Clinical Presentation of Alcoholic Hepatitis
Alcoholic hepatitis is a clinical syndrome of jaundice and liver failure that generally occurs after decades of heavy alcohol use. The cardinal sign of alcoholic hepatitis is the rapid onset of jaundice. Other common signs and symptoms include fever, ascites, and proximal muscle loss. Patients with severe alcoholic hepatitis may have encephalopathy. Typically, the liver is enlarged and tender.
Treatment of Alcoholic Hepatitis
General approaches for patients with decompensated liver disease include treatment of ascites (salt restriction and diuretics) and of hepatic encephalopathy (lactulose and gut-cleansing antibiotics). Infections should be treated with appropriate antibiotics, chosen according to the sensitivity of the organisms isolated. Enteral feeding may be required, as patients are often anorectic. A daily protein intake of 1.5 g per kilogram of body weight is recommended, even among patients with hepatic encephalopathy. Thiamine and other vitamins should be administered.
Delirium tremens and the acute alcohol withdrawal syndrome should be treated with short-acting benzodiazepines. The use of corticosteroids to treat alcoholic hepatitis has been controversial. Pentoxifylline, a nonselective phosphodiesterase inhibitor, decreases the transcription of tumor necrosis factor. Since TNF is elevated in alcoholic hepatitis, the agent is considered for use in some patients. Selected patients with severe alcoholic hepatitis who fail to respond to medical management should be evaluated for liver transplantation.
New England Journal of Medicine - Vol. 360, No. 26, June 25, 2009