What Is Alcoholic Hepatitis?

Alcoholic hepatitis refers to a liver disease caused by long-term excessive drinking. Its main clinical features are nausea, vomiting, jaundice, liver enlargement and tenderness. It can be accompanied by liver failure and upper gastrointestinal bleeding.

Basic Information

English name: alcoholic hepatitis
Visiting department: Gastroenterology

Common causes: Caused by long-term excessive drinking
Common symptoms: Bloating, general fatigue, loss of appetite, diarrhea, nausea, vomiting, abdominal pain, weight loss, etc.

Causes of alcoholic hepatitis

Caused by long-term excessive drinking.

Clinical manifestations of alcoholic hepatitis

The clinical manifestations of patients are significantly different due to different drinking methods, individual sensitivity to ethanol, and the severity of liver tissue damage. Symptoms are generally related to the amount of alcohol consumed and the length of time alcohol is consumed, and patients can be free of any liver symptoms and signs for a long time. The clinical manifestations of alcoholic hepatitis are quite different. Before the onset, there is often a history of heavy alcohol consumption in the near future, with obvious abdominal distension, general fatigue, loss of appetite, diarrhea, nausea, vomiting, abdominal pain, and weight loss. Some patients have fever, which is characterized by jaundice, hepatomegaly, and tenderness; a few patients have splenomegaly, dull complexion, ascites, edema, spider moles, etc .; patients with liver dysfunction have ascites obvious; some patients have neuropsychiatric symptoms.

Alcoholic hepatitis test

1. Blood and biochemical examination

An increase in white blood cell counts (mainly neutrophils), resembles a bacterial infection. Alcoholic hepatitis has a characteristic enzymatic change, that is, the increase in aspartate aminotransferase (AST) is significantly higher than that of alanine aminotransferase (ALT). AST / ALT is often greater than 2, but the AST and ALT values are rarely greater than 500IU / L, otherwise Should consider whether there is liver damage caused by other reasons.

2. Pathological examination

Liver biopsy is a reliable method for determining alcoholic liver disease and staging, and is an important basis for judging its severity and prognosis.

Alcoholic hepatitis diagnosis

Alcoholic hepatitis occurs in chronic alcoholics, often with a history of continuous heavy drinking for a short period of time before onset. Alcoholic hepatitis can be asymptomatic, but is usually accompanied by nonspecific gastrointestinal symptoms, hepatomegaly, and elevated liver enzymes. Some patients have severe liver damage and may have symptoms such as fever, anorexia, jaundice, and elevated white blood cell counts, as well as liver failure or hepatic encephalopathy.

Alcoholic hepatitis treatment

Abstain from drinking

The primary method of treating alcoholic liver disease is to quit drinking, and its effect is related to the severity of liver disease. For ordinary alcoholic liver disease, the clinical and pathological manifestations can be significantly improved within a few weeks to months after timely abstinence, and the mortality rate is significantly reduced; for severe alcoholic liver disease, abstinence and drug support treatment may not improve Symptoms; Alcoholic liver cirrhosis accompanied by decreased prothrombin activity and ascites, the course is often repetitive, and it is difficult to reverse alcohol abstinence; for alcoholic fatty liver, alcohol abstinence is the only treatment, intrahepatic fat Can disappear within weeks to months, if supplemented with protein or amino acid at the same time, it can further promote liver cell recovery.

Glucocorticoid

In alcoholic liver disease, there are inflammatory reactions in the liver, swelling and necrosis of liver cells, and collagen production and deposition. The initiation and development of alcoholic liver disease involves immune factors, and antibodies against Mallory bodies can be found in patients' blood. Glucocorticoids can inhibit the lipoxygenase and cyclooxygenase pathways of arachidonic acid metabolism, thereby inhibiting the pro-inflammatory effects of leukotrienes and prostaglandins, and can also promote albumin synthesis and prevent type I collagen production. Therefore, some people have suggested that glucocorticoids can be used to treat alcoholic liver disease, but many research results are inconsistent.

3. Insulin and Glucagon

There are reports of daily intravenous drip of insulin and glucagon for 12 hours and treatment for 3 weeks, which can improve liver function in patients with alcoholic liver disease, but whether this method can prolong the survival of patients, conclusions are different. Some people think that if epithelial growth factor is given first, then insulin and glucagon, the effect may be better; there are also reports that insulin-glucagon therapy is not effective for alcoholic liver disease. In general, this therapy can be used for alcoholic liver disease, but blood sugar should be detected during treatment to prevent fatal hypoglycemia.

4.propylthiouracil

Animals and humans who have long-term intake of alcohol show a high metabolic state. The liver damage of alcoholic liver disease is more serious in the hepatic acinar area, which is similar to liver ischemic damage, while thyroidectomy and propylthiouracil (PTU) treatment can partially prevent hypoxic liver damage in animals ingesting alcohol. The above facts promote the clinical application of PTU in the treatment of active alcoholic liver disease.

5. Liver transplantation

Patients with severe alcoholic liver disease, especially end-stage liver cirrhosis, may consider liver transplantation if they meet strict screening criteria. Compared with liver transplantation in patients with non-alcoholic liver disease, patients with alcoholic liver disease have higher survival rates and fewer recurrences after surgery.

Prognosis of alcoholic hepatitis

Alcoholic hepatitis has a higher independent risk of death and is more likely to cause death than inactive cirrhosis. According to a set of liver biopsy histological studies, the prognosis of patients with fatty liver is the best, and the survival rate of 4 to 5 years is 70% to 80%; the prognosis of patients with alcoholic cirrhosis with alcoholic hepatitis is the worst, 4 to 5 The annual survival rate is 30% to 50%; while the prognosis of patients with alcoholic hepatitis or cirrhosis lies between the two, the 4 to 5 year survival rate is 50% to 75%.