Severe alcoholic hepatitis is a life-threatening condition caused by excessive consumption of alcohol (may have alcohol use disorder) over a long period of time, usually several years, but in some cases it can occur within a matter of months.
Alcoholic hepatitis, also often referred to as alcohol-induced liver disease, occurs when individuals consume more alcohol than the liver can process, which causes damage to the liver. The liver becomes incredibly inflamed and cells may start to die.
At this point, it becomes harder and harder for the liver to do its job, which is to process substances that enter the body and filter out toxins. This results in toxins remaining in the body and having a wide range of effects.
Jaundice - yellowing of the skin - is the most common side effect of the condition, but it can also cause:
These symptoms tend to come about and worsen very gradually. However, if they suddenly become more acute, the condition may have escalated to severe alcoholic hepatitis, in which case the patient may show:
The inflammation that alcoholic hepatitis causes to the liver eventually leads to liver cells being destroyed. At this point, the liver becomes scarred - this is known as cirrhosis. Cirrhosis is reversible in some instances, but it can do long-term damage to the liver and permanently inhibit full liver function if it becomes severe enough and results in full liver failure.
If you're experiencing the symptoms listed above and are a heavy drinker, you should seek advice from your doctor. The first step will be assessing your history of alcohol consumption and current drinking habits. Even if you have stopped drinking for several weeks before noticing symptoms, it may still be possible that you are suffering from alcoholic hepatitis.
The next step will be for you to have blood tests. Doctors will want to examine cellular blood counts, bleeding times, electrolytes and liver studies, and they may also test for other chemicals in the body.
In some cases, ultrasound, CT or MRI scans are performed to achieve a more detailed view of the liver and its health. Occasionally, liver biopsies may be performed and these are done by making a small incision in the abdomen to insert a needle to take a sample of cells. It is a short outpatient procedure which typically only takes a few minutes and does not require a general anesthetic, although mild sedatives may be provided where necessary.
In mild cases of the disease, treatment may not be necessary. Patients must cease drinking alcohol; continuing to do so will only make the condition worse and could lead to acute symptoms and severe cirrhosis. Doctors may recommend the use of supplements to help restore levels of vitamins and minerals as the body recovers.
For acute alcoholic hepatitis, urgent medical care is vital since the risk of death within 30 days is 50%. Sufferers should be admitted to hospital where medical staff can provide ongoing observation of their condition and provide additional therapies where appropriate.
Corticosteroids are often recommended to help minimize liver inflammation. However, these cannot be used if the kidneys are also failing, if the patient has gastrointestinal bleeding, or there is an infection present. Pentoxifylline is often used as an alternative, but it is not always effective.
Liver transplant tends to provide the best outlook for patients with severe alcoholic hepatitis, but this is not without risks or difficulty. Around 6,000 liver transplants take place in the US ever year, but around 17,000 people are on the national waiting list for a transplant. Organizations may also be wary of providing a liver transplant to a patient with a history of alcohol abuse unless they can demonstrate they will be able to successfully abstain from alcohol in future.
Severe alcoholic hepatitis is a life-threatening condition which is incredibly difficult to treat. Ultimately, complete abstinence from alcohol is necessary for those showing mild symptoms of the condition to minimize the risk of it developing into the acute form of the disease.