Gastroenterology Book

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Alcoholic HepatitisAka: Alcoholic Liver Disease

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  1. Pathophysiology
    1. Precursor to Cirrhosis
    2. Characteristics
      1. Hepatocyte Inflammation, degeneration, and necrosis
      2. Neutrophil and Lymphocyte infiltration
  2. Epidemiology
    1. Alcoholic Hepatitis seen in 33% of chronic Alcoholics
  3. Symptoms
    1. Anorexia
    2. Nausea and Vomiting
    3. Weight loss
    4. Fever
    5. Generalized Abdominal Pain
  4. Signs
    1. Tender Hepatomegaly (80-90% of cases)
    2. Jaundice
    3. Ascites
    4. Splenomegaly
    5. Spider angioma
  5. Labs
    1. Aspartate Aminotransferase (AST) increased to 100-300
      1. AST to ALT ratio = 2:1
    2. Alkaline Phosphatase elevated
    3. Gamma glutamyl transferase (GGT) markedly elevated
    4. Hypoalbuminemia
    5. Prolonged ProTime
    6. Mean Corpuscular Volume (MCV) elevated
  6. Management
    1. See Prevention of Liver Disease Progression
    2. Alcohol Cessation
    3. Alcohol Withdrawal protocol
    4. Increased caloric and protein intake
    5. Vitamin supplementation
      1. Thiamine
      2. Folate
      3. Multivitamin
    6. Corticosteroids (Prednisolone)
      1. Efficacy: Improves survival (n=61)
        1. Two month survival 88% versus 45% with Placebo
        2. Improved survival persists for 1 year
        3. No advantage after 1 year
      2. References
        1. Mathurin (1996) Gastroenterology 110:1847
  7. Prognosis
    1. Mortality 10-15% from acute hepatitis
    2. Cirrhosis develops in 50% of Alcoholic hepatitis
  8. References
    1. Hill (1998) Postgrad Med 103(4):261

Hepatitis, Alcoholic (C0019187)

Definition (MSH)INFLAMMATION of the LIVER due to ALCOHOL ABUSE. It is characterized by NECROSIS of HEPATOCYTES, infiltration by NEUTROPHILS, and deposit of Mallory hyaline bodies. Depending on its severity, the inflammatory lesion may be reversible or progress to LIVER CIRRHOSIS.
Definition (CSP)acute or chronic degenerative and inflammatory lesion of the liver in the alcoholic which is potentially progressive though sometimes reversible; it does not necessarily include steatosis, fibrosis, or cirrhosis of the liver, although it is frequently associated with these conditions; it is characterized by liver cell necrosis, infiltration by polymorphonuclear leukocytes and lymphocytes, and Mallory bodies.
ConceptsDisease or Syndrome (T047)
EnglishALCOHOLIC HEPATITIS
Spanishhepatitis alcohólica, hepatitis alcoholica
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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