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Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption.
Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C. The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis in Western countries.
Some alcoholics get an acute hepatitis or inflammatory reaction to the cells affected by fatty change. This is not directly related to the dose of alcohol. Some people seem more prone to this reaction than others. This is called alcoholic steatonecrosis and the inflammation probably predisposes to liver fibrosis.

Contents

Symptoms and signs

Diagnosis

Pathophysiology

Treatment/Management

Corticosteroids

Pentoxifylline

References

See also

External links

Symptoms and signs

Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset.

Diagnosis

The ratio of aspartate aminotransferase to alanine aminotransferase is usually > 2.^[1]

Pathophysiology

Some signs and pathological changes in liver histology include:

★ Mallory's Hyaline - a condition where pre-keratin filaments accumulate in hepatocytes. This sign is not limited to alcoholic liver disease, but is often characteristic.^[2]

★ Ballooning degeneration - hepatocytes in the setting of alcoholic change often swell up with excess fat, water and protein; normally these proteins are exported into the bloodstream. Accompanied with ballooning, there is necrotic damage. The swelling is capable of blocking nearby biliary ducts, leading to diffuse cholestasis.^[3]

★ Inflammation - Neutrophilic invasion is triggered by the necrotic changes and presence of cellular debris within the lobules. Ordinarily the amount of debris is removed by Kupffer cells, although in the setting of inflammation they become overloaded, allowing other white cells to spill into the parenchyma. These cells are particularly attracted to hepatocytes with Mallory bodies.^[3]
If chronic liver disease is also present:

★ fibrosis

★ Cirrhosis - a progressive and permanent type of fibrotic degeneration of liver tissue.

Treatment/Management

Clinical practice guidelines by the American College of Gastroenterology recommend corticosteroids.^[5]

Corticosteroids

Patients with a discriminant function score > 32 or hepatic encephalopathy should be considered for treatment with prednisolone 40 mg daily for four weeks followed by a taper.

Pentoxifylline

A randomized controlled trial found that 5 patients with a discriminant function score > 32 and at least one of palpable tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic bruit must be treated with pentoxifylline 400 mg orally 3 times daily for 4 weeks for one to prevent one patient from dying. ^[6]

References

1. The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease, Sorbi D, Boynton J, Lindor KD, , , Am. J. Gastroenterol., 1999
2. Robbins Pathologic Basis of Disease, , , Cotran, W.B Saunders Company, , 0-7216-7335-X
3.
4.
5. Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology, McCullough AJ, O'Connor JF, , , Am. J. Gastroenterol., 1998
6. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial, Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O, , , Gastroenterology, 2000 (ACP Journal Club synopsis)

See also

External links