Alcoholic Hepatitis Vs Cirrhosis – Similarities and Differences
Approximately two-thirds of adults in the United States drink alcohol, while 7.2% suffer from alcohol use disorder (AUD). Excessive alcohol intake is the third leading preventable cause of death in the United States. A 10-year survey, from 2001 through 2011 from 211 hospitals revealed a 0.08% to 0.09% admissions related to alcoholic hepatitis. [1] There should be no comparison for Alcoholic Hepatitis vs Cirrhosis as both can be life-threatening and require you to stop drinking alcohol.
Excessive alcohol consumption could result in fatty liver disease or steatosis, alcoholic hepatitis (AH), and eventually cirrhosis. Alcoholic hepatitis is a severe syndrome of alcoholic liver disease (ALD).
Alcoholic hepatitis usually progresses to cirrhosis if drinking is continued. For those who discontinue alcohol, hepatitis returns to normal within a few months but the cirrhosis that has already occurred does not reverse. [2]
- Both hepatitis and cirrhosis are conditions involving the liver that can cause abnormal liver function tests and symptoms of liver dysfunction.
- Both hepatitis and cirrhosis can lead to liver cancer, liver failure, or the need for a liver transplant.
General Symptoms of Liver Diseases
What is alcoholic liver disease?
Alcoholic liver disease is common but can be prevented. There are 3 types. Many heavy drinkers progress through these 3 types over time:
- Fatty liver. Fatty liver is the build-up of fat inside the liver cells. It leads to an enlarged liver. It’s the most common alcohol-induced liver problem.
- Alcoholic hepatitis. Alcoholic hepatitis is an acute inflammation of the liver. There is death of liver cells, often followed by permanent scarring.
- Alcoholic cirrhosis. Alcoholic cirrhosis is the destruction of normal liver tissue. It leaves scar tissue in place of the working liver tissue.
The liver is a large organ that sits up under the ribs on the right side of the belly (abdomen). The liver:
- Helps filter waste from the body
- Makes bile to help digest food
- Stores sugar that the body uses for energy
- Makes proteins that work in many places in the body, for example, proteins that cause blood to clot
What are the symptoms of alcoholic liver disease?
The effects of alcohol on the liver depend on how much and how long you have been drinking alcohol. These are the most common symptoms [3] and signs:
Fatty liver
- Often causes no symptoms
- Build-up of fat inside the liver cells enlarges the liver, causing upper abdominal (belly) discomfort on the right side
- Tiredness and weakness
- Weight loss
Alcoholic hepatitis
- Pain over the liver
- Fever
- Weakness
- Nausea and vomiting
- Appetite loss
- Yellowing of the skin and eyes (jaundice)
Alcoholic cirrhosis, all of the symptoms of alcoholic hepatitis and:
- Portal hypertension (increased resistance to blood flow through the liver)
- Enlarged spleen
- Poor nutrition
- Bleeding in the intestines
- Ascites (fluid build-up in the belly)
- Kidney failure
- Confusion
- Liver cancer
The symptoms of alcoholic liver disease may look like other health problems. Always see a doctor for a diagnosis.
Management
What are some lifestyle changes that can help with fatty liver disease or alcohol-related liver diseases (ARLD)?
If you have any of the types of fatty liver disease, there are some lifestyle changes that can help:
- Eat a healthy diet, limiting salt and sugar, plus eating lots of fruits, vegetables, and whole grains
- Get vaccinations for hepatitis A and B, the flu and pneumococcal disease. If you get hepatitis A or B along with fatty liver, it is more likely to lead to liver failure. People with chronic liver disease are more likely to get infections, so the other two vaccinations are also important.
- Get regular exercise, which can help you lose weight and reduce fat in the liver
- Talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices. Some herbal remedies can damage your liver. [4]
The most important part of treating alcohol-related fatty liver disease is to stop drinking alcohol. If you need help doing that, you may want to see a therapist or participate in an alcohol recovery program. There are also medications that can help, either by reducing your cravings or making you feel sick if you drink alcohol.
Prognosis
Although the amount of alcohol ingested is the most important risk factor for the development of chronic liver disease, the progression to alcohol-induced chronic liver disease is neither dose-dependent nor is the correlation with the quantity of alcohol consumed and liver injury linear. Even shorter durations of alcohol abuse could lead to AH.
A typical patient would be between 40 to 60 years of age with a history of more than 100 g/day of alcohol consumption for a decade, in whom you have ruled out other causes of acute hepatitis. Risk factors include a high BMI (body mass index), female sex, and having a genetic variant of patatin-like phospholipase domain-containing protein 3 (PNPLA3). Clinical jaundice is a poor prognostic factor. Acute binge drinking is likely the trigger for AH in patients with a history of chronic, heavy alcohol abuse. [5]
Forty percent of the patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome.
Mild alcoholic hepatitis generally runs a benign course and is completely reversible with the cessation of alcohol consumption.
Complications
Patients with AH are prone to infections, especially when on steroids. This is particularly important as it might lead to a poor prognosis, acute renal injury, and multi-organ dysfunction. Patients with AH are at risk of alcohol withdrawal. Lorazepam and oxazepam are the preferred benzodiazepines for prophylaxis and treatment of alcohol withdrawal. Daily caloric intake should be documented in patients with AH, and nutritional supplementation (preferably via mouth or NG tube) should be considered if oral intake is less than 1200 kcal in a day. [6]
Following are some common complications of alcoholic hepatitis:
- Variceal hemorrhage
- Hepatic encephalopathy
- Coagulopathy
- Thrombocytopenia
- Ascites
- Spontaneous bacterial peritonitis
- Iron overload
Treatment
Quit Drinking
You may be able to reverse the injury to your liver by avoiding alcohol in the early stages of the disease. However, once more notable damage has occurred, the changes within the liver become permanent. Considerable damage can lead to conditions such as cirrhosis, blood clotting problems, and high bilirubin levels.
Even if the damage is too difficult to reverse, you should still stop drinking to prevent further harm to your liver. In people with permanent liver damage due to alcohol, there’s a 30% increase in survival rate among those who stop drinking compared to those who remain to drink.
Abstinence along with adequate nutritional support remains the cornerstone of the management of patients with alcoholic hepatitis. An addiction specialist could help individualize and enhance the support required for abstinence. About 10% to 20% of patients with AH are likely to progress to cirrhosis annually, and 10% of the individuals with AH have regression of liver injury with abstinence. [7]
Patients with alcoholic hepatitis need long-term follow-up. Many can benefit from attending AA or a similar abuse treatment program. Serology for viral hepatitis should be ordered and period surveillance for liver cancer is recommended.
Patients with alcoholic hepatitis should be immunized against hepatitis A, hepatitis B, influenza A virus, and pneumococcus.
Those with end-stage liver should be referred to a transplant nurse to determine eligibility. The transplant nurse should assist in coordination for transplant and report findings to the clinical transplant surgeon and hepatologist managing the case. Due to the complexity of care, an interprofessional team of specialty-trained nurses and clinicians should coordinate the long-term care of these patients.
How We Can Help
Recovery at We Level Up TX treatment center utilizes a multidisciplinary and multidimensional approach.
We incorporate various proven treatments that provide you or your loved one with opportunities for the most optimal treatment outcome: long-term sobriety.
Our treatment focuses on symptom reduction and the development of healthy coping skills and spiritual growth for our guests to attain an independent life filled with purpose, health, hope, and fulfillment. We Level Up also includes evidence-based therapeutic practices and offers support to family members and loved ones, friends, and the community at large. [8]
Alcoholism Treatment & Detox
Treatment professionals at a rehab facility will be able to help you manage your pain with different medications. This allows you to focus on your recovery and get better.
Some individuals are fearful of stopping drinking due to concerns about the withdrawal symptoms associated with alcohol detox. While some individuals may have relatively mild symptoms of drinking, others may experience severe agony. In addition, withdrawal symptoms can change quickly and aggressively, which is why it’s important to detox under the care of medical professionals.
If you or someone you love is seeking a safe, secure, and compassionate resource for alcoholism treatment, We Level Up TX treatment center is here for you. Call us and speak with an addiction counselor today about our levels of care and how to avoid and understand the complications of alcoholic hepatitis vs cirrhosis.
Sources:
[1-2, 5-7] Alcoholic Hepatitis – National Center for Biotechnology Information, U.S. National Library of Medicine
[3] Alcoholic Liver Disease – Johns Hopkins Medicine
[4] Fatty Liver Disease – U.S. Department of Health and Human Services, National Institutes of Health
[8] We Level Up » Addiction » Alcoholic Cirrhosis