Is alcoholic hepatitis serious?

As the name suggests, alcoholic hepatitis is closely related to excessive drinking. We know that drinking too much will increase the burden on the liver, easily cause liver disease, and eventually become alcoholic liver. Alcoholic liver is also relatively serious. It can easily lead to persistent liver symptoms that develop into liver fibrosis, cause cirrhosis, etc., and finally develop into liver cancer. Therefore, patients must first quit drinking and then receive regular treatment.

Is alcoholic hepatitis serious?

The clinical manifestations of patients vary significantly depending on the way they drink, their individual sensitivity to ethanol, and the severity of liver tissue damage. Symptoms are generally related to the amount of alcohol consumed and the duration of alcoholism, and patients may not have any liver symptoms or signs for a long time. The clinical manifestations of alcoholic hepatitis vary greatly.

Before the onset of the disease, there is often a history of heavy drinking in the recent period, with obvious abdominal distension, general fatigue, loss of appetite, diarrhea, nausea, vomiting, abdominal pain, and weight loss. Some patients have fever, characterized by jaundice, liver enlargement and tenderness; a few patients have splenomegaly, sallow complexion, ascites, edema, spider nevi, etc.; when patients have liver dysfunction, ascites is obvious; some patients will experience neuropsychiatric symptoms.

Treatment

1. Stop drinking

The primary method of treating alcoholic liver disease is to quit drinking, and its effectiveness is related to the severity of the liver disease. For common alcoholic liver disease, timely cessation of alcohol often leads to significant improvement in clinical and pathological manifestations within a few weeks to months, and a significant decrease in mortality rate; for severe alcoholic liver disease, cessation of alcohol and drug support may not necessarily improve symptoms; in alcoholic cirrhosis accompanied by decreased prothrombin activity and ascites, the course of the disease often recurs, and cessation of alcohol is difficult to reverse; for alcoholic fatty liver, cessation of alcohol is the only treatment method, and the fat in the liver can disappear within a few weeks to months. If protein or amino acids are supplemented at the same time, it can further promote the recovery of liver cells.

2. Glucocorticoids

In alcoholic liver disease, there is an inflammatory reaction in the liver, swelling and necrosis of liver cells, and collagen production and deposition. Immune factors are involved in the initiation and development of alcoholic liver disease, and anti-Mallory body antibodies can be detected in the patient's blood. Glucocorticoids can inhibit the lipoxygenase and cyclooxygenase pathways of arachidonic acid metabolism, thereby inhibiting the pro-inflammatory effects of leukotrienes and prostaglandins. They can also promote albumin synthesis and prevent the production of type I collagen. Therefore, some people have suggested that glucocorticoids can be used to treat alcoholic liver disease, but many research results are inconsistent.

3. Insulin and Glucagon

There are reports that daily intravenous infusion of insulin and glucagon for 12 hours for 3 weeks can improve liver function in patients with alcoholic liver disease, but there are conflicting conclusions on whether this method can prolong the patient's survival. Some people believe that the effect may be better if epidermal growth factor is given first, followed by insulin and glucagon; there are also reports that insulin-glucagon therapy is ineffective for alcoholic liver disease. In conclusion, this therapy can be tried for alcoholic liver disease, but blood sugar should be monitored during treatment to prevent fatal hypoglycemia.

4. Propylthiouracil

Animals and humans who consume alcohol for a long time are in a state of high metabolism. The liver damage of alcoholic liver disease is more severe in the hepatic acinar area, which is similar to hepatic ischemic damage. Thyroidectomy and propylthiouracil (PTU) treatment can partially prevent the occurrence of hypoxic liver damage in animals consuming alcohol. The above facts have prompted the clinical application of PTU in the treatment of active alcoholic liver disease.

5. Liver transplantation

Patients with severe alcoholic liver disease, especially end-stage cirrhosis, may be considered for liver transplantation if they meet strict selection criteria. Compared with liver transplantation for patients with non-alcoholic liver disease, patients with alcoholic liver disease have a higher survival rate and less recurrence after surgery.