Alcoholic Hepatitis
Overview
Alcoholic Hepatitis is a kind of liver disease caused by long-term alcohol abuse. The main clinical symptoms are nausea, vomit, jaundice, enlargement of the liver and pressing pain. Additional symptoms that may be associated with this disease are liver failure and upper gastrointestinal hemorrhage.
Causes
Morbidity of alcoholic hepatitis and severity of damage to liver is positively associated with time and dosage of alcohol consuming. In Europe countries, the morbidity of alcoholic hepatitis is very high. The severe alcoholic liver damage tends to increase in women. Among the alcoholics, about 10% to 20% of them have alcoholic hepatitis in different degree. Above 90% of alcohol has oxidation metabolism in liver and generates acetaldehyde and acetic acid, both of which have direct toxic effect to liver. Long-term alcohol abuse can increase the liver-toxic effect of common-used medicine, some vitamin, liver-toxic substances and carcinogen.
Clinical Symptoms
As alcoholic hepatitis is tested by histopathological diagnosis, so it varies in clinical symptoms, which can be asymptomatic, jaundice, or dying of complications. It usually develops from fatty liver, and it may also overlap with liver cirrhosis.
1. Symptoms
Patients often have alcohol abuse in the near future. They may feel anorexia, nausea, vomiting, abdominal pain and weight loss and fever.
2. Physical Sign
The characters of this disease are jaundice, enlargement of the liver and pressing pain. About 80% to 100% of patients have symptom of liver enlargement. And 10% to 70% patients are found with ascites, fever, enlargement of liver and spleen and spider angioma. Enlargement of parotid of some patient also can be found in part of patients. The diagnosis is relying on the liver biopsy. As Liver Lesions is Diffused, so non-targeted biopsies by puncture can be adopted.
Diagnosis
Based on patient’s long-term alcohol abuse; fever, jaundice, enlargement of liver, pressing pain and more quantity of leukocyte in clinical symptom; increasing of MCV、r-GT、ALP (AKP) and AST/ALT＞2 , they are helpful for the diagnose of alcoholic hepatitis. But the diagnosis should be confirmed by liver biopsies by puncture then. The mistake in diagnosis usually caused by presuming the liver organ changed according to traditional test result. Change of enzyme is poorly associated with histopathology in alcoholic hepatitis patients. It is reported, 89 cases is approved suffering from alcoholic hepatitis by liver puncturing test. 49% of them are normal in serum bilirubin, 19% of them are normal in AST level, 37% of them have not higher ALP and 59% of them are normal in serum albumin. But after 30 months, 38% of them have hepatocirrhosis, and the death rate is as high as 22%.
Differential diagnosis
Differential diagnosis should confirm whether chronic alcoholism or alcohol-induced liver disease; the stage of alcoholic liver disease belongs to and identification with other liver disease. Test on alcohol concentration in blood and liver biopsy are the most important means of diagnosis. This disease should be identified with liver abscesses, biliary disease, metastatic liver cancer and sepsis.
Treatment
The patients of alcoholic hepatitis should stop drinking as soon as possible. The people who are with obvious symptoms should be in hospital and rest on bed and adopt comprehensive treatment.
Treatment principle of alcoholic hepatitis is: ① to stop drinking and strengthen nutrition ② according to severity of disease, identify which patients should be with drug treatment. The most effective treatment drug of hepatitis is adrenal steroids, but it has mild effect on patients without severe disease. If the patients can stop drinking timely and accept treatment in hospital, most of them could resume, and mortality can be reduced to below 10%. Main death causes were liver failure and acute pancreatitis. If they continue to drink, it easily develops into cirrhosis. 5-year survival rate was only 34.1% to 68.2%.
