Alcoholic Hepatitis

Aka: Alcoholic Hepatitis, Alcoholic Liver Disease, Acute Alcoholic Hepatitis

II. Epidemiology

  1. Alcoholic Hepatitis seen in 33% of chronic Alcoholics

III. Precautions

  1. Acute Alcoholic Hepatitis, although often asymptomatic, may be severe and life threatening

IV. Pathophysiology

  1. Chronic Alcoholic Hepatitis is a precursor to Cirrhosis
  2. Characteristics
    1. Hepatocyte Inflammation, degeneration, and necrosis
    2. Neutrophil and Lymphocyte infiltration

V. Symptoms: Acute Alcoholic Hepatitis

  1. Anorexia
  2. Nausea and Vomiting
  3. Weight loss
  4. Fever
  5. Generalized Abdominal Pain or Right Upper Quadrant Abdominal Pain

VI. Signs: Acute Alcoholic Hepatitis

  1. Tender Hepatomegaly (80-90% of cases)
  2. Jaundice
  3. Ascites
  4. Splenomegaly
  5. Other chronic stigmata may be present (Spider angioma)

VII. Labs

  1. Liver Function Tests
    1. Aspartate Aminotransferase (AST) increased to 100-300 U/L
      1. AST to ALT ratio = 2:1
    2. Alkaline Phosphatase elevated
    3. Gamma glutamyl transferase (GGT) markedly elevated
    4. Serum Bilirubin elevated
    5. Hypoalbuminemia
  2. Complete Blood Count
    1. White Blood Cell Count increased (mean 12.4k, but may range up to 20k)
    2. Mean Corpuscular Volume (MCV) elevated
  3. Other labs
    1. Prolonged INR (or ProTime)

VIII. Management

  1. See Prevention of Liver Disease Progression
  2. Alcohol Cessation
  3. Alcohol Withdrawal protocol
  4. Increased caloric and protein intake
  5. Vitamin Supplementation
    1. Thiamine
    2. Folate
    3. Multivitamin
  6. Corticosteroids (Prednisolone)
    1. Efficacy: Improves survival (n=61)
      1. Two month survival 88% versus 45% with Placebo
      2. Improved survival persists for 1 year
      3. No advantage after 1 year
    2. References
      1. Mathurin (1996) Gastroenterology 110:1847-53 [PubMed]

IX. Prognosis

  1. Acute Alcoholic Hepatitis
    1. Maddrey Discriminant Function predicts patients at highest risk of death
    2. Mortality 10-15% from Acute Hepatitis
  2. Chronic Alcholic Hepatitis
    1. Cirrhosis develops in 50% of chronic Alcoholic Hepatitis patients

X. References

  1. Hill (1998) Postgrad Med 103(4):261-275 [PubMed]

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Related Studies

Ontology: Acute alcoholic liver disease (C0001306)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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