Alcoholic Hepatitis
Section snippets
Epidemiology
In the United States, recent estimates suggest that 67% of the adult population drinks alcohol [1]. The prevalence of alcohol dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, has remained low, however, at 4%, according to the 1990 and 1995 National Alcohol Survey [2]. The prevalence is higher in men (6%) than in women (2%). The prevalence of alcohol dependence is particularly high among young adults (18 to 29 years of age), those who never
Pathogenesis
The wide range of individual susceptibility to alcoholic liver disease could be explained by the genetic polymorphism of various metabolic and enzymatic pathways that modulate ethanol metabolism [3]. Such metabolic pathways generate reactive oxygen species that are potent inducers of lipid peroxidation, which in turn causes hepatocyte death by necrosis or apoptosis. High levels of endotoxemia also have been documented among patients who have acute alcoholic hepatitis, probably because of
Pathology
Acute alcoholic hepatitis is characterized morphologically by steatosis, steatohepatitis with polymorphonuclear or mixed infiltration, hepatocyte ballooning, intracytoplasmic Mallory bodies, and fibrosis with perivenular, perisinusoidal, and pericellular distribution (Fig. 1) [8]. Steatosis is mainly macrovesicular and is most prominent in the centrilobular regions. Hepatocytes appear bloated and may have megamitochondria. Mallory bodies are intracellular, eosinophilic, ropelike deposits formed
Clinical features
Patients who have alcoholic hepatitis may be asymptomatic, have only hepatomegaly, perhaps a dull ache over the liver, or have a full-blown picture with tender hepatomegaly, jaundice, fever, malaise, anorexia, and nausea and vomiting. Many have lost a considerable amount of weight, and malnutrition can be seen in about 90% of cases. On physical examination, there are usually florid stigmata of chronic liver disease such as spider nevi and facial telangiectasias. Palmar erythema, Dupuytren's
Prognosis
The mortality of hospitalized patients who have alcoholic hepatitis varies widely. The short-term (<3 months) mortality ranges from 15% to 55% for those who have mild and severe alcoholic hepatitis, respectively [14], [15], [16], [17]. Thus, it is paramount to identify those patients who might benefit from aggressive intervention as well as those for whom the therapeutic benefit-to-risk ratio is unfavorable [18]. Assessing severity of disease in patients who have alcoholic hepatitis is useful
Management and treatment issues
A myriad of treatment options for alcoholic hepatitis have been evaluated over the years, but current therapy still focuses predominantly on supportive care.
Summary
Alcoholic hepatitis still remains a difficult-to-treat clinical condition. Although the Maddrey Discriminant Function traditionally has been used for prognosticating, several newer clinical scoring systems, including MELD and GAHS, have been developed but still require prospective validation. Abstinence, close monitoring, and supportive care are the standard of care in alcoholic hepatitis. Treatment with corticosteroids has been studied in several clinical trials with conflicting results;
Acknowledgements
The authors most sincerely thank Dr. A. J. Demetris, Professor of Transplant Pathology at the University of Pittsburgh, for kindly providing the composite histopathology slide and the legend for Fig. 1.
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Hepatoprotective effects of Lactococcus chungangensis CAU 1447 in alcoholic liver disease
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2016, Clinics in Liver DiseaseCitation Excerpt :Alcoholic hepatitis is estimated to occur in 10% to 35% of heavy drinkers and has a poor prognosis.1 Individuals with alcoholic hepatitis may present with mild, asymptomatic disease manifested by hepatomegaly and increased serum aminotransferase levels with the aspartate aminotransferase level twice or greater than the ALT level.27 Severe disease is associated with jaundice, fever, malaise, tender hepatomegaly, and malnutrition.
Treatment with metadoxine and its impact on early mortality in patients with severe alcoholic Hepatitis
2014, Annals of HepatologyCitation Excerpt :The pathophysiology of SAH is complex. Kupffer cell (KC) activation, production of pro-inflammatory cytokines and reactive oxygen species (ROS) are implied factors in liver damage.12,13 Moreover, there is severe depletion of mitochondrial glutathione (mGSH), which is the principal antioxidant agent in hepatocytes.14,15
Liver abnormalities in drug and substance abusers
2013, Best Practice and Research: Clinical GastroenterologyAlcoholic Hepatitis: A Clinician's Guide
2012, Clinics in Liver DiseaseCitation Excerpt :Many complain that their muscles disappeared as their abdomen began to swell. Malnutrition is seen in approximately 90% of patients with AH.17 Fever ranging from 100.4° to 104° due to AH and not attributable to infection can be seen in more than half of patients diagnosed with severe AH.18
Cytokeratins in hepatitis
2011, Clinica Chimica Acta