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Alcoholic Hepatitis

Background Knowledge ๐Ÿง 


An acute inflammation of the liver caused by excessive alcohol intake. It’s characterised by liver dysfunction and hepatocellular necrosis.


  • Typically seen in individuals with a long history of high alcohol intake.
  • Amount and duration of alcohol intake, genetics, and diet can influence susceptibility.

Clinical Features ๐ŸŒก๏ธ

Clinical Features

  • Rapid onset jaundice.

  • Anorexia, nausea, and vomiting.

  • Abdominal pain (usually in the right upper quadrant).

  • Fever.

  • Hepatomegaly.

  • Ascites and signs of liver failure in severe cases.

Investigations ๐Ÿงช

Initial Tests

  • Blood tests: Raised bilirubin, raised transaminases (with AST typically greater than ALT, often in a 2:1 ratio), elevated gamma-glutamyltransferase (GGT), and leucocytosis.
  • Alcohol levels: Might be elevated.

Diagnostic Tests

  • Liver biopsy: Gold standard for diagnosis but not always necessary; shows hepatocyte ballooning, neutrophil infiltration, and Mallory bodies.

  • Imaging: Ultrasound or CT may show hepatomegaly and exclude other pathologies.

Management ๐Ÿฅผ


  • Abstinence from alcohol: Primary intervention and is essential for improvement.

  • Corticosteroids: Used for severe alcoholic hepatitis, reduces inflammation; typically prednisolone.

  • Nutritional support: Many patients are malnourished.

  • Supportive care: Addressing complications like ascites, encephalopathy, and bleeding varices.


  • Maddrey’s discriminant function: A score to determine severity and prognosis.

  • Continued alcohol consumption has a poor prognosis.

  • Abstinence can lead to complete recovery or progression to cirrhosis in some cases.


  • Liver failure

  • Portal hypertension

  • Hepatic encephalopathy

  • Ascites

  • Variceal bleeding

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