Overview

Diagnosis of Alcoholic Hepatitis

Diagnosing alcoholic hepatitis starts with a physical exam and an honest discussion about alcohol consumption. Healthcare providers may also speak with family members to get a clearer picture of drinking habits.

Liver Enzymes and Liver Function Tests (LFTs)

Blood tests are essential to evaluate liver inflammation and damage. Typical findings in alcoholic hepatitis may include:

  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT): AST/ALT ratio often greater than 2:1, suggesting alcohol-related liver injury.

  • Total bilirubin: Elevated levels can cause jaundice (yellowing of skin and eyes).

  • International normalized ratio (INR) / Prothrombin time (PT): High levels indicate reduced clotting protein production, increasing bleeding risk.

  • Albumin: Low levels signal poor liver function and possible malnutrition.

  • Gamma-glutamyltransferase (GGT): Often elevated in alcohol-related liver disease.

These tests guide diagnosis but are not definitive on their own; they are interpreted alongside symptoms and alcohol history.

Other Blood Tests

Additional blood tests may help rule out conditions that mimic alcoholic hepatitis, including:

  • Viral hepatitis (A, B, or C)

  • Autoimmune liver disease

  • Genetic or metabolic disorders such as Wilson’s disease or alpha-1 antitrypsin deficiency

  • Iron studies

Imaging Tests

Ultrasound, CT scan, or MRI can detect:

  • Liver size and fat buildup

  • Scarring or fibrosis

  • Bile duct problems or liver tumors

Liver Biopsy

A liver biopsy may be necessary if other tests are inconclusive. A small tissue sample is examined under a microscope to confirm inflammation and rule out other conditions.

Treatment of Alcoholic Hepatitis

Effective treatment focuses on stopping alcohol consumption and supporting liver recovery.

Quitting Alcohol

  • Complete alcohol abstinence is crucial for recovery.

  • Mild to moderate cases may improve within weeks if drinking stops.

  • In severe cases, stopping alcohol remains vital, though damage may be irreversible.

  • Professional support is recommended to prevent withdrawal complications.

Support options include:

  • Medications

  • Counseling or therapy

  • Alcoholics Anonymous (AA) or other support groups

  • Structured treatment programs

Nutrition Management

Malnutrition is common in alcoholic hepatitis. Treatment may involve:

  • Special diet plans tailored by a dietitian

  • Feeding tube support in severe cases to provide essential nutrients

Medications to Reduce Liver Inflammation

  • Corticosteroids: Can improve survival in severe cases, but may have serious side effects.

  • N-acetylcysteine: Experimental therapy; more research is needed.

Liver Transplant

For advanced alcoholic hepatitis, a liver transplant may be life-saving. Modern studies show carefully selected patients achieve survival rates comparable to other liver diseases.

Prognosis and Duration

  • Mild to moderate alcoholic hepatitis: Symptoms can improve in weeks to months with alcohol cessation. Liver function may return to near normal.

  • Severe alcoholic hepatitis: May cause long-term liver damage and ongoing complications, such as fluid retention or confusion. Only a small percentage recover fully without complications.

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