This is what you need to know about Alcoholic hepatitis

Alcoholic hepatitis is inflammation of the liver caused by drinking alcohol heavily over many years.

However, the relationship between drinking and alcoholic hepatitis is not easy to understand as not all heavy drinkers develop the disease, and it can occur in people who drink only moderately.

Once you are diagnosed with alcoholic hepatitis, you must stop drinking alcohol – otherwise you face a high risk of serious liver damage – and death.

Causes

Alcoholic hepatitis develops when the alcohol damages your liver. Just how alcohol damages the liver and why it does so only in some heavy drinkers isn’t clear.

What happens is that chemicals produced when alcohol is broken down cause inflammation that destroys the liver cells. Over time, scars replace healthy liver tissue, interfering with liver function. This irreversible scarring (cirrhosis) is the final stage of the disease.

Risk factors

The major risk factor is the amount of alcohol you consume. How much alcohol it takes to put you at risk of alcoholic hepatitis isn’t known, so to be safe, avoid alcohol or only drink moderately and ensure that you are properly nourished. However, it can occur among those who drink less.

Other risk factors include:

Gender. Being a woman seems to have a higher risk of developing alcoholic hepatitis, possibly because of differences in the way alcohol is processed in women.

Obesity. Heavy drinkers who are overweight might be likelier to develop alcoholic hepatitis and to progress to cirrhosis.

Genetic factors. Studies suggest there may be a genetic component in alcohol-induced liver disease although it’s difficult to separate genetic and environmental factors.

Race and ethnicity. Blacks and Hispanics might be at higher risk of alcoholic hepatitis.

Binge drinking. Five or more drinks within two hours for men and four or more for women might increase your risk.

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Complications

The issue which result from severe liver damage, relate to scar tissue, which can slow blood flow through your liver, increasing pressure in a major blood vessel (portal vein), and the buildup of toxins.

Complications include:

Enlarged veins (varices). Blood that can’t flow freely through the portal vein can back up into other blood vessels in the stomach and oesophagus. These blood vessels have thin walls and are likely to bleed if filled with too much blood. Heavy bleeding in the upper stomach or oesophagus is life-threatening and requires immediate medical care.

Corticosteroids. These meds have shown some short-term benefit in increasing the survival of certain people with severe alcoholic hepatitis. However, they have serious side effects and generally aren’t prescribed if you have failing kidneys, gastrointestinal bleeding or an infection.

Liver Transplant

For many people with severe alcoholic hepatitis, the risk of death is high without a liver transplant. Historically, those with the disease have not been liver transplant candidates because of the risk they will return to harmful drinking.

Studies, however, suggest that carefully selected patients with severe alcoholic hepatitis have post-transplant survival rates similar to those of transplant recipients with other types of liver disease.

• Ascites is when fluid accumulates in the abdomen and might become infected and require treatment with antibiotics. Ascites aren’t life-threatening but are usually a sign of advanced alcoholic hepatitis or cirrhosis.

• Confusion,drowsiness and slurred speech (hepatic encephalopathy). A damaged liver has trouble removing toxins from your body. The build-up of toxins can damage your brain. Severe hepatic encephalopathy can result in coma.

• Kidney failure. A damaged liver can affect blood flow to the kidneys, resulting in damage.

• Cirrhosis. This scarring of the liver can lead to liver failure.

Prevention

You may be protected from alcoholic hepatitis if you:

• Drink alcohol in moderation, if at all.

• Protect yourself from hepatitis C – an infectious liver disease caused by a virus. Untreated, it can lead to cirrhosis. If you have hepatitis C and drink alcohol, you’re far more likely to develop cirrhosis than if you didn’t drink.

Diagnosis

The doctor will take full history and do a physical examination. Your history of alcohol use is very important so you must be honest about your drinking habits.

Once that is done the following tests are important:

• Liver function tests.

• Blood tests.

• An ultrasound, CT or MRI scan of the liver. A liver biopsy

Treatment

Stop drinking: If you’ve been diagnosed with alcoholic hepatitis, you must stop drinking alcohol. If it’s difficult then consider rehabilitation, doctor recommended medications, counselling or support groups.

Treatment for malnutrition

Your doctor might recommend a special diet to correct nutritional problems. You might be referred to a dietitian, who can suggest ways to increase your consumption of the vitamins and nutrients you lack. If you have trouble eating, your doctor might recommend tube feeding, which passes special nutrient-rich liquid diet into your stomach.

Medications

If you have severe alcoholic hepatitis, your doctor might recommend:

• Corticosteroids. These meds have shown some short-term benefit in increasing the survival of certain people with severe alcoholic hepatitis. However, they have serious side effects and generally aren’t prescribed if you have failing kidneys, gastrointestinal bleeding or an infection.

Liver Transplant

For many people with severe alcoholic hepatitis, the risk of death is high without a liver transplant. Historically, those with the disease have not been liver transplant candidates because of the risk they will return to harmful drinking.

Studies, however, suggest that carefully selected patients with severe alcoholic hepatitis have post-transplant survival rates similar to those of transplant recipients with other types of liver disease.

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