The most common sign of alcoholic hepatitis is yellowing of the skin and whites of the eyes (jaundice)
Other signs and symptoms include:
- Loss of appetite
- Nausea and vomiting
- Abdominal tenderness
- Fever, which is often low-grade
- Fatigue and weakness
- Weight loss
Just about everyone who has alcoholic hepatitis is malnourished. Drinking large amounts of alcohol suppresses the appetite, and heavy drinkers get most of their calories in the form of alcohol.
Signs and symptoms of severe alcoholic hepatitis include:
- Fluid accumulation in your abdomen (ascites)
- Confusion and behavior changes due to a buildup of toxins normally broken down and eliminated by the liver
- Kidney and liver failure
When to see a doctor
Alcoholic hepatitis is a serious disease. Up to 30 to 40 percent of people with severe alcoholic hepatitis can die within one month.
See your doctor if:
- You have any signs or symptoms of alcoholic hepatitis
- You feel you can't control your drinking
- You would like help to cut back on your drinking
Alcoholic hepatitis develops when the alcohol that you drink damages your liver. Just how alcohol damages the liver — and why it does so only in some heavy drinkers — isn't clear.
It is known that:
- The body's process for breaking down alcohol produces highly toxic chemicals
- These chemicals trigger inflammation that destroys liver cells
- Over time, scars replace healthy liver tissue, interfering with liver function
- This irreversible scarring (cirrhosis) is the final stage of alcoholic liver disease
Other factors that can contribute to alcoholic hepatitis include:
- Other types of hepatitis. If you have hepatitis C and also drink — even moderately — you're more likely to develop cirrhosis than if you don't drink.
- Malnutrition. Many people who drink heavily are malnourished, because they eat poorly or because alcohol and its byproducts prevent the body from properly absorbing nutrients. Lack of nutrients contributes to liver cell damage.
The major risk factor for alcoholic hepatitis is the amount of alcohol you consume. The amount of alcohol intake that puts a person at risk of alcoholic hepatitis isn't known. But most people with the condition have a history of drinking more than 3.4 ounces (100 grams) — equivalent to seven glasses of wine, seven beers or seven shots of spirits — daily for at least 20 years.
Other risk factors include:
- Your sex. Women seem to have a higher risk of developing alcoholic hepatitis possibly because of differences in the way alcohol is processed in women.
- Obesity. Heavy drinkers who are overweight might be likelier to develop alcoholic hepatitis and to progress from that condition to cirrhosis.
- Genetic factors. Studies suggest there may be a genetic component in alcohol-induced liver disease although it's difficult to separate genetic and environmental factors.
- Race and ethnicity. Although it's difficult o separate genetic and environmental factors, African-Americans and Hispanics might be at higher risk of alcoholic hepatitis.
- Binge drinking. Consuming five or more drinks at one time might increase your risk of alcoholic hepatitis.
Complications of alcoholic hepatitis include:
- High blood pressure in the liver. Scar tissue can slow the flow of blood through your liver, causing an increase in pressure in a major blood vessel (portal vein).
- Enlarged veins (varices). Blood that can’t flow freely through the portal vein can back up into other blood vessels in the stomach and esophagus. These blood vessels have thin walls and are likely to bleed if filled with too much blood. Heavy bleeding in the upper stomach or esophagus is life-threatening and requires immediate medical care.
- Ascites. Fluid that accumulates in the abdomen might become infected and require treatment with antibiotics. Ascites aren’t life-threatening but are usually a sign of advanced alcoholic hepatitis or cirrhosis.
- Jaundice. A damaged liver can't remove the residue of old red blood cells (bilirubin) from your blood. Bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color.
- Confusion, drowsiness and slurred speech (hepatic encephalopathy). A damaged liver has trouble removing toxins from your body. The buildup of toxins can damage your brain. Severe hepatic encephalopathy can result in coma.
- Cirrhosis. This irreversible scarring of the liver frequently leads to liver failure.
- Kidney failure. A damaged liver can affect blood flow to the kidneys, resulting in damage to those organs.
Aug. 04, 2017
- Friedman SL. Alcoholic hepatitis: Clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed Sept. 11, 2015.
- Ferri FF. Alcoholic hepatitis. In: Ferri's Clinical Advisor 2016. Philadelphia, Pa.: Mosby Elsevier; 2016. http://www.clinicalkey.com. Accessed Sept. 12, 2015.
- Singal AK, et al. Alcoholic hepatitis: Current challenges and future directions. Clinical Gastroenterology and Hepatology. 2014;12:555.
- Kumar V, et al, eds. Liver and gallbladder. In: Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Sept. 11, 2015.
- Walker BR, et al, eds. Liver and biliary tract disease. In: Davidson's Principles and Practice of Medicine. 22th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Sept. 11, 2015.
- Friedman SL. Alcoholic hepatitis: Natural history and management. http://www.uptodate.com/home. Accessed Sept. 11, 2015.
- AskMayoExpert. Initial evaluation for alcoholic liver disease. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Goldman L, et al, eds. Alcoholic and nonalcoholic steatohepatitis. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Sept. 12, 2015.
- Mathurin P, et al. Trends in the management and burden of alcoholic liver disease. Journal of Hepatology. 2015;62:538.
- Anderson-Shaw L, et al. Ethical issues in liver transplantation. http://www.uptodate.com/home. Accessed Sept. 11, 2015.
- Cirrhosis. National Heart, Lung, and Blood Institute. http://www.niddk.nih.gov/health-information/health-topics/liver-disease/cirrhosis/Pages/facts.aspx#cause. Accessed Sept. 12, 2015.
- Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 1, 2015.