Alcoholic hepatitis is an inflammatory lesion characterized by infiltration of the liver with leucocytes, liver cell necrosis and alcoholic hyaline deposition.

Pathology

Liver cells are ballooned, degenerated and necrosed with infiltration with polymorphs and lymphocytes. Hepatocytes contain Mallory bodies or alcoholic hyaline which are clumps of perinuclear, deeply eosinophilic material that represents intermediate filaments.

Mallory bodies are also seen with morbid obesity, jejuno-ileal shunt, uncontrolled diabetes mellitus, Wilson’s disease, Indian childhood cirrhosis, etc.

Clinical Features: This varies from asymptomatic patient to mild illness to fatal liver cell failure.

• Anorexia, nausea, vomiting, abdominal pain, malaise, weight loss and jaundice.
• Fever as high as 39 to 40 degree Celsius may be seen in 50 percent of cases
• Tender hepatomegaly is usually present. Splenomegaly occurs in 33 percent cases
• Signs of liver cell failure like spider angioma, jaundice, ascites, edema, GI bleeding and encephalopathy may be present
• Cholestatic jaundice may occur in some

Most of the patient recover after several weeks to months after abstinence.

Histological abnormalities may persist for 6 months.

Anemia may occur from GI bleeding, nutritional deficiency (folate and B12 deficiency), hypersplenism, direct bone marrow suppressant effect of alcohol and hemolysis due to acanthoytosis. Leucocytosis is usually present. However, leucopenia and thrombocytopenia could occur due to hypersplenism.

Alkaline phosphatase may be elevated.

Serum prothrombin is prolonged due to reduced synthesis of Vitamin K dependent clotting factors.  Serum albumin is usually reduced due to impairment in hepatic protein synthesis.

Hypomagnesemia and hypophosphatemia may occur due to dietary deficiency. Hypokalemia may occur due to hyperaldosteronism (aldosterone is normally destroyed in liver).

Prognosis

In milder cases, clinical recovery can occur completely. However, repeated bouts of alcoholic hepatitis may lead to irreversible progressive liver injury, abstinence from alcohol can reduce long term morbidity and mortality.

Marked hyperbilirubinemia, elevated creatinine, elevated prothrombin time,  ascites and encephalopathy are associated with poor short term prognosis.

Treatment

• Abstinence from alcohol.
• Nutritious diet rich in calories. Proteins should be 1 gm/kg.
• Multivitamin supplements
• supportive therapy