Disease In Focus: Alcoholic hepatitis

 

Alcoholic hepatitis describes liver inflammation caused by drinking alcohol.

 

Though alcoholic hepatitis is most likely to occur in people who drink heavily over many years, the relationship between drinking and alcoholic

hepatitis is complex. Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately.

 

If you're diagnosed with alcoholic hepatitis, you must stop drinking alcohol. People who continue to drink alcohol face a high risk of serious liver damage and death.

 

SYMPTOMS

Yellowing of the skin and whites of the eyes (jaundice) and increasing girth (due to fluid accumulation) are the most common signs of alcoholic hepatitis that lead people to seek medical care.

 

People may also complain of:

 

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

Just about everyone who has alcoholic hepatitis is malnourished. Drinking large amounts of alcohol suppresses the appetite, and heavy drinkers get most of their calories in the form of alcohol.

 

Signs and symptoms of severe alcoholic hepatitis include:

 

Retaining large amounts of fluid in your abdominal cavity (ascites)

Confusion and behavior changes due to brain damage from buildup of toxins (encephalopathy)

Kidney and liver failure

 

CAUSES

Alcoholic hepatitis occurs when the liver is damaged by the alcohol you drink. Just how alcohol damages the liver -— and why it does so only in a minority of heavy drinkers — isn't clear. What is known is that the process of breaking down ethanol — the alcohol in beer, wine and liquor — produces highly toxic chemicals, such as acetaldehyde. These chemicals trigger inflammation that destroys liver cells. Over time, web-like scars and small knots of tissue replace healthy liver tissue, interfering with the liver's ability to function. This irreversible scarring, called cirrhosis, is the final stage of alcoholic liver disease.

 

Risk increases with time, amount consumed

Heavy alcohol use can lead to liver disease, and the risk increases with the length of time and amount of alcohol you drink. But because many people who drink heavily or binge drink never develop alcoholic hepatitis or cirrhosis, it's likely that factors other than alcohol play a role. These include:

 

Other types of hepatitis. Long-term alcohol abuse worsens the liver damage caused by other types of hepatitis, especially hepatitis C. If you have hepatitis C and also drink — even moderately — you're more likely to develop cirrhosis than if you don't drink.

Malnutrition. Many people who drink heavily are malnourished, either because they eat poorly or because alcohol and its toxic byproducts prevent the body from properly absorbing and breaking down nutrients, especially protein, certain vitamins and fats. In both cases, the lack of nutrients contributes to liver cell damage.

Obesity.

Genetic factors. Having mutations in certain genes that affect alcohol metabolism may increase your risk of alcoholic liver disease as well as of alcohol-associated cancers and other complications of heavy drinking. The exact genetic associations have not yet been identified.

 

RISK FACTORS

Major risk factors for alcoholic hepatitis comprise:

 

Alcohol use. The amount of alcohol consumed is the most important risk factor for alcoholic liver disease. One study found that the risk of cirrhosis of the liver increased with daily ingestion of more than 2 to 2.8 ounces (60 to 80 grams) of alcohol over 10 years for men and 0.7 ounces (20 grams) for women. Yet still, only about 35 percent of heavy long-term drinkers develop alcoholic hepatitis.

Your sex. Women have a higher risk of developing alcoholic hepatitis than men do. This disparity may result from differences in the way alcohol is processed by women.

Genetic factors. A number of genetic mutations have been identified that affect the way alcohol is broken down in the body. Having one or more of these mutations may increase the risk of alcoholic hepatitis.

 

Other factors which may increase your risk include:

• Type of beverage (beer or spirits are riskier than wine)
• Binge drinking
• Obesity — alcohol and obesity may have a synergistic effect on the liver; that is, their combined effect is worse than the effect of either of them alone

 

COMPLICATIONS

Complications of alcoholic hepatitis include:

 

Increased blood pressure in the portal vein. Blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. If scar tissue slows normal circulation through the liver, this blood backs up, leading to increased pressure within the vein (portal hypertension).

Enlarged veins (varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels in the stomach and esophagus. These blood vessels are thin walled, and because they're filled with more blood than they're meant to carry, they're likely to bleed. Massive bleeding in the upper stomach or esophagus from these blood vessels is a life-threatening emergency that requires immediate medical care.

Fluid retention. Alcoholic hepatitis can cause large amounts of fluid to accumulate in your abdominal cavity (ascites). The fluid may become infected and require treatment with antibiotics. Although not life-threatening in itself, ascites is usually a sign of advanced alcoholic hepatitis or cirrhosis.

Jaundice. This occurs when your liver isn't able to remove bilirubin — the residue of old red blood cells — from your blood. Bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color.

Hepatic encephalopathy. A liver damaged by alcoholic hepatitis has trouble removing toxins from your body — normally one of the liver's key tasks. The buildup of toxins can damage your brain, leading to changes in your mental state, behavior and personality (hepatic encephalopathy). Signs and symptoms of hepatic encephalopathy include forgetfulness, confusion and mood changes, and in the most severe cases, coma.

Scarred liver (cirrhosis). Over time, the liver inflammation that occurs in alcoholic hepatitis can cause irreversible scarring of the liver (cirrhosis). Cirrhosis frequently leads to liver failure, which occurs when the damaged liver is no longer able to adequately function.

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