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Alcoholic hepatitis
Other Resources UpToDate PubMed

Alcoholic hepatitis

Contributors: Michael W. Winter MD, Christine Osborne MD, Nishant H. Patel MD, Desiree Rivera-Nieves MD, Khaled Bittar MD
Other Resources UpToDate PubMed

Synopsis

Alcoholic hepatitis is a syndrome of progressive inflammatory liver injury associated with long-term heavy intake of ethanol that may progress to liver fibrosis and cirrhosis. Acute alcoholic hepatitis refers to the sudden development of hepatocellular injury and, in some instances, impairment in synthetic liver function. Cessation of alcohol is the mainstay of treatment and can lead to complete recovery of the liver. In some instances, the extent of liver injury is severe and corticosteroids can be of therapeutic value, although some patients will require liver transplant evaluation.

Acute alcoholic hepatitis almost exclusively affects patients with alcohol use disorder, either patients with chronic alcohol use or patients who binge drink alcohol. Prevalence is increased among individuals aged 20-60 years, when alcohol use tends to be the highest. 

Some patients with alcoholic hepatitis are asymptomatic, and those who present typically have nonspecific symptoms including malaise, nausea, jaundice, and low-grade fever. Additionally, patients may present with complications of impaired liver function and acute liver failure including confusion and lethargy from hepatic encephalopathy, bleeding varices, or ascites.

Physical examination typically reveals fever, tachycardia, tachypnea, tender hepatomegaly, jaundice, ascites, and hepatic encephalopathy. Malnutrition is often present. Acute kidney injury occurs frequently, including in up to one-third of severe cases.

Codes

ICD10CM:
K70.10 – Alcoholic hepatitis without ascites

SNOMEDCT:
235875008 – Alcoholic Hepatitis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Acute viral hepatitis (Hepatitis A virus infection, Hepatitis B virus infection, Hepatitis C virus infection)
  • Chronic pancreatitis
  • Metabolic dysfunction-associated steatotic liver disease
  • Acetaminophen poisoning
  • Drug-induced hepatotoxicity or drug reactions
  • Toxin-induced hepatitis (Mushroom poisoning, carbon tetrachloride)
  • Ischemic hepatitis
  • Budd-Chiari syndrome
  • HELLP syndrome (hemolysis, elevated liver enzymes, low platelets)
  • Wilson disease
  • Autoimmune hepatitis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:11/28/2016
Last Updated:01/25/2023
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Alcoholic hepatitis
A medical illustration showing key findings of Alcoholic hepatitis : Fever, Hepatomegaly, Jaundice, Nausea, Ascites, AST elevated, Chronic, heavy alcohol use
Clinical image of Alcoholic hepatitis - imageId=7359793. Click to open in gallery.
Copyright © 2024 VisualDx®. All rights reserved.