Alcoholic hepatitis is an inflammatory liver condition. The main cause is frequent, heavy alcohol use. Processing excessive amounts of alcohol can result in injury to the liver cells, which can lead to swelling and scarring of the liver.

The condition can be mild or severe. In severe cases, a person may require a liver transplant if they do not receive treatment or do not stop consuming alcohol during the early stages.

This article explores the relationship between alcohol and the liver, the symptoms and causes of alcoholic hepatitis, and possible treatment options.

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Alcoholic hepatitis is a type of alcoholic liver disease that occurs when a person consumes more alcohol than the liver can process. The Alcoholic Hepatitis Consortia define alcoholic hepatitis as a condition with rapid onset of symptoms and liver swelling due to heavy alcohol use.

The liver is the second largest organ in the body. It is on the right side of the torso, under the rib cage. Its main role is to convert foods and drinks into nutrients that the body can use easily.

The liver also filters poisons and harmful substances, including alcohol, from the blood.

The liver breaks down alcohol for removal from the body. However, alcohol can damage and destroy liver cells, and the liver can only process alcohol in small doses. Any excess alcohol circulates throughout the body.

Drinking more alcohol than the body can process may cause injury or serious damage to the liver.

Ethyl alcohol or ethanol is an ingredient in beer, wine, and liquor that causes intoxication. Alcohol affects every organ in the body and the central nervous system. The way a person experiences the effects of alcohol depends directly on the amount they consume.

Excessive alcohol consumption can lead to a variety of health problems, including:

Alcohol can harm a fetus during pregnancy and increase the risk of sudden infant death syndrome. It can also lead to unintentional motor accidents and violence.

One of the most common signs of alcoholic hepatitis is jaundice, or yellowing of the skin and eyes. Additional symptoms can include:

  • loss of appetite
  • nausea
  • vomiting
  • stomach pain and tenderness
  • fever
  • tiredness and weakness
  • weight loss

Alcoholic hepatitis can be either mild or severe. It is possible to reverse the condition in the early stages by ceasing to drink alcohol.

Severe alcoholic hepatitis can occur without warning, leading to life threatening complications, such as liver failure. Once the condition becomes severe, symptoms include:

  • a buildup of fluid in the upper body
  • confusion and behavior changes
  • liver and kidney failure

Signs and symptoms vary between people and depend on the severity of the disease. They can also flare up after consuming alcohol.

The main cause of alcoholic hepatitis is heavy drinking over an extended period of time. The process of breaking down alcohol in the liver causes inflammation that can destroy liver cells.

Over time, scars begin to replace functional liver tissue in the body. This interferes with how the liver works. Irreversible scarring, or cirrhosis, is the final stage of alcoholic liver disease.

Cirrhosis can quickly progress to liver failure once it develops. A damaged liver can also interfere with blood flow to the kidneys. This can result in damage and kidney failure.

Other factors can contribute to alcoholic hepatitis. For example, people with other types of hepatitis have a higher risk. As a result, it is not advisable for them to drink alcohol.

A person with alcoholic hepatitis may also experience malnourishment. Drinking significant amounts of alcohol can suppress the appetite. Alcohol may become the main source of calories for an individual. Malnutrition can also contribute to liver disease.

Other possible risk factors may include:

  • sex assigned at birth, as females may have a higher risk of developing alcoholic hepatitis
  • obesity
  • genetic factors
  • race and ethnicity, as African American and Hispanic people may face a higher risk of developing alcoholic hepatitis

Some people may not show symptoms until the disease reaches a severe stage.

A doctor will:

  • take a complete medical history
  • carry out a physical examination
  • ask the person about their history of alcohol consumption and their drinking habits

Blood tests to determine alcoholic hepatitis can include:

  • liver function studies
  • cellular blood counts
  • measuring bleeding times
  • electrolyte tests
  • tests for other chemicals in the body

An ultrasound, CT scan, or MRI scan can show a more detailed view of the liver and any physical damage.

If other tests do not provide a clear answer, the doctor may conduct a liver biopsy. This involves taking a small tissue sample from the liver using a needle or through surgery for testing in a laboratory.

The results will help to determine the type and scale of the problem.

The main treatment option for alcoholic hepatitis is to stop consuming alcohol. In cases of early diagnosis, abstinence from alcohol may help to reverse liver damage. In more advanced cases, it can still help to prevent the condition from progressing.

People can discuss options such as counseling, medication, and detoxification programs with their doctor to help them safely reduce their alcohol intake.

There is currently no cure for alcoholic hepatitis, but treatment will aim to reduce or eliminate symptoms and stop the progression of the disease. Scarring of the liver is permanent, but the liver can repair some of the damage.

Treatment aims to restore typical function to the liver as much as possible. Some options may include:

  • Dietary changes: A doctor may recommend dietary changes. Vitamin supplements or a focused diet plan may help to correct the balance of nutrients in the body if a person has malnourishment after regular alcohol use.
  • Medication: Doctors may prescribe medications, including corticosteroids and pentoxifylline, to help reduce liver inflammation.
  • Liver transplant: In severe cases, a liver transplant may be the only chance for survival. However, the process of finding a donor can be long and complicated.

A doctor may also suggest other lifestyle changes that can help to improve liver health. This may include:

  • maintaining a healthy weight
  • getting regular exercise
  • avoiding toxins and illegal drugs
  • using a condom or other barrier method during sex
  • receiving vaccinations

Additionally, research continues into alternative medicines. For example, evidence suggests that cannabidiol may help reduce alcohol-related liver inflammation. However, more research is still necessary.

Doctors will likely emphasize that the best hope of recovery is to be aware of the possible signs and symptoms and to reduce, manage, or stop alcohol consumption before the condition progresses.

Treatment programs and support

Doctors may recommend alcohol treatment programs for people who find it difficult to cut out alcohol. Programs are available both in and out of hospital settings, depending on the severity of the dependence.

These programs can help people reduce and eventually stop consuming alcohol. Examples of these programs include:

Alcoholic hepatitis can result in severe and lasting liver damage, which can lead to serious health complications. These typically occur due to liver scarring, blood vessel damage, and a buildup of fluid. Potential complications of alcoholic hepatitis may include:

  • Cirrhosis: This is a progressive disease where scar tissue gradually replaces healthy liver cells. As scar tissue accumulates, the liver begins to lose its ability to function properly.
  • Internal, or variceal, bleeding: Damage to the liver may raise blood pressure in the portal vein, causing portal hypertension. Due to scarring, the liver is unable to filter blood in the body effectively. This increases blood pressure, putting extra strain on blood vessels. It may cause blood to go through other, thinner blood vessels. This can cause veins to swell and bleed and can result in esophageal varices and internal bleeding.
  • Malnutrition: Nutritional issues are common with alcoholic hepatitis, as symptoms can affect appetite and limited liver function can affect the absorption of food.
  • Ascites: This refers to a buildup of fluid in the abdomen that can occur when the liver is not working properly. As the fluid accumulates, it can cause discomfort and difficulty breathing.
  • Infections: People may also experience infections. For example, people may experience peritonitis, which refers to an infection of ascitic fluid. Without prompt treatment, this can lead to septic shock.
  • Hepatic encephalopathy: This condition describes inflammation and a decline in brain function due to toxins in the blood. When the liver is unable to remove toxins from the bloodstream, these toxins can enter the brain and damage brain cells. This can result in brain injury and lead to a coma.
  • Liver cancer: Evidence notes that alcohol is a group 1 carcinogen, and excessive alcohol consumption can increase the risk of liver cancer.
  • Organ failure: In addition to damaging the liver, alcoholic hepatitis can also affect blood flow to the kidneys. This is known as hepatorenal syndrome. Without treatment, these organs may fail.

Not everyone who consumes large amounts of alcohol will develop alcoholic hepatitis. More research is necessary to confirm why some people who drink in excess develop the disease, while others do not.

It is important to note that alcoholic hepatitis can still occur in people who drink moderately, although the risk is far lower.

According to the American Liver Foundation, up to 35% of people who consume alcohol heavily develop alcoholic hepatitis. Of these, 55% already have cirrhosis.

Because alcohol can have a wide range of harmful effects on the body, it is advisable for those who consume alcohol to do so safely and in moderation.

If a person receives a diagnosis of alcoholic hepatitis, it is possible to reverse some liver damage in the early stages if they stop drinking. The long-term outlook for an individual with no scar tissue in the liver is positive.

However, the outlook worsens if they continue to drink excessively and if they have scarring of the liver. As such, it is advisable for people with alcoholic hepatitis to stop drinking completely to improve their outlook.

It is not possible for them to reverse liver damage that occurs due to scarring. Those who continue to drink have a less favorable outlook, as they are more likely to experience a variety of life threatening health complications.

Alcoholic hepatitis is a liver condition that mainly occurs due to heavy alcohol use on a regular basis. Alcohol can damage the liver, which may eventually lead to irreversible liver scarring, known as cirrhosis.

Ceasing to drink alcohol will often reverse the condition in its early stages. However, the symptoms may not always be clear until the later stages.

There is no direct treatment for alcoholic hepatitis, but treatment can help to manage the symptoms. If liver damage is extensive, a transplant may be necessary.

It is important to drink alcohol in moderation and to know the early signs that a person is drinking too much.

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