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Alcoholic Hepatitis

DEFINITION

Alcoholic hepatitis is a term meaning inflammation or infection of the liver as a result of alcohol use. The liver normally works to helps process nutrients for the body, create proteins including those that help blood clot, and remove drugs and toxins (as well as alcohol). The liver is an amazing organ which is capable of regeneration but can be irreversible damaged. It is not clear how alcohol damages the liver, but it may have to do with how the liver processes the toxin and the chemical byproducts it makes (like acetylaldehyde). These chemical byproducts cause inflammation at the site with development of tight scar tissue over time in the liver. This scar tissue impedes its ability to function properly, a change that becomes irreversible which is called cirrhosis. While there is a clear link between alcohol and liver disease, not everyone who drinks heavily gets liver disease and some people who drink less can also get alcoholic hepatitis. The risk of getting alcoholic hepatitis increases with length of time a person has been drinking as well as the amount of alcohol he/she has consumed. Other risk factors include genetics, age, female sex, having hepatitis from another cause (like Hepatitis B or C), hemochromatosis (another disease that affects the liver), and poor nutrition (lack of nutrients make the body function poorly and less able to repair itself). A safe level of alcohol is generally believed to be no more than two drinks per day for men and no more than one drink for women. Binge drinking is classified as more than four drinks in two hours for women and five drinks in two hours for men. Too much alcohol is never a good idea, but for people with alcoholic hepatitis, drinking at all can be harmful, leading to cirrhosis (chronic, detrimental changes to the liver) and liver failure. In fact, some of the damage to the liver can often be reversed if the person stops drinking. Over time, the complications of alcoholic hepatitis can include: portal hypertension (increased pressure in the blood vessel that bring blood to the liver), varices (enlarged veins with thin walls that can bleed easily and profusely which can be in places like the esophagus), ascites (fluid retention in the abdomen which can impede breathing and become infected), bruising or bleeding (from decreased protein production by the liver), jaundice (yellowing of the skin and eyes from backup of bile in the liver), hepatic encephalopathy (changes in mental status that result from a buildup of toxins that the body cannot get rid of) and cirrhosis (chronic scarring of liver that leads to permanent loss of liver function).

SYMPTOMS
Abdominal pain, abdominal tenderness, nausea, vomiting, blood in vomits, yellowing of skin or eyes, fever, swelling of abdomen due to fluid, confusion, dry mouth, increased thirst, fatigue, paleness, lightheadedness, rapid weight gain

DIAGNOSIS
The diagnosis of alcoholic liver disease is made with careful history (including alcohol consumption) and physical exam as well as some other testing. Blood tests that your doctor can perform include those to check the function of the liver (called AST, ALT and GGT). Once those tests are abnormal, your doctor will likely check to see if you have another cause of hepatitis by checking labs for hepatitis A, B and C. There is no specific blood test for alcoholic hepatitis. After these lab tests, an ultrasound of the liver is generally done to look for changes consistent with inflammation (a bigger liver) or cirrhosis (a small, scarred-down liver). Sometimes, other imaging like a CT scan or MRI may be done. If the cause of elevated liver enzymes is not clear, a gastroenterologist (specialist in the gastrointestinal tract and liver) may want to have a liver biopsy done to look at the cells of the liver.

TREATMENT
The absolute most important treatment for alcoholic hepatitis is abstaining from alcohol. Stopping drinking alcohol can sometimes allow the liver to regenerate healthy liver cells. If a person with alcoholic hepatitis continues to drink, he/she will most certainly have worsened liver disease and, possibly, progress to irreversible cirrhosis. Nutrition changes like a high-calorie, nutrient-dense diet with low fat will likely be recommended by your doctor or nutritionist. Your doctor will also likely recommend stopping smoking, not using illicit drugs and losing weight if you are obese. Sometimes other medications like steroids or pentoxyfylline may be used to decrease inflammation in the liver. Other medications that can be tried include those that inhibit tumor necrosis factor like etanercept or infliximab. Your doctor may also recommend anti-oxidants like SAMe to get rid of dangerous free radicals which can do more damage to the liver. Liver transplant is the only ultimate solution to curing cirrhosis. Having a liver transplant means a lifetime of taking medication so that the body will not reject that organ and requires a person with strong motivation and suport. Getting a liver for transplant can be difficult as the line of people who need transplant is long. Many centers have strict restrictions about doing transplant on those who are still drinking because cirrhosis is likely to recur in the new liver. If alcohol is a problem or difficult to stop, please discuss this with your doctor. Your doctor will be able to get you the appropriate resources to help stop drinking.

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