Yellowing of the skin and whites of the eyes (jaundice) and increasing girth (due to fluid accumulation) are the most common signs of alcoholic hepatitis that lead people to seek medical care.
People may also complain of:
- Loss of appetite
- Nausea and vomiting
- Abdominal pain and tenderness
- 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:
- Retaining large amounts of fluid in your abdominal cavity (ascites)
- Confusion and behavior changes due to brain damage from buildup of toxins (encephalopathy)
- Kidney and liver failure
When to see a doctor
Alcoholic hepatitis is a serious disease. As many as 35 percent of heavy drinkers develop alcoholic hepatitis. And more than a third of them die within six months after signs and symptoms begin to appear.
See your doctor if you have any signs or symptoms of alcoholic hepatitis or other signs and symptoms that worry you. If you ever feel as though you can't control your drinking or feel that you'd like help in cutting back on your drinking, see your doctor.
Alcoholic hepatitis occurs when the liver is damaged by the alcohol you drink. Just how alcohol damages the liver -— and why it does so only in a minority of heavy drinkers — isn't clear. What is known is that the process of breaking down ethanol — the alcohol in beer, wine and liquor — produces highly toxic chemicals, such as acetaldehyde. These chemicals trigger inflammation that destroys liver cells. Over time, web-like scars and small knots of tissue replace healthy liver tissue, interfering with the liver's ability to function. This irreversible scarring, called cirrhosis, is the final stage of alcoholic liver disease.
Risk increases with time, amount consumed
Heavy alcohol use can lead to liver disease, and the risk increases with the length of time and amount of alcohol you drink. But because many people who drink heavily or binge drink never develop alcoholic hepatitis or cirrhosis, it's likely that factors other than alcohol play a role. These include:
- Other types of hepatitis. Long-term alcohol abuse worsens the liver damage caused by other types of hepatitis, especially hepatitis C. 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, either because they eat poorly or because alcohol and its toxic byproducts prevent the body from properly absorbing and breaking down nutrients, especially protein, certain vitamins and fats. In both cases, the lack of nutrients contributes to liver cell damage.
- Genetic factors. Having mutations in certain genes that affect alcohol metabolism may increase your risk of alcoholic liver disease as well as of alcohol-associated cancers and other complications of heavy drinking. The exact genetic associations have not yet been identified.
Major risk factors for alcoholic hepatitis comprise:
- Alcohol use. The amount of alcohol consumed is the most important risk factor for alcoholic liver disease. One study found that the risk of cirrhosis of the liver increased with daily ingestion of more than 2 to 2.8 ounces (60 to 80 grams) of alcohol over 10 years for men and 0.7 ounces (20 grams) for women. Yet still, only about 35 percent of heavy long-term drinkers develop alcoholic hepatitis.
- Your sex. Women have a higher risk of developing alcoholic hepatitis than men do. This disparity may result from differences in the way alcohol is processed by women.
- Genetic factors. A number of genetic mutations have been identified that affect the way alcohol is broken down in the body. Having one or more of these mutations may increase the risk of alcoholic hepatitis.
Other factors which may increase your risk include:
- Type of beverage (beer or spirits are riskier than wine)
- Binge drinking
- Obesity — alcohol and obesity may have a synergistic effect on the liver; that is, their combined effect is worse than the effect of either of them alone
- African-American or Hispanic
Complications of alcoholic hepatitis include:
- Increased blood pressure in the portal vein. Blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. If scar tissue slows normal circulation through the liver, this blood backs up, leading to increased pressure within the vein (portal hypertension).
- Enlarged veins (varices).When circulation through the portal vein is blocked, blood may back up into other blood vessels in the stomach and esophagus. These blood vessels are thin walled, and because they're filled with more blood than they're meant to carry, they're likely to bleed. Massive bleeding in the upper stomach or esophagus from these blood vessels is a life-threatening emergency that requires immediate medical care.
- Fluid retention. Alcoholic hepatitis can cause large amounts of fluid to accumulate in your abdominal cavity (ascites). The fluid may become infected and require treatment with antibiotics. Although not life-threatening in itself, ascites is usually a sign of advanced alcoholic hepatitis or cirrhosis.
- Jaundice. This occurs when your liver isn't able to remove bilirubin — the residue of old red blood cells — from your blood. Bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color.
- Hepatic encephalopathy. A liver damaged by alcoholic hepatitis has trouble removing toxins from your body — normally one of the liver's key tasks. The buildup of toxins can damage your brain, leading to changes in your mental state, behavior and personality (hepatic encephalopathy). Signs and symptoms of hepatic encephalopathy include forgetfulness, confusion and mood changes, and in the most severe cases, coma.
- Scarred liver (cirrhosis). Over time, the liver inflammation that occurs in alcoholic hepatitis can cause irreversible scarring of the liver (cirrhosis). Cirrhosis frequently leads to liver failure, which occurs when the damaged liver is no longer able to adequately function.
- Kidney failure.
You may reduce your risk of alcoholic hepatitis if you:
- Drink alcohol in moderation, if at all. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. The only certain way to prevent alcoholic hepatitis is to avoid all alcohol. If you've ever been diagnosed with alcoholic hepatitis, don't drink alcohol.
- Check the label before mixing medications with alcohol. Check the label of over-the-counter medications for warnings about drinking alcohol. Ask your doctor if it's safe to drink alcohol when taking your prescription medications. Don't drink alcohol when taking medications that warn of complications when combined with alcohol. This is especially true for over-the-counter pain relievers such as acetaminophen (Tylenol, others).
Protect yourself from hepatitis C. Hepatitis C is a highly infectious liver disease caused by a virus. Untreated, it can lead to cirrhosis. If you have hepatitis C and drink alcohol, you're far more likely to develop cirrhosis than is someone who doesn't drink. Because there's no vaccine to prevent hepatitis C, the only way to protect yourself is to avoid exposure to the virus.
Contaminated drug paraphernalia is responsible for the majority of new cases of hepatitis C. Don't share needles or other drug paraphernalia. Hepatitis C can sometimes be transmitted sexually. If you aren't absolutely certain of the health status of a sexual partner, use a new condom every time you have sex. See your doctor if you have or have had hepatitis C or think you may have been exposed to the virus.