICHESKII, GEPATIT ALKOGOL'NYI, АЛКОГОЛЬНЫЙ ГЕПАТИТ, ГЕПАТИТ АЛКОГОЛЬНЫЙ, ГЕПАТИТ АЛКОГОЛЬНЫЙ ХРОНИЧЕСКИЙ |
| German | Alkoholische Hepatitis, Hepatitis alkoholisch, Alkoholhepatitis, Hepatitis, alkoholische |
| Korean | 알코올성 간염 |
| Polish | Zapalenie wątroby alkoholowe |
| Hungarian | Alkoholos májgyulladás, Alkoholos hepatitis |
| Norwegian | Alkoholisk hepatitt, Alkoholisk leverbetennelse, Hepatitt, alkoholrelatert, Leverbetennelse, alkoholrelatert |
| Spanish | hepatitis alcohólica (trastorno), hepatitis alcohólica, Hepatitis alcohólica, Hepatitis Alcohólica |
| Portuguese | Hepatite alcoólica, Hepatite Alcoólica |
| French | Hépatite alcoolique, Hépatite éthylique |
Ontology: Alcoholic Liver Diseases (C0023896)
| Definition (MSHCZE) | Jaterní onemocnění spojené s ALKOHOLISMEM. Obvykle je deskriptorem odkazováno na výskyt dvou či více alkoholických následků jako je např. ukládání tuku v játrech (STEATÓZA JATER ALKOHOLICKÁ), HEPATITIDA nebo cirhóza (JÁTRA - CIRHÓZA). |
| Definition (NCI) | A disorder caused by damage to the liver parenchyma due to alcohol consumption. It may present with an acute onset or follow a chronic course, leading to cirrhosis. |
| Definition (MSH) | Liver diseases associated with ALCOHOLISM. It usually refers to the coexistence of two or more subentities, i.e., ALCOHOLIC FATTY LIVER; ALCOHOLIC HEPATITIS; and ALCOHOLIC CIRRHOSIS. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D008108 |
| ICD10 | K70 , K70.9 |
| SnomedCT | 155809006, 266537000, 41309000 |
| English | Liver Disease, Alcoholic, Liver Diseases, Alcoholic, Alcoholic liver disease, unspecified, LIVER DIS ALCOHOLIC, ALCOHOLIC LIVER DIS, alcohol induced liver disorder, alcoholic liver disorder, Alcoholic liver disease NOS, Hepatopathy alcoholic, Liver Diseases, Alcoholic [Disease/Finding], alcoholic disease liver, alcoholic diseases liver, alcoholics disease liver, alcoholic liver disease, alcoholic liver diseases, alcoholic liver disease (diagnosis), Alcoholic liver diseases, ALD - Alcoholic liver disease, Alcoholic liver disease, disease (or disorder); liver, alcoholic, liver; alcohol, liver; disease, alcoholic, alcohol; liver, Alcoholic liver disease, NOS, Alcoholic Liver Diseases, Alcoholic Liver Disease |
| Italian | Epatopatia alcoolica, Epatopatia alcoolica NAS, Malattie epatiche alcoliche |
| Dutch | alcoholische hepatopathie, leverziekte door alcoholgebruik NAO, aandoening; lever, bij alcoholgebruik, alcohol; lever, lever; aandoening, bij alcoholgebruik, lever; alcohol, Alcoholische leverziekte, niet gespecificeerd, alcoholische leverziekte, Alcoholische leverziekte, Alcoholische leverziekten, Leverziekte, alcoholische, Leverziekten, alcoholische, Ziekte, lever-, alcoholische |
| French | Hépatopathie alcoolique, Maladie alcoolique du foie SAI, MAF (Maladie Alcoolique du Foie), Maladies hépatiques dues à l'alcool, Maladie alcoolique du foie, Maladie du foie liée à l'alcool, Maladies alcooliques du foie, Maladies hépatiques alcooliques |
| German | alkoholische Lebererkrankung NNB, Lebererkrankung alkoholbedingt, Alkoholische Leberkrankheit, nicht naeher bezeichnet, Alkoholische Leberkrankheit, alkoholische Lebererkrankung, Alkoholische Leberkrankheiten, Leberkrankheiten, alkoholische |
| Portuguese | Hepatopatia alcoólica NE, Hepatopatia alcoólica, Doença hepática associada ao álcool, Hepatopatias Alcoólicas |
| Spanish | Hepatopatía alcohólica NEOM, Hepatopatía alcohólica, hepatopatía alcohólica (trastorno), hepatopatía alcohólica, Enfermedad alcohólica del hígado, Hepatopatías Alcohólicas |
| Japanese | アルコール性肝疾患ＮＯＳ, ｱﾙｺｰﾙｾｲｶﾝｼｯｶﾝNOS, ｱﾙｺｰﾙｾｲｶﾝｼｯｶﾝ, ｱﾙｺｰﾙｾｲｶﾝｼｮｳｶﾞｲ, 肝疾患-アルコール性, アルコール性肝疾患, アルコール性肝障害 |
| Swedish | Leversjukdomar, alkoholbetingade |
| Finnish | Alkoholimaksasairaudet |
| Russian | ALKOGOL'NYE BOLEZNI PECHENI, PECHENI BOLEZNI ALKOGOL'NYE, АЛКОГОЛЬНЫЕ БОЛЕЗНИ ПЕЧЕНИ, ПЕЧЕНИ БОЛЕЗНИ АЛКОГОЛЬНЫЕ |
| Czech | Alkoholická hepatopatie, Poškození jater alkoholem, Alkoholická jaterní léze NOS, alkoholické nemoci jater, onemocnění jater způsobená alkoholem, játra - nemoci alkoholické |
| Korean | 상세불명의 알코올성 간질환, 알코올성 간질환 |
| Croatian | JETRENE BOLESTI, ALKOHOLNE |
| Polish | Choroby wątroby alkoholowe, Choroby wątroby poalkoholowe |
| Hungarian | Alkoholos májbetegség, Alkoholos májbetegség k.m.n., Hepatopathia alkoholica |
| Norwegian | Leversykdommer, alkoholrelaterte, Alkoholiske leversykdommer |
