Alcoholic Hepatitis - Causes, Symptoms, Diagnosis, Treatment, and Complications

Introduction:

Alcoholic hepatitis is a liver swelling caused by drinking too much alcohol for many years. This results in fat deposition in the liver initially, leading to inflammation or swelling of the liver and, finally, damage to the liver cells. Excess alcohol consumption means drinking more than 14 drinks per week.

As a result, the patient may present with signs and symptoms like pain in the belly region (abdomen), enlarged belly (ascites), frequent episodes of low fever, vomiting blood, malnutrition (when the body lacks essential nutrients), jaundice (yellowish discoloration of the skin and eyes), enlarged liver, enlarged spleen, enlarged veins in the esophagus (food pipe) and bleeding in the gastrointestinal tract. The disease is found by performing various blood tests like liver function tests, complete blood count, and blood clotting tests.

What Causes Alcoholic Hepatitis?

Alcohol-induced hepatitis is caused by consuming heavy alcohol over many years. Drinking alcohol of more than 100 mg per day over 20 years results in alcoholic hepatitis. Heavy drinking is considered to consume 14 drinks a week in males and seven drinks a week in females. One of the liver's primary functions is to metabolize alcohol and medications (absorb the intake and remove the waste from the body).

During this breakdown of alcohol, harmful (toxic) chemicals are released into the blood. These toxins are removed from the blood and taken out of the body by the liver. When there is a constant presence of alcohol in the blood, there is also an abnormal accumulation of toxins. These toxins damage the liver cells, causing excess fat deposition and swelling of the liver. The inflamed (swollen) liver cells replace the healthy liver tissues with scar tissues, leading to liver scarring (cirrhosis). This prevents the liver from working properly and causes liver failure.

What Are the Symptoms of Alcoholic Hepatitis?

• Swelling of the Abdomen (Ascites): Fluid accumulation in the abdomen. The portal veins carry blood from the digestive system to the liver. When the liver does not function properly, there is high pressure in the portal vein. As a result, the fluid overflows from the vein and gets collected in the abdomen.

• Pain in the Belly Region (Abdomen): The liver is in the abdomen. There will be pain since the liver is inflamed and healthy liver cells are damaged.

• Vomiting Blood (Hematemesis): The alcohol damages and tears the gastrointestinal (GI) walls. These tears cause bleeding in the GI tract, resulting in blood vomiting.

• Jaundice: The liver removes bilirubin (a yellow pigment) from the blood, which results from the processing of red blood cells. However, when the liver does not function properly, the bilirubin is not removed and remains in the blood, causing jaundice.

• Malnutrition: Alcohol interferes with absorbing nutrients and extracts them from the body.

• Bleeding in the Gastrointestinal (GI) Tract: Consuming alcohol causes damage to the intestinal walls.

• Hepatomegaly: Enlargement or swelling of the liver due to damaged liver tissues.

• Splenomegaly: Enlarged or swelling of the spleen results from the deposition of blood or fluids in the spleen. The portal vein carries blood supply to the liver. When the vein is blocked by scar tissue, the pressure inside the portal vein increases; this causes the blood to backflow and accumulate in the spleen.

• Low-Grade Fever: Endotoxins are substances present in the cell wall of gram-negative bacteria. They create fever and swelling when they are released into the blood. These endotoxins are present in portal blood. During liver damage, these endotoxins are not cleared from the blood by the liver. Hence, frequent low-grade fever is present.

• Loss of Appetite: Alcohol suppresses the urge to take food.

How Can Alcoholic Hepatitis Be Found?

• Physical Examination: The doctor will touch the abdomen and feel the liver and spleen if they are enlarged. They will also check for jaundice in the skin and eyes.

• Complete Blood Count: This is a blood test where all the blood components, like red blood cells, white blood cells, platelets, and hemoglobin, are checked.

• Liver Function Tests (LFT): Liver function tests are performed to rule out liver disease. Liver enzymes like alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and lactate dehydrogenase (LD) are checked. Proteins like albumin and globulin, bilirubin, and prothrombin tests are done. Changes in the normal values of these components confirm liver damage or disease.

• Ultrasound Scan: A high-frequency sound wave captures images of structures or organs inside the body. An ultrasound scan of the abdomen helps to find liver disease.

• CT Scan: Computerized tomography (CT) uses X-ray radiation to capture images of internal organs and bony structures with the help of a computer-generated report. It unravels if any abnormality is detected in the liver.

• MRI Scan: Magnetic resonance imaging (MRI) captures pictures of internal organs, soft tissues, and other nearby structures. It uses a combination of radio waves and magnetic waves for a detailed image of the structure to detect abnormalities.

• Liver Biopsy: In a liver biopsy, a tiny tissue is removed from the lesion or the suspected organ to look for pathological changes in a microscope. It detects the abnormality and discloses the type of lesion or condition.

Alcoholic Hepatitis Is Prevalent In?

Alcoholic hepatitis is prevalent in adults aged 40 to 60 years and people drinking more than 100 mg of alcohol daily over 20 years.

Who Is at Risk of Getting Alcoholic Hepatitis?

• Women: Women are at risk as there is a difference in the processing of alcohol in men and women.

• Genetic Factors: People with a family history of liver diseases are at high risk.

• Race: Africans and Hispanics (people from countries related to Spain and Spanish culture).

What Are the Complications of Alcoholic Hepatitis?

• Cirrhosis: The scar tissue forms over the healthy liver cells when there is a progressive liver disease. This hardens the liver and does not function properly, further leading to liver failure.

• Enlarged Esophageal Veins: Esophageal varices or enlarged esophageal veins result from blockage of the blood flow to the liver. This blockage can be due to a clot or liver scar tissue.

• Liver Cancer: Since alcohol is a class 1 carcinogen (cancer-causing agent), excess alcohol drinking increases the risk of liver cancer.

• Ascites: Accumulation of fluid in the abdomen.

• Organ Failure: Alcoholic hepatitis affects the blood flow to the kidney, causing the organ to fail to function correctly.

• Infection: A damaged liver does not function properly and is more prone to infection. People also get peritonitis (infection of ascites) and other bacterial infections.

• Hepatic Encephalopathy: The damaged liver does not remove toxins from the blood, accumulating toxins in the blood. These toxins travel to the brain and affect the brain cells, causing severe hepatic encephalopathy (disturbed nervous system). Hepatic encephalopathy causes confusion, drowsiness, slurred speech, and progression to coma.

How Is Alcoholic Hepatitis Treated?

• Quitting Alcohol: Quitting alcohol in the early detection of the disease will reverse the liver damage. The liver will self-repair entirely if there is no alcohol in the system for six to twelve months. Though the scar tissues on the liver are permanent, a few parts of the liver will self-heal.

• Antibiotics: Antibiotics will be recommended as patients with alcoholic hepatitis are more prone to bacterial infections.

• Diet: Following a low-sodium diet.

• Steroids: Corticosteroids will be recommended to reduce liver inflammation.

• Vitamin Supplements: Vitamins and minerals supplements will be prescribed to patients with alcoholic hepatitis as they are malnourished.

• Liver Transplant: A liver transplant will be considered in severe liver damage cases. Alcohol needs to be stopped six months before the procedure.

• Counseling: Quitting alcohol totally might create withdrawal symptoms like confusion, seizure, anxiety, hallucinations, and excessive sweating. Psychological counseling by an expert might help crush alcohol cravings and avoid drinking.

What Is the Prognosis of Alcoholic Hepatitis?

The prognosis of the disease is good with early detection and quitting alcohol. However, if the person continues drinking alcohol, the liver is further damaged, resulting in cirrhosis.

How to Prevent Alcoholic Hepatitis?

Alcoholic hepatitis can be prevented by limiting drinking alcohol. Women can limit to less than one drink daily, and men can limit to less than two drinks daily.

• Quitting alcohol completely is the best choice.

• Following a healthy lifestyle.

• Exercising regularly.

• Eating a balanced diet includes proteins, fibers, vitamins, and carbohydrates.

• Following a low-sodium diet and staying hydrated.

Conclusion:

Alcoholic encephalopathy is a serious condition if not found early. The damage to the liver can be reversed by quitting alcohol. The liver has the property of self-healing. In mild cases of liver damage, the liver will recover completely within 6 to 12 months without alcohol in the system. In severe cases, only a few portions of the liver will heal without alcohol consumption. Though alcoholic encephalopathy is a serious condition, quitting alcohol and following a healthy lifestyle will delay the disease's progression.