Alcoholic hepatitis is one of the serious symptoms or a syndrome associated with the liver that is damaged by alcohol. It is characterized by some symptoms that can develop suddenly, for instance, jaundice, general malaise, hepatomegaly and weak inflammatory signals all over the body. Complication that develops because of cirrhosis of the liver if the inflammation of alcoholic hepatitis is because of regular use of alcohol. Unexpectedly, hepatitis returns to normal in infected individuals who quit alcohol intake within a few months, however the progressed cirrhosis is irreversible.
Epidemiology
Investigations have shown that in the USA for instance over two thirds of its population take alcohol and 7.2% is the prevalence of alcohol use disorder. Alcoholism is the third leading cause that comes under the preventable causes of death recorded in the US. A cross-sectional survey performed over the World Wide Web for a decade on 211 hospitals from 2001 to 2011 stated that 0. 08 to 0. 09%. cause of mortality is attributed to alcoholic hepatitis.
Anatomy
Pathophysiology
In hepatocytes, alcohol is metabolized through the oxidative pathway that reduces the proportion of NAD to NADH. Promoting the oxidation of the triglycerides and the fatty acid from oxidation increases lipogenesis. There is still another recognised route of action of alcohol on the hepatocytes, which is the entrance of lipopolysaccharide bound endotoxin through the intestinal wall into the liver cells.
Lipopolysaccharides bind in Kupffer cells within the liver to the CD-14 and toll-like receptor 4, all triggering the release of reactive oxygen species. These cytokines included platelet-derived growth factor, interleukin-8, tumor necrosis factor-alpha, monocyte chemotactic protein, and the reactive oxygen species were able to raise these cytokines and the end effect is the augmentation of macrophages and neutrophils as well as manifesting the inherent clinical features of alcohol injury.
Etiology
Although the most significant risk factor for developing chronic liver disease is the amount of alcohol consumed, neither the course of alcohol-induced chronic liver disease nor the relationship between the amount of alcohol and liver injury is linear.
Alcoholic hepatitis is mainly attributed to the autointoxication effect arising from excess and chronic use of alcohol. During the metabolism of alcohol in liver, it produces toxic by-products which are capable of inflicting harm to liver cells. This damage causes inflammation in the liver furthering the development of alcoholic hepatitis.
Genetics
Prognostic Factors
Although the most significant risk factor for developing chronic liver disease is the amount of alcohol consumed, neither the course of alcohol-induced chronic liver disease nor the relationship between the amount of alcohol and liver injury is linear.
Alcoholic hepatitis is mainly attributed to the autointoxication effect arising from excess and chronic use of alcohol. During the metabolism of alcohol in liver, it produces toxic by-products which are capable of inflicting harm to liver cells. This damage causes inflammation in the liver furthering the development of alcoholic hepatitis.
Clinical History
General Symptoms: Fatigue, malaise, anorexia, and weight loss are common.
Gastrointestinal Symptoms: Nausea, vomiting, abdominal pain (usually in the right upper quadrant), and jaundice (yellowing of the skin and eyes).
Systemic Symptoms: Fever, confusion or altered mental status (hepatic encephalopathy), and signs of malnutrition.
Age group:
Alcoholic hepatitis targets adults who are regular alcohol takers over time. It most frequently manifests itself in the third and fourth decades, that is between 30 and 50 years of age but can occur any time where relatively heavy alcohol intake becomes the pattern.
Physical Examination
General Appearance
Jaundice
Cachexia
Fever
Malaise
Abdominal Examination
Hepatomegaly
Splenomegaly
Ascites
Caput Medusae
Abdominal Tenderness
Age group
Associated comorbidity
Liver Cirrhosis
Fatty Liver Disease
Pancreatitis
Gastrointestinal Bleeding
Neurological Disorders
Associated activity
Acuity of presentation
Symptoms: In the early stages or at initial stages, the symptoms are very slight and in form of fatigue; weakness; anorexia; and general feeling of being unwell.
Jaundice: With each passing days, patient develop features of liver cirrhosis such as jaundice, where the skin and the eyes turn yellow.
Abdominal Pain: Pain and tenderness in the abdomen.
Ascites: Swelling in the abdomen (ascites) is one of the more frequent symptoms which is manifested in severe forms of the disease.
Hepatic Encephalopathy: Later symptoms may include confusion and disorientation and even coma because of the liver disease & the encephalopathy.
Differential Diagnoses
Non-Alcoholic Fatty Liver Disease
Viral Hepatitis
Autoimmune Hepatitis
Drug-Induced Liver Injury
Primary Biliary Cholangitis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment paradigm
Medications:
Corticosteroids: It is also administrated in severe cases to help reduce inflammation with prednisolone medication.
Pentoxifylline: That is less often now because corticosteroids cannot be used often or were shown to be insolvent.
Management of Complications:
Infection control: The care includes frequent observation of any infections because with the immunocompromised status of the patient, infections become even more frequent and life threatening.
Treatment of hepatic encephalopathy: This disease may be treated with lactulose and rifaximin.
Liver Transplantation:
About the management of severe AH not responsive to medical treatment, LT has been considered appropriate for suitable candidates.
Supportive Care:
General supportive care includes plenty of fluid intake and close follow-up of hepatic profile.
Psychosocial Support:
Psychotherapy and self-help programs are critical in dealing with the root cause, which is alcohol use disorder.
Abstinence from Alcohol: This may require eliminating the purchase of alcoholic products in the house, and refusal of any occasions where there is the consumption of alcohol.
Nutritional Support: Offer vitamin and mineral resources plus proteins to the patients. It is advisable to consult a dietitian to help in designing the diet for the patient with special consideration for the liver and healing.
Medication Adherence: Prescribed medications for patients are highly recommended to be taken regularly and according to the healthcare provider’s advice.
Effectiveness of corticosteroids in treating alcoholic hepatitis
Prednisolone: Prednisolone is sometimes prescribed in the management of severe alcoholic hepatitis, especially if inflammation of the liver and impaired liver function is present.
Liver transplantation should be done in patients with AH who fail medical management and alcohol withdrawal and have severe AH. Usually, this is done in cases where a patient has progressed to acute liver failure or those with severe liver dysfunction after optimal medical therapy.
Assessment and Diagnosis: This comprises of clinical assessment and examination, biochemical tests (for example liver function tests, full blood count), imaging studies (including ultrasound), though in some cases liver biopsy to determine the degree of damage.
Initial Management: Abstinence from alcohol is also important with this condition, especially when it has reached this stage. Additional care consists of giving proper nutrition to patients, balancing electrolyte imbalance, and handling of other associated problems such as infections.
Specific Therapies:
Prednisolone: corticosteroids are required for the severe indication, as they decrease inflammation improving short-term prognosis. Further drugs should be used depending on the situation with the patient.
Monitoring and Follow-up: In addition, close supervision of patients’ liver function, clinical status and complications is advisable. The patients are normally suggested for alcohol rehabilitation programs in order to avoid the instance of recurrence.
Liver Transplantation: The transplant indications include those patients with severe alcoholic hepatitis who have failed medical management or those who present recurrent severe episodes.
Long-term Care: These are abstinence from alcohol and other relevant lifestyle changes accompanied by regular follow up and medical intervention towards controlling liver diseases or any related ailments.
Alcoholic hepatitis is one of the serious symptoms or a syndrome associated with the liver that is damaged by alcohol. It is characterized by some symptoms that can develop suddenly, for instance, jaundice, general malaise, hepatomegaly and weak inflammatory signals all over the body. Complication that develops because of cirrhosis of the liver if the inflammation of alcoholic hepatitis is because of regular use of alcohol. Unexpectedly, hepatitis returns to normal in infected individuals who quit alcohol intake within a few months, however the progressed cirrhosis is irreversible.
Investigations have shown that in the USA for instance over two thirds of its population take alcohol and 7.2% is the prevalence of alcohol use disorder. Alcoholism is the third leading cause that comes under the preventable causes of death recorded in the US. A cross-sectional survey performed over the World Wide Web for a decade on 211 hospitals from 2001 to 2011 stated that 0. 08 to 0. 09%. cause of mortality is attributed to alcoholic hepatitis.
In hepatocytes, alcohol is metabolized through the oxidative pathway that reduces the proportion of NAD to NADH. Promoting the oxidation of the triglycerides and the fatty acid from oxidation increases lipogenesis. There is still another recognised route of action of alcohol on the hepatocytes, which is the entrance of lipopolysaccharide bound endotoxin through the intestinal wall into the liver cells.
Lipopolysaccharides bind in Kupffer cells within the liver to the CD-14 and toll-like receptor 4, all triggering the release of reactive oxygen species. These cytokines included platelet-derived growth factor, interleukin-8, tumor necrosis factor-alpha, monocyte chemotactic protein, and the reactive oxygen species were able to raise these cytokines and the end effect is the augmentation of macrophages and neutrophils as well as manifesting the inherent clinical features of alcohol injury.
Although the most significant risk factor for developing chronic liver disease is the amount of alcohol consumed, neither the course of alcohol-induced chronic liver disease nor the relationship between the amount of alcohol and liver injury is linear.
Alcoholic hepatitis is mainly attributed to the autointoxication effect arising from excess and chronic use of alcohol. During the metabolism of alcohol in liver, it produces toxic by-products which are capable of inflicting harm to liver cells. This damage causes inflammation in the liver furthering the development of alcoholic hepatitis.
Although the most significant risk factor for developing chronic liver disease is the amount of alcohol consumed, neither the course of alcohol-induced chronic liver disease nor the relationship between the amount of alcohol and liver injury is linear.
Alcoholic hepatitis is mainly attributed to the autointoxication effect arising from excess and chronic use of alcohol. During the metabolism of alcohol in liver, it produces toxic by-products which are capable of inflicting harm to liver cells. This damage causes inflammation in the liver furthering the development of alcoholic hepatitis.
General Symptoms: Fatigue, malaise, anorexia, and weight loss are common.
Gastrointestinal Symptoms: Nausea, vomiting, abdominal pain (usually in the right upper quadrant), and jaundice (yellowing of the skin and eyes).
Systemic Symptoms: Fever, confusion or altered mental status (hepatic encephalopathy), and signs of malnutrition.
Age group:
Alcoholic hepatitis targets adults who are regular alcohol takers over time. It most frequently manifests itself in the third and fourth decades, that is between 30 and 50 years of age but can occur any time where relatively heavy alcohol intake becomes the pattern.
General Appearance
Jaundice
Cachexia
Fever
Malaise
Abdominal Examination
Hepatomegaly
Splenomegaly
Ascites
Caput Medusae
Abdominal Tenderness
Liver Cirrhosis
Fatty Liver Disease
Pancreatitis
Gastrointestinal Bleeding
Neurological Disorders
Symptoms: In the early stages or at initial stages, the symptoms are very slight and in form of fatigue; weakness; anorexia; and general feeling of being unwell.
Jaundice: With each passing days, patient develop features of liver cirrhosis such as jaundice, where the skin and the eyes turn yellow.
Abdominal Pain: Pain and tenderness in the abdomen.
Ascites: Swelling in the abdomen (ascites) is one of the more frequent symptoms which is manifested in severe forms of the disease.
Hepatic Encephalopathy: Later symptoms may include confusion and disorientation and even coma because of the liver disease & the encephalopathy.
Non-Alcoholic Fatty Liver Disease
Viral Hepatitis
Autoimmune Hepatitis
Drug-Induced Liver Injury
Primary Biliary Cholangitis
Treatment paradigm
Medications:
Corticosteroids: It is also administrated in severe cases to help reduce inflammation with prednisolone medication.
Pentoxifylline: That is less often now because corticosteroids cannot be used often or were shown to be insolvent.
Management of Complications:
Infection control: The care includes frequent observation of any infections because with the immunocompromised status of the patient, infections become even more frequent and life threatening.
Treatment of hepatic encephalopathy: This disease may be treated with lactulose and rifaximin.
Liver Transplantation:
About the management of severe AH not responsive to medical treatment, LT has been considered appropriate for suitable candidates.
Supportive Care:
General supportive care includes plenty of fluid intake and close follow-up of hepatic profile.
Psychosocial Support:
Psychotherapy and self-help programs are critical in dealing with the root cause, which is alcohol use disorder.
Gastroenterology
Abstinence from Alcohol: This may require eliminating the purchase of alcoholic products in the house, and refusal of any occasions where there is the consumption of alcohol.
Nutritional Support: Offer vitamin and mineral resources plus proteins to the patients. It is advisable to consult a dietitian to help in designing the diet for the patient with special consideration for the liver and healing.
Medication Adherence: Prescribed medications for patients are highly recommended to be taken regularly and according to the healthcare provider’s advice.
Gastroenterology
Prednisolone: Prednisolone is sometimes prescribed in the management of severe alcoholic hepatitis, especially if inflammation of the liver and impaired liver function is present.
Liver transplantation should be done in patients with AH who fail medical management and alcohol withdrawal and have severe AH. Usually, this is done in cases where a patient has progressed to acute liver failure or those with severe liver dysfunction after optimal medical therapy.
Gastroenterology
Assessment and Diagnosis: This comprises of clinical assessment and examination, biochemical tests (for example liver function tests, full blood count), imaging studies (including ultrasound), though in some cases liver biopsy to determine the degree of damage.
Initial Management: Abstinence from alcohol is also important with this condition, especially when it has reached this stage. Additional care consists of giving proper nutrition to patients, balancing electrolyte imbalance, and handling of other associated problems such as infections.
Specific Therapies:
Prednisolone: corticosteroids are required for the severe indication, as they decrease inflammation improving short-term prognosis. Further drugs should be used depending on the situation with the patient.
Monitoring and Follow-up: In addition, close supervision of patients’ liver function, clinical status and complications is advisable. The patients are normally suggested for alcohol rehabilitation programs in order to avoid the instance of recurrence.
Liver Transplantation: The transplant indications include those patients with severe alcoholic hepatitis who have failed medical management or those who present recurrent severe episodes.
Long-term Care: These are abstinence from alcohol and other relevant lifestyle changes accompanied by regular follow up and medical intervention towards controlling liver diseases or any related ailments.
Alcoholic hepatitis is one of the serious symptoms or a syndrome associated with the liver that is damaged by alcohol. It is characterized by some symptoms that can develop suddenly, for instance, jaundice, general malaise, hepatomegaly and weak inflammatory signals all over the body. Complication that develops because of cirrhosis of the liver if the inflammation of alcoholic hepatitis is because of regular use of alcohol. Unexpectedly, hepatitis returns to normal in infected individuals who quit alcohol intake within a few months, however the progressed cirrhosis is irreversible.
Investigations have shown that in the USA for instance over two thirds of its population take alcohol and 7.2% is the prevalence of alcohol use disorder. Alcoholism is the third leading cause that comes under the preventable causes of death recorded in the US. A cross-sectional survey performed over the World Wide Web for a decade on 211 hospitals from 2001 to 2011 stated that 0. 08 to 0. 09%. cause of mortality is attributed to alcoholic hepatitis.
In hepatocytes, alcohol is metabolized through the oxidative pathway that reduces the proportion of NAD to NADH. Promoting the oxidation of the triglycerides and the fatty acid from oxidation increases lipogenesis. There is still another recognised route of action of alcohol on the hepatocytes, which is the entrance of lipopolysaccharide bound endotoxin through the intestinal wall into the liver cells.
Lipopolysaccharides bind in Kupffer cells within the liver to the CD-14 and toll-like receptor 4, all triggering the release of reactive oxygen species. These cytokines included platelet-derived growth factor, interleukin-8, tumor necrosis factor-alpha, monocyte chemotactic protein, and the reactive oxygen species were able to raise these cytokines and the end effect is the augmentation of macrophages and neutrophils as well as manifesting the inherent clinical features of alcohol injury.
Although the most significant risk factor for developing chronic liver disease is the amount of alcohol consumed, neither the course of alcohol-induced chronic liver disease nor the relationship between the amount of alcohol and liver injury is linear.
Alcoholic hepatitis is mainly attributed to the autointoxication effect arising from excess and chronic use of alcohol. During the metabolism of alcohol in liver, it produces toxic by-products which are capable of inflicting harm to liver cells. This damage causes inflammation in the liver furthering the development of alcoholic hepatitis.
Although the most significant risk factor for developing chronic liver disease is the amount of alcohol consumed, neither the course of alcohol-induced chronic liver disease nor the relationship between the amount of alcohol and liver injury is linear.
Alcoholic hepatitis is mainly attributed to the autointoxication effect arising from excess and chronic use of alcohol. During the metabolism of alcohol in liver, it produces toxic by-products which are capable of inflicting harm to liver cells. This damage causes inflammation in the liver furthering the development of alcoholic hepatitis.
General Symptoms: Fatigue, malaise, anorexia, and weight loss are common.
Gastrointestinal Symptoms: Nausea, vomiting, abdominal pain (usually in the right upper quadrant), and jaundice (yellowing of the skin and eyes).
Systemic Symptoms: Fever, confusion or altered mental status (hepatic encephalopathy), and signs of malnutrition.
Age group:
Alcoholic hepatitis targets adults who are regular alcohol takers over time. It most frequently manifests itself in the third and fourth decades, that is between 30 and 50 years of age but can occur any time where relatively heavy alcohol intake becomes the pattern.
General Appearance
Jaundice
Cachexia
Fever
Malaise
Abdominal Examination
Hepatomegaly
Splenomegaly
Ascites
Caput Medusae
Abdominal Tenderness
Liver Cirrhosis
Fatty Liver Disease
Pancreatitis
Gastrointestinal Bleeding
Neurological Disorders
Symptoms: In the early stages or at initial stages, the symptoms are very slight and in form of fatigue; weakness; anorexia; and general feeling of being unwell.
Jaundice: With each passing days, patient develop features of liver cirrhosis such as jaundice, where the skin and the eyes turn yellow.
Abdominal Pain: Pain and tenderness in the abdomen.
Ascites: Swelling in the abdomen (ascites) is one of the more frequent symptoms which is manifested in severe forms of the disease.
Hepatic Encephalopathy: Later symptoms may include confusion and disorientation and even coma because of the liver disease & the encephalopathy.
Non-Alcoholic Fatty Liver Disease
Viral Hepatitis
Autoimmune Hepatitis
Drug-Induced Liver Injury
Primary Biliary Cholangitis
Treatment paradigm
Medications:
Corticosteroids: It is also administrated in severe cases to help reduce inflammation with prednisolone medication.
Pentoxifylline: That is less often now because corticosteroids cannot be used often or were shown to be insolvent.
Management of Complications:
Infection control: The care includes frequent observation of any infections because with the immunocompromised status of the patient, infections become even more frequent and life threatening.
Treatment of hepatic encephalopathy: This disease may be treated with lactulose and rifaximin.
Liver Transplantation:
About the management of severe AH not responsive to medical treatment, LT has been considered appropriate for suitable candidates.
Supportive Care:
General supportive care includes plenty of fluid intake and close follow-up of hepatic profile.
Psychosocial Support:
Psychotherapy and self-help programs are critical in dealing with the root cause, which is alcohol use disorder.
Gastroenterology
Abstinence from Alcohol: This may require eliminating the purchase of alcoholic products in the house, and refusal of any occasions where there is the consumption of alcohol.
Nutritional Support: Offer vitamin and mineral resources plus proteins to the patients. It is advisable to consult a dietitian to help in designing the diet for the patient with special consideration for the liver and healing.
Medication Adherence: Prescribed medications for patients are highly recommended to be taken regularly and according to the healthcare provider’s advice.
Gastroenterology
Prednisolone: Prednisolone is sometimes prescribed in the management of severe alcoholic hepatitis, especially if inflammation of the liver and impaired liver function is present.
Liver transplantation should be done in patients with AH who fail medical management and alcohol withdrawal and have severe AH. Usually, this is done in cases where a patient has progressed to acute liver failure or those with severe liver dysfunction after optimal medical therapy.
Gastroenterology
Assessment and Diagnosis: This comprises of clinical assessment and examination, biochemical tests (for example liver function tests, full blood count), imaging studies (including ultrasound), though in some cases liver biopsy to determine the degree of damage.
Initial Management: Abstinence from alcohol is also important with this condition, especially when it has reached this stage. Additional care consists of giving proper nutrition to patients, balancing electrolyte imbalance, and handling of other associated problems such as infections.
Specific Therapies:
Prednisolone: corticosteroids are required for the severe indication, as they decrease inflammation improving short-term prognosis. Further drugs should be used depending on the situation with the patient.
Monitoring and Follow-up: In addition, close supervision of patients’ liver function, clinical status and complications is advisable. The patients are normally suggested for alcohol rehabilitation programs in order to avoid the instance of recurrence.
Liver Transplantation: The transplant indications include those patients with severe alcoholic hepatitis who have failed medical management or those who present recurrent severe episodes.
Long-term Care: These are abstinence from alcohol and other relevant lifestyle changes accompanied by regular follow up and medical intervention towards controlling liver diseases or any related ailments.
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