Alcoholic hepatitis
Definition :
Alcoholic hepatitis describes liver inflammation caused by drinking alcohol.
Though alcoholic hepatitis is most likely to occur in people who drink heavily over many years, the relationship between drinking and alcoholic hepatitis is complex. Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately.
If you're diagnosed with alcoholic hepatitis, you must stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death.
Symptoms:
Yellowing of the skin and whites of the eyes (jaundice) and increasing girth (due to fluid accumulation) are the most common signs of alcoholic hepatitis that lead people to seek medical care.
People may also complain of:
Signs and symptoms of severe alcoholic hepatitis include:
Alcoholic hepatitis is a serious disease. As many as 35 percent of heavy drinkers develop alcoholic hepatitis. And more than a third of them die within six months after signs and symptoms begin to appear.
See your doctor if you have any signs or symptoms of alcoholic hepatitis or other signs and symptoms that worry you. If you ever feel as though you can't control your drinking or feel that you'd like help in cutting back on your drinking, see your doctor.
Causes:
Alcoholic hepatitis occurs when the liver is damaged by the alcohol you drink. Just how alcohol damages the liver -— and why it does so only in a minority of heavy drinkers — isn't clear. What is known is that the process of breaking down ethanol — the alcohol in beer, wine and liquor — produces highly toxic chemicals, such as acetaldehyde. These chemicals trigger inflammation that destroys liver cells. Over time, web-like scars and small knots of tissue replace healthy liver tissue, interfering with the liver's ability to function. This irreversible scarring, called cirrhosis, is the final stage of alcoholic liver disease.
Risk increases with time, amount consumed
Heavy alcohol use can lead to liver disease, and the risk increases with the length of time and amount of alcohol you drink. But because many people who drink heavily or binge drink never develop alcoholic hepatitis or cirrhosis, it's likely that factors other than alcohol play a role. These include:
Complications:
Complications of alcoholic hepatitis include:
Stop drinking alcohol
If you've been diagnosed with alcoholic hepatitis, you must stop drinking alcohol. It's the only way of possibly reversing liver damage or, in more advanced cases, preventing the disease from becoming worse. Many people who stop drinking have dramatic improvement in symptoms in just a few months.
If you continue to drink alcohol, you're likely to experience serious complications.
If you are dependent on alcohol and want to stop drinking, your doctor can recommend a therapy that's tailored for your needs. This might include medications, counseling, Alcoholics Anonymous, an outpatient treatment program or a residential inpatient stay.
Treatment for malnutrition
Your doctor may recommend a special diet to reverse nutritional deficiencies that often occur in people with alcoholic hepatitis. You may be referred to a dietitian who can help you assess your current diet and suggest changes to increase the vitamins and nutrients you are lacking.
If you have trouble eating enough to get the vitamins and nutrients your body needs, your doctor may recommend tube feeding. This may involve passing a tube down your throat and into your stomach. A special nutrient-rich liquid diet is then passed through the tube.
Medications to reduce liver inflammation
Your doctor may recommend corticosteroids drugs if you have severe alcoholic hepatitis. These drugs have shown some short-term benefit in increasing survival. Steroids have significant side effects and are not recommended if you have failing kidneys, gastrointestinal bleeding or an infection. About 40 percent of people do not respond to corticosteroids. Your doctor may also recommend pentoxifylline, especially if corticosteroids don't work for you. Some studies of pentoxifylline have sh
own some benefit, others have not. You might also ask about clinical trials of other therapies.
Liver transplant
For many people with severe alcoholic hepatitis, liver transplant is the only hope to avoid death. Survival rates for liver transplant for alcoholic hepatitis are similar to those for other forms of hepatitis, greater than 70 percent five-year survival.
However, most medical centers are reluctant to perform liver transplants on people with alcoholic liver disease because of the fear they will resume drinking after surgery. For most people with alcoholic hepatitis, the disease is considered a contraindication for liver transplantation in most transplant centers in the U.S.
For transplant to be an option, you would need to find a program that will consider you. You would have to meet the requirements of the program, including abstaining from alcohol for six months prior to transplant and agreeing not to resume drinking afterward.
Definition :
Alcoholic hepatitis describes liver inflammation caused by drinking alcohol.
Though alcoholic hepatitis is most likely to occur in people who drink heavily over many years, the relationship between drinking and alcoholic hepatitis is complex. Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately.
If you're diagnosed with alcoholic hepatitis, you must stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death.
Symptoms:
Yellowing of the skin and whites of the eyes (jaundice) and increasing girth (due to fluid accumulation) are the most common signs of alcoholic hepatitis that lead people to seek medical care.
People may also complain of:
- Loss of appetite
- Nausea and vomiting
- Abdominal pain and tenderness
- Weight loss
Signs and symptoms of severe alcoholic hepatitis include:
- Retaining large amounts of fluid in your abdominal cavity (ascites)
- Confusion and behavior changes due to brain damage from buildup of toxins (encephalopathy)
- Kidney and liver failure
Alcoholic hepatitis is a serious disease. As many as 35 percent of heavy drinkers develop alcoholic hepatitis. And more than a third of them die within six months after signs and symptoms begin to appear.
See your doctor if you have any signs or symptoms of alcoholic hepatitis or other signs and symptoms that worry you. If you ever feel as though you can't control your drinking or feel that you'd like help in cutting back on your drinking, see your doctor.
Causes:
Alcoholic hepatitis occurs when the liver is damaged by the alcohol you drink. Just how alcohol damages the liver -— and why it does so only in a minority of heavy drinkers — isn't clear. What is known is that the process of breaking down ethanol — the alcohol in beer, wine and liquor — produces highly toxic chemicals, such as acetaldehyde. These chemicals trigger inflammation that destroys liver cells. Over time, web-like scars and small knots of tissue replace healthy liver tissue, interfering with the liver's ability to function. This irreversible scarring, called cirrhosis, is the final stage of alcoholic liver disease.
Risk increases with time, amount consumed
Heavy alcohol use can lead to liver disease, and the risk increases with the length of time and amount of alcohol you drink. But because many people who drink heavily or binge drink never develop alcoholic hepatitis or cirrhosis, it's likely that factors other than alcohol play a role. These include:
- Other types of hepatitis. Long-term alcohol abuse
worsens the liver damage caused by other types of hepatitis, especially
hepatitis C. If you have hepatitis C and also drink — even moderately —
you're more likely to develop cirrhosis than if you don't drink.
- Malnutrition. Many people who drink heavily are
malnourished, either because they eat poorly or because alcohol and its
toxic byproducts prevent the body from properly absorbing and breaking
down nutrients, especially protein, certain vitamins and fats. In both
cases, the lack of nutrients contributes to liver cell damage.
- Obesity.
- Genetic factors. Having mutations in certain genes that affect alcohol metabolism may increase your risk of alcoholic liver disease as well as of alcohol-associated cancers and other complications of heavy drinking. The exact genetic associations have not yet been identified.
Complications:
Complications of alcoholic hepatitis include:
- Increased blood pressure in the portal vein.
Blood from your intestine, spleen and pancreas enters your liver
through a large blood vessel called the portal vein. If scar tissue
slows normal circulation through the liver, this blood backs up, leading
to increased pressure within the vein (portal hypertension).
- Enlarged veins (varices). When
circulation through the portal vein is blocked, blood may back up into
other blood vessels in the stomach and esophagus. These blood vessels
are thin walled, and because they're filled with more blood than they're
meant to carry, they're likely to bleed. Massive bleeding in the upper
stomach or esophagus from these blood vessels is a life-threatening
emergency that requires immediate medical care.
- Fluid retention. Alcoholic hepatitis can cause
large amounts of fluid to accumulate in your abdominal cavity (ascites).
The fluid may become infected and require treatment with antibiotics.
Although not life-threatening in itself, ascites is usually a sign of
advanced alcoholic hepatitis or cirrhosis.
- Jaundice. This occurs when your liver isn't able to
remove bilirubin — the residue of old red blood cells — from your
blood. Bilirubin builds up and is deposited in your skin and the whites
of your eyes, causing a yellow color.
- Hepatic encephalopathy. A liver damaged by
alcoholic hepatitis has trouble removing toxins from your body —
normally one of the liver's key tasks. The buildup of toxins can damage
your brain, leading to changes in your mental state, behavior and
personality (hepatic encephalopathy). Signs and symptoms of hepatic
encephalopathy include forgetfulness, confusion and mood changes, and in
the most severe cases, coma.
- Scarred liver (cirrhosis). Over time, the liver inflammation that occurs in alcoholic hepatitis can cause irreversible scarring of the liver (cirrhosis). Cirrhosis frequently leads to liver failure, which occurs when the damaged liver is no longer able to adequately function.
Stop drinking alcohol
If you've been diagnosed with alcoholic hepatitis, you must stop drinking alcohol. It's the only way of possibly reversing liver damage or, in more advanced cases, preventing the disease from becoming worse. Many people who stop drinking have dramatic improvement in symptoms in just a few months.
If you continue to drink alcohol, you're likely to experience serious complications.
If you are dependent on alcohol and want to stop drinking, your doctor can recommend a therapy that's tailored for your needs. This might include medications, counseling, Alcoholics Anonymous, an outpatient treatment program or a residential inpatient stay.
Treatment for malnutrition
Your doctor may recommend a special diet to reverse nutritional deficiencies that often occur in people with alcoholic hepatitis. You may be referred to a dietitian who can help you assess your current diet and suggest changes to increase the vitamins and nutrients you are lacking.
If you have trouble eating enough to get the vitamins and nutrients your body needs, your doctor may recommend tube feeding. This may involve passing a tube down your throat and into your stomach. A special nutrient-rich liquid diet is then passed through the tube.
Medications to reduce liver inflammation
Your doctor may recommend corticosteroids drugs if you have severe alcoholic hepatitis. These drugs have shown some short-term benefit in increasing survival. Steroids have significant side effects and are not recommended if you have failing kidneys, gastrointestinal bleeding or an infection. About 40 percent of people do not respond to corticosteroids. Your doctor may also recommend pentoxifylline, especially if corticosteroids don't work for you. Some studies of pentoxifylline have sh
own some benefit, others have not. You might also ask about clinical trials of other therapies.
Liver transplant
For many people with severe alcoholic hepatitis, liver transplant is the only hope to avoid death. Survival rates for liver transplant for alcoholic hepatitis are similar to those for other forms of hepatitis, greater than 70 percent five-year survival.
However, most medical centers are reluctant to perform liver transplants on people with alcoholic liver disease because of the fear they will resume drinking after surgery. For most people with alcoholic hepatitis, the disease is considered a contraindication for liver transplantation in most transplant centers in the U.S.
For transplant to be an option, you would need to find a program that will consider you. You would have to meet the requirements of the program, including abstaining from alcohol for six months prior to transplant and agreeing not to resume drinking afterward.
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