Alcoholic Hepatitis: Symptoms, Severity & Emergency Recognition

Alcoholic hepatitis is acute-on-chronic liver inflammation from heavy alcohol use. It's a medical emergency—mortality without treatment reaches 30–50% in severe cases. Hospitalization is often required.

Common Symptoms

• Jaundice (often deep, rapid onset)
• Nausea, vomiting, anorexia
• Right upper quadrant abdominal pain/tenderness
• Fatigue, weakness, malaise
• Peripheral edema (legs/ankles)
• Mental status changes: confusion, disorientation, personality change (hepatic encephalopathy)
• Easy bruising/bleeding: epistaxis, gum bleeding, GI bleeding (coagulopathy + thrombocytopenia + portal hypertension)
• Fever (often low-grade, inflammatory)

Severe Liver Failure Signs (Maddrey DF ≥32 or MELD ≥21)

• Severe jaundice, marked encephalopathy (confusion → coma)
• Ascites (tense abdominal distension)
• Refractory edema, oliguria
• Uncontrolled bleeding, coagulopathy (INR >2.5)
• Infection (SBP, pneumonia, sepsis)
• Renal failure (hepatorenal syndrome)

Diagnostic Workup

• LFTs: AST:ALT ratio >2:1 (classic), elevated GGT, bilirubin, INR
• CBC: leukocytosis, thrombocytopenia, anemia
• Renal function, electrolytes, ammonia, lactate
• Imaging: US (liver echogenicity, ascites, portal flow), CT if needed
• Liver biopsy (transjugular if coagulopathic) for definitive diagnosis/staging

Treatment

• Alcohol cessation — absolute, immediate
• Nutritional support: High-calorie, high-protein, thiamine, folate, multivitamins. Enteral preferred.
• Corticosteroids (prednisolone 40mg/day ×28d): For severe (Maddrey ≥32) without contraindications (infection, GI bleed, renal failure). Lille score at day 7 guides continuation.
• Pentoxifylline: Alternative if steroids contraindicated (modest benefit).
• Manage complications: Lactulose/rifaximin (encephalopathy), diuretics (ascites), antibiotics (SBP prophylaxis/treatment), blood products (bleeding), CRRT (HRS).
• Early liver transplant evaluation for select severe cases (controversial, requires abstinence commitment, psychosocial eval).

Alcoholic hepatitis demands urgent, multidisciplinary care. Abstinence is the only path to recovery.