Alcoholic hepatitis is an inflammation of the liver caused by alcohol consumption.

Alcoholic hepatitis most likely occurs in heavy drinkers; however, it may not always be the case. Moderate drinkers are also at the risk of developing this disease.

An alcoholic hepatitis diagnosis prohibits alcohol consumption since further alcohol consumption carries a high risk of serious or irreparable liver damage and death.

Symptoms

The most common symptoms of alcoholic hepatitis are:

  • Yellowing of the skin and whites of the eyes (jaundice)
  • Increasing girth due to fluid accumulation

Other symptoms include:

  • Loss of appetite
  • Weight loss
  • Abdominal pain and tenderness
  • Nausea and vomiting

Almost everyone suffering from alcoholic hepatitis is malnourished. The loss of appetite combined with heavy drinking leads to most of the calories in the body to be in the form of alcohol.

The following are severe signs of alcoholic hepatitis:

  • Retention of large quantities of fluid in the abdominal cavity (ascites)
  • Behavioral changes and confusion due to brain damage from the build up of toxins (encephalopathy)
  • Liver and kidney failure

Causes

Alcohol consumption is the main cause of alcoholic hepatitis. It is not specifically determined what amount of alcohol causes the disease or why it affects a minority of heavy drinkers.

The process of breaking down ethanol in the body (the main component of alcohol) produces chemicals such as acetaldehyde, which are highly toxic. The inflammation caused by these chemicals destroys the liver cells. The healthy liver tissue is then replaced with scars and small knots of tissue causing interference with liver functions. The scaring (cirrhosis) is irreversible and it is the final stage of liver disease brought on by alcohol.

The risk of liver disease increases with the length of time and quantity of alcohol consumed. However, there are other factors to be considered other than alcohol since many heavy drinkers never develop alcoholic hepatitis or cirrhosis.

  • Other types of hepatitis: Suffering from hepatitis C combined with alcohol can cause more severe liver damage and make one more prone to developing cirrhosis.
  • Malnutrition: Heavy drinkers are usually malnourished due to poor diet or because the toxic chemicals from alcohol are absorbed and nutrients, proteins, vitamins and fats cannot be properly broken down by the body.
  • Obesity: The combination of obesity and alcohol can have a severely detrimental effect on the liver.
  • Genetic factors: Certain genetic mutations that affect alcohol metabolism can increase the risk of liver disease or cancers associated with alcohol. The exact genetic mutations are not yet determined.

Risk Factors

The main risk factors for alcoholic hepatitis include:

  • Alcohol consumption: The amount of alcohol intake is the most significant risk factor for alcoholic hepatitis. A study has shown that daily consumption of 60-80 grams of alcohol can increase the risk of cirrhosis in men while 20 grams of alcohol per day increases the risk for women both over a period of 10 years. However, approximately 35% of heavy long-term drinkers develop cirrhosis.
  • Gender: Women are at a higher risk for developing alcoholic hepatitis due to the differences of how alcohol is processed by women.
  • Genetics: Some genetic mutations can affect the way alcohol is processed in the body, which increase the risk of developing cirrhosis.

Other risk factors include:

  • Type of beverage
  • Binge drinking
  • Obesity
  • African-American or Hispanic ethnicity

Complications

Alcoholic hepatitis can cause various complications:

  • Increased blood pressure in the portal vein: The liver receives blood from the intestine, spleen and pancreas through a large blood vessel known as the portal vein. Scar tissue from alcoholic hepatitis slows the liver’s circulation and the blood backs up thus increasing blood pressure within the portal vein (portal hypertension).
  • Enlarged veins (varices): Blocked circulation in the portal vein forces the blood to back up in other smaller blood vessels such as the ones in the abdomen or esophagus. These blood vessels have thin walls so increased blood pressure causes them to bleed. Bleeding in the abdomen or esophagus is a significant life-threatening complication.
  • Jaundice: Jaundice is a state of yellowing of the skin and the whites of the eyes. It is caused due to the liver’s inability to remove bilirubin (residue of old red blood cells), which later builds up and sets in the skin and the eyes.
  • Fluid retention: Alcoholic hepatitis sometimes causes large quantities of fluid to build up in the abdominal cavity (ascites). The fluid may become infected and require antibiotic treatment. Ascites is a symptom of progressive alcoholic hepatitis or cirrhosis.
  • Hepatic encephalopathy: A damaged liver gradually loses the ability to remove toxins from the body. The accumulation of toxins can damage the brain causing changes in mental state, personality and behavior (hepatic encephalopathy). The symptoms of hepatic encephalopathy include confusion, mood changes, forgetfulness and in severe cases, coma.
  • Cirrhosis: The liver inflammation caused by alcoholic hepatitis can lead to irreversible liver scarring (cirrhosis). Cirrhosis often results in liver failure because the liver cannot function properly.
  • Kidney failure

Prevention

The following precautions can help prevent and reduce the risk of alcohol hepatitis:

  • Consume alcohol in moderation, if at all – Alcohol should be consumed in moderation. This means that one drink per day is enough for women of all ages and men over the age of 65 while men younger than 65 can have up to 2 drinks a day. However, the only certain way to prevent alcoholic hepatitis is not to drink alcohol at all.
  • Extra caution before mixing alcohol with medications: The labels of over-the-counter medications always state if the medication could be mixed with alcohol and warns of complications when combined with alcohol. Therefore, one should check the labels for warnings and avoid alcohol when taking medications.
  • Protection from hepatitis C: Hepatitis C is a highly infectious liver disease. It is caused by a virus and if left untreated it can lead to cirrhosis. There is no vaccine to prevent hepatitis C and people with hepatitis C are far more prone to develop cirrhosis if they drink alcohol. Contaminated drug paraphernalia causes the majority of hepatitis C cases. It can also be transmitted sexually, therefore it is important to practice safe sex and not to share needles or other drug paraphernalia.