Alcoholic hepatitis usually occurs after years of excessive drinking. The longer the duration of alcohol use and the greater the consumption of alcohol, the greater the probability of developing liver disease.

Malnutrition develops as a result of empty calories from alcohol, reduced appetite, and malabsorption (inadequate absorption of nutrients from the intestinal tract). Malnutrition contributes to liver disease.

The toxicity of ethanol to the liver, individual susceptibility to alcohol-induced liver disease, and genetic factors also contribute to the development of alcoholic liver disease.

Alcoholic liver disease does not affect all heavy drinkers, and women may be more susceptible than men. Drunkenness is not essential for the development of the disease.

In some drinkers, the rate of alcohol metabolism can be high enough to allow for the consumption of large quantities of alcohol without raising the blood alcohol level to detectable concentrations by conventional breath analyzer.

Changes start within the liver as inflammation (hepatitis) and progress to fatty liver and cirrhosis. Cirrhosis is the final phase of alcoholic liver disease. Symptoms may not be present until the disease is relatively advanced.

Serious complications are associated with advanced disease such as alcoholic encephalopathy (damage to brain tissue) and portal hypertension (high blood pressure within the liver).

• loss of appetite
• nausea
• swollen abdomen or increased abdominal circumference (from enlarged liver)
• jaundice
• abdominal pain and tenderness
• fever
• ascites (fluid collection in the abdomen)
• unintentional weight gain (because of fluid collection)
• mental confusion
• excessive thirst
• dry mouth
• fatigue

Additional symptoms that may be associated with this disease:

• vomiting blood or material that looks like coffee grounds
• bloody or dark black or tarry bowel movements (melena)
• abnormally dark or light skin
• redness on feet or hands
• paleness
• light-headedness or fainting, especially with upright posture
• rapid heart rate (tachycardia) when rising to standing position
• slow, sluggish, lethargic movement
• breast development in males
• impaired ability to concentrate
• agitation
• fluctuating mood
• difficulty paying attention (attention deficit)
• impaired judgment
• confusion (encephalopathy)
  • altered level of consciousness
  • impaired short-term memory
  • impaired long-term memory
• hallucinations

Note: Symptoms vary with the severity of the disease and are usually worse after a recent period of heavy drinking.

• A CBC may show anemia and other abnormalities.
• Liver function tests such as ALP are abnormal.
• Liver biopsy shows alcoholic liver disease.

Tests to rule out other diseases include:

• ultrasound of the abdomen
• CT scan – abdominal
• blood tests for other causes of liver disease

This disease may also alter the results of the following tests:

• reticulocyte count
• ferritin
• alpha fetoprotein
• abdominal tap (paracentesis)

The objective of treatment is to discontinue alcohol, and to provide a high-carbohydrates, high-calorie diet to reduce protein breakdown in the body. Vitamins, especially B1 and folic acid, are associated with improvement. An alcohol rehabilitation program or counseling may be necessary to break the alcohol addiction. Management of the complications of chronic liver disease may be needed.

Continued excessive drinking is associated with a shorter life expectancy. The probable outcome is poor if drinking continues.

• bleeding esophageal varices
• portal hypertension
• hepatic encephalopathy

• Call your health care provider if symptoms suggestive of alcoholic liver disease develop.
• Call your health care provider if symptoms develop after prolonged or heavy drinking or if you are concerned that drinking may be damaging your health.
  

Limit alcohol consumption to moderate levels.