From the Guidelines
Early signs of alcoholic hepatitis include jaundice, malaise, tender hepatomegaly, and decompensation, and the condition is reversible in its early stages if alcohol consumption is stopped completely. The diagnosis of alcoholic hepatitis is based on a combination of clinical, laboratory, and histological findings, including a history of heavy alcohol use, elevated serum aspartate transaminase (AST) and bilirubin levels, and a liver biopsy showing macrovesicular steatosis, neutrophil infiltration, and Mallory-Denk bodies 1. Patients with alcoholic hepatitis may also experience fatigue, weakness, nausea, vomiting, loss of appetite, abdominal pain or tenderness, fever, and mental confusion.
Some key points to consider in the diagnosis and management of alcoholic hepatitis include:
- The importance of complete abstinence from alcohol to prevent further liver damage 1
- The use of scoring systems, such as the Maddrey Discriminant Function and the MELD score, to assess the severity of alcoholic hepatitis and predict mortality 1
- The role of liver biopsy in confirming the diagnosis and assessing the severity of liver damage 1
- The need for early identification and treatment of infections, which are a common complication of alcoholic hepatitis 1
- The importance of long-term follow-up and support to maintain abstinence and prevent relapse 1
In terms of management, complete abstinence from alcohol is the most important intervention to prevent further liver damage, and patients with severe alcoholic hepatitis may require corticosteroid therapy or other treatments to reduce inflammation and improve liver function 1. The Lille score can be used to assess the response to treatment and identify patients who are not responding to corticosteroids 1. Overall, the management of alcoholic hepatitis requires a comprehensive approach that addresses the underlying liver disease, as well as the patient's overall health and well-being.
From the Research
Early Signs of Alcoholic Hepatitis
The early signs of alcoholic hepatitis can be identified through various clinical presentations and laboratory abnormalities. Some of the common early signs include:
- Anorexia, weight loss, and fatigue 2
- Symptoms of alcohol withdrawal and hepatomegaly 2
- Fever, leukocytosis, jaundice, and tender hepatomegaly 2
- Laboratory abnormalities such as leukocytosis or leukopenia, anemia, a prolonged prothrombin time, and elevated liver enzymes, including aspartate amino-transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and bilirubin 2
- An AST-to-ALT ratio greater than 2 is common in patients with alcoholic hepatitis 2
Clinical Diagnosis
The clinical diagnosis of alcoholic hepatitis can be made in alcoholics with associated fever, leukocytosis, jaundice, and tender hepatomegaly 2. Liver biopsy may be required to establish the diagnosis and to identify other pathology, such as cirrhosis 2.
Prognosis and Treatment
The prognosis of alcoholic hepatitis depends on the severity of the disease, with severe cases having a high short-term mortality rate 3, 4, 5. Treatment options include abstinence from alcohol, nutritional supplementation, and corticosteroids for severe cases 2, 6. The use of corticosteroids is recommended for patients with a modified Maddrey discriminant function score > 32, provided that the patient does not have active gastrointestinal bleeding and does not have an active infection 6.