Is Alcoholic Hepatitis The Same As Cirrhosis
Alcoholic cirrhosis is an advanced stage of alcoholic liver disease, and is irreversible. Cirrhosis results when sustained inflammation destroys healthy, functioning liver cells which are replaced by scar tissue.
Taking remedial steps for alcoholic hepatitis can help regain significant liver function, but liver damage from cirrhosis is permanent and often leads to liver failure.
Symptoms & Side Effects Of Alcoholic Hepatitis
Symptoms of alcoholic hepatitis may be mild or severe. Jaundice, a condition that causes a yellow coloring of the skin or eyes, is one of the most common symptoms of alcoholic hepatitis.
Other common symptoms of alcoholic hepatitis include:
- Fever
- Scarring of the liver can lead to liver failure.
- Kidney failure
- Damage to the liver can disrupt blood flow to the kidneys.
When complications related to alcoholic hepatitis arent treated, they can be life-threatening. If the complications are detected early, most are reversible. However, a person may require a major procedure or lifelong treatment for complications such as encephalopathy, cirrhosis or kidney failure.
Who Is At Risk For Hepatitis
Individuals who share needles and practice unprotected sex increase their likelihood of contracting hepatitis. The main risk factor for alcoholic hepatitis is protracted alcohol abuse. Gender, weight, ethnicity, and certain genetic factors may affect the extent to which acute or chronic hepatitis develops in some people. Furthermore, some forms of hepatitis are transmitted genetically, through contaminated food, sharing silverware, or injury. So, it is difficult to completely reduce the risk of all forms of hepatitis. However, living a purposeful life enhanced by exercise and a healthy diet can reduce the risk for illness.
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Transmission Via Injection Drug Use
If you use syringes to inject drugs, such as LSD, cocaine or heroine into your body, it only takes one incident of sharing a syringe with an infected person to contract the virus. This means someone who has only experimented with injection drugs on a single occasion can be exposed to the virus. This easy transmission route makes hepatitis C contraction a major risk factor for injection drug use.
Hepatitis C can appear in acute form or chronic form. The acute form develops into a short-term illness within the first six months of exposure. If left untreated, acute hepatitis C will develop into a chronic viral infection that lives in the liver and attacks it on a daily basis. Fortunately, in recent years, several treatment methods have come to market, primarily consisting of the antiviral drug ribavirin combined with pegylated interferon alpha. This is able to effectively cure Hepatitis C in 70-80% of those treated over a 6 to 10-month course of treatment. Other drugs, such as boceprevir, telaprevir and sofosbuvir, have been shown to improve this cure rate, though all carry additional side effects.
Key Points About Alcoholic Hepatitis
- Hepatitis is inflammation of the liver that leads to liver cell damage and cell death.
- Alcoholic hepatitis is caused by drinking too much alcohol. The liver breaks down alcohol and if, over time, you drink more alcohol than the liver can process, it can become seriously damaged.
- Alcoholic hepatitis usually develops over time with continued drinking. Severe alcoholic hepatitis can develop suddenly and quickly lead to liver failure and death.
- You must completely stop drinking alcohol and may need an alcohol treatment program. Sometimes diet changes are recommended, too. Treatment involves reducing the symptoms and halting the progression of the disease.
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Willowbrook State School Experiments
A New York University researcher named Saul Krugman continued this research into the 1950s and 1960s, most infamously with his experiments on mentally disabled children at the Willowbrook State School in New York, a crowded urban facility where hepatitis infections were highly endemic to the student body. Krugman injected students with gamma globulin, a type of antibody. After observing the temporary protection against infection this antibody provided, he then tried injected live hepatitis virus into students. Krugman also controversially took feces from infected students, blended it into milkshakes, and fed it to newly admitted children.
Eugene R Schiff Md And Nuri Ozden Md
Eugene R. Schiff, M.D., is chief of the Division of Hepatology, director of the Center for Liver Diseases, and a professor of medicine at the University of Miami School of Medicine, Miami, Florida.
Nuri Ozden, M.D., is a clinical fellow in hepatology at the University of Miami Center for Liver Diseases, Miami, Florida.
Patients infected with the hepatitis C virus who drink heavily are likely to suffer more severe liver injury, promoting disease progression to cirrhosis and increasing their risk for liver cancer. Some research, although not conclusive, suggests that even moderate drinking may spur liver damage in HCVinfected patients. Research areas that have the greatest potential for developing more effective treatment options include HCV virology, immunology, animal models, and the mechanisms of liver injury. Key words: hepatitis C virus alcoholic beverage chronic AODE amount of AOD use epidemiology risk factors disease course alcoholic liver cirrhosis gender differences biochemical mechanism RNA mutation apoptosis inflammation hepatocellular carcinoma regulatory proteins immune response alcoholic fatty liver treatment issues treatment outcome interferon
This article discusses the mechanisms by which alcohol may exacerbate HCVinfected patients risk of disease progression, reviews issues in the treatment of alcoholic patients with HCV infection, and addresses important areas of future research.
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What Are The Different Types Of Alcohol
Alcohol-related liver disease, as the name implies, is caused by excessive consumption of alcohol and is a common, but preventable, disease. For most people, moderate drinking will not lead to the disease. There are three main types of alcohol-related liver disease:
Fatty liver, also called steatosis, is the earliest stage of alcohol-related liver disease and the most common alcohol-related liver disorder. It is characterized by an excessive accumulation of fat inside liver cells, which makes it harder for the liver to function. Usually there are no symptoms, although the liver can be enlarged and you may experience upper abdominal discomfort on the right side. Fatty liver occurs fairly soon in almost all people who drink heavily. The condition will usually go away if you stop drinking.
Alcoholic hepatitis is an inflammation, or swelling, of the liver accompanied by the destruction of liver cells. Up to 35 percent of heavy drinkers develop alcoholic hepatitis, which can be mild or severe. Symptoms may include fever, jaundice, nausea, vomiting, abdominal pain and tenderness. In its mild form, alcoholic hepatitis can last for years and will cause progressive liver damage, although the damage may be reversible over time if you stop drinking. In its severe, acute form the disease may occur suddenly after binge drinking for instance and can quickly lead to life-threatening complications.
Symptoms of cirrhosis include those of alcoholic hepatitis, as well as the following:
What Is The Prognosis For Patients Who Have Alcoholic Hepatitis
If the patient who has alcoholic hepatitis gives up drinking alcohol completely, the liver may improve, and the long-term prognosis is good if there is no underlying scar in the liver. However, if the patient continues to drink excessively, the liver will continue to get worse and possibly develop cirrhosis, a serious condition that may ultimately lead to liver failure over time. Other health problems may also develop, including infections and malnutrition.
Last reviewed by a Cleveland Clinic medical professional on 06/21/2018.
References
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Alcohol Drinking Diary And Change Plan
To keep track of how much you drink, use a drinking diary. Record the number of drinks you have every day. At the end of the month, add up the total number of drinks you had during each week.
One way to make any kind of change in your behavior is to come up with a “change plan.” This exercise has you list the specific goals you would like to achieve, outline the steps and challenges you will meet in reaching those goals, and figure out ways to overcome those challenges.
From Steatosis To Cirrhosis
Alcoholic Liver Disease includes three conditions: Fatty liver, alcoholic hepatitis, and cirrhosis. Heavy drinking for as little as a few days can lead to “fatty” liver, or steatosis-the earliest stage of alcoholic liver disease and the most common alcohol-induced liver disorder.
Steatosis is marked by an excessive buildup of fat inside liver cells. This condition can be reversed, however, when drinking stops.
Drinking heavily for longer periods may lead to a more severe, and potentially fatal condition, alcoholic hepatitis-an inflammation of the liver. Symptoms include nausea, lack of appetite, vomiting, fever, abdominal pain and tenderness, jaundice, and, sometimes, mental confusion. Scientists believe that if drinking continues, in some patients this inflammation eventually leads to alcoholic cirrhosis, in which healthy liver cells are replaced by scar tissue , leaving the liver unable to perform its vital functions.
The presence of alcoholic hepatitis is a red flag that cirrhosis may soon follow: Up to 70 percent of all alcoholic hepatitis patients eventually may go on to develop cirrhosis. Patients with alcoholic hepatitis who stop drinking may have a complete recovery from liver disease, or they still may develop cirrhosis.
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Increased Risk Of Hepatocellular Carcinoma
Hepatocellular carcinoma is the most common form of liver cancer in the U.S., and one of the more common complications of chronic hepatitis C infection. Even more so than liver cirrhosis, the association between alcoholism and HCC is strong, with 80% of HCC cases being identified as heavy alcohol users.
The risk appears to increase with the amount a person drinks. One Italian study showed that the likelihood of HCC doubled when a person drank between 3.4 and 6.7 drinks per day. Similarly, studies have shown that heavy drinking can accelerate the development of HCC by as much as five years, resulting in not only larger tumors but far shorter survival times.
What Factors Increase Your Risk For Alcohol
The amount of alcohol you consume is the most important risk factor for developing alcohol-related liver disease. The risk increases with the length of time and amount of alcohol you drink. However, because many people who drink heavily or binge drink do not develop alcohol-related liver disease, we know there are other factors that affect a persons susceptibility. Additional risk factors that play a role in someone developing alcohol-related liver disease include:
Obesity: Obesity is a contributing factor to fatty liver disease. The combined effect of obesity and alcohol together is worse than the effect of either one of them alone.
Malnutrition: Many people who drink heavily are malnourished, either because they eat poorly due to loss of appetite and nausea or because alcohol and its toxic byproducts prevent the body from breaking down and absorbing nutrients. In both cases, the lack of nutrients contributes to liver cell damage.
Genetic factors: Genetics can influence how the body processes alcohol and may predispose someone to alcoholism and alcohol-related liver disease.
Race and ethnicity: A higher risk of liver injury appears to be associated with ones racial and ethnic heritage. For example, rates of alcoholic cirrhosis are higher in African-American and Hispanic males compared with Caucasian males.
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Alcoholism & Hepatitis C
What happens if you are an alcoholic and you contract hepatitis C?
Significant liver damage can be expected, even leading to cirrhosis.
It is of the utmost importance that you stop drinking forever.
If you are HCV positive, just three or more drinks a day or more increases your risk of cirrhosis, according to a JAMA study.
Need more reasons to stop drinking? Continued alcohol use may also interfere with your ability to consistently adhere to a medication regimen that can tackle HCV infection. In fact, you may not be prescribed HCV treatment if you continue to drink.
Enhancing Healthcare Team Outcomes
This article discusses hepatitis, which is a complex disease and requires an interprofessional approach from healthcare providers to tackle it. The article discusses strategies to prevent hepatitis through patient education and vaccination and the importance of closer monitoring for disease progression and complications. These strategies require significant interprofessional communication and care coordination by physicians, including primary care physicians and specialists, nurses, pharmacists, and other health professionals, to enhance patient-centered care. Nursing needs to work closely with the patient to ensure they understand their disease, are compliant with medications and vaccines, and note progress or lack thereof. Pharmacists are crucial to ensuring the proper medications at the correct dose are in the therapy regimen, and that there are no interactions. Any issues noted by any member of the interprofessional healthcare team need to be shared and charted, so everyone operates from the same data. These measures can help improve the outcomes and aid to patient safety and can also help enhance team performance.
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Diagnosis Of Hcv Infection
HCV liver disease was confirmed in each patient by the detection of anti-HCV antibody in serum tested by second generation radioimmunoblot assay or serum HCV RNA by the the polymerase chain reaction. All patients with hepatitis B surface antigen positivity and immunological disorders of chronic liver disease were excluded from our study. Patients who had not received interferon therapy before liver biopsy were included in this study. HCV RNA was measured in serum by the signal amplification technique employing branched deoxyribonucleic acid in a sandwich hybridization assay . Serum HCV RNA titres were expressed as mega equivalent copies of viral genome per millilitre of serum .
Demographic And Biochemical Data
There was no difference in the age of all male patients in the alcohol and alcohol-free groups . The median alcohol intake for Groups A and D was similar and was considered indicative of heavy alcohol consumption. The median alcohol intake for Group C was 65 g/day and this was considered as a group of moderate alcohol consumption. The AST/ALT ratio was > 1 for Group A, but was < 1 for the other groups. We did not find any significant difference in the serum levels of other biochemical parameters in these four groups except gamma-glutamyl transpeptidase and leucine aminopeptidase , which showed a higher value in Group A compared to the other groups .
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How Is Alcoholic Hepatitis Diagnosed
To diagnose alcoholic hepatitis, the doctor will ask about the patients drinking habits. The doctor will also examine the patient and look for signs of the disease, such as weight loss, a bloated abdomen, or yellow skin tone. The doctor may order blood tests to check for other problems in the liver and to check the livers function.
The doctor may also order a biopsy of the liver if the patients condition is severe or if the diagnosis is unclear.
Directions For Future Research
A recent National Institute on Alcohol Abuse and Alcoholism conference identified areas of research with the greatest potential for leading to more effective treatment options. Conference recommendations for research within these areas were as follows:
Clinical Studies
-
Determine how variations in the amount and pattern of drinking, combined drinking and smoking, and nutritional deficiencies affect HCVinfected patients risk of liver injury, disease progression, and death.
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Evaluate the effectiveness of alcohol cessation programs in patients with HCV.
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Specify how alcohol affects patients response to interferon treatment, including chemical interactions and daytoday changes in virus activity during treatment.
HCV Virology
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Determine how alcohol affects viral replication, clearance, and persistence and the evolution of new HCV quasispecies.
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Examine whether alcohol use leads to greater dominance of more harmful genetic variants of HCV.
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Determine whether alcohol interacts with the HCV viral proteins to alter the viruss genetic activity.
Immunology
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Identify the effects of alcohol on immune responses to HCV, including changes in quality, behavior, and survival of immune cell populations both within and outside the liver.
Mechanisms of Liver Injury
Model Systems
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Develop animal models of HCV infection and of alcoholic liver disease that reproduce disease processes found in humans.
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Acute Vs Chronic Alcoholic Hepatitis
Hepatitis caused by alcohol consumption is usually an acute or short-term condition. Lifestyle changes, such as reduced alcohol consumption, may be the only treatment for acute cases of alcoholic hepatitis. Medications may be prescribed for severe cases.
When people return to heavy drinking after recovering from acute alcoholic hepatitis, they increase their risk of developing chronic alcoholic hepatitis. Chronic alcoholic hepatitis is reoccurring liver inflammation that can lead to cirrhosis, or scarring, of the liver.
Is There A Safe Level Of Drinking
For most people, moderate drinking will not lead to alcohol-related liver disease. According to the Dietary Guidelines for Americans, moderate drinking is one drink a day for women and two drinks a day for men. Each of these alcoholic beverages, in the following amounts, is considered one drink and contains the same amount of alcohol:
- One 12-ounce bottle of beer
- One 4-ounce glass of wine
- One 1-ounce shot of hard liquor.
However, if you have chronic liver disease, even small amounts of alcohol can make your liver disease worse. People with alcohol-related liver disease and those with cirrhosis from any cause should abstain from alcohol completely.
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What Effect Does Alcohol Have On Patients With Hep C
How alcohol worsens HCV and speeds up progression of liver disease is not completely understood. We do know that alcohol acts in several ways to worsen the impact that the virus has on the body. Specifically, excessive alcohol consumption1 :
- Increases HCV replication
- Increases the rate of HCV mutations, increasing the chances for resistant HCV quasispecies
- Has a general negative effect on the health of the body
In one laboratory study, HCV replication or reproduction was increased three-fold in HCV cells that were treated with alcohol. Other studies have looked at how alcohol affects immunity on a cellular level. Alcohol and HCV both decrease the function of specific types of immune system cells involved in protecting liver and other cells. In studies conducted in animals, alcohol consumption resulted in an impaired immune response to HCV.1
Not only does alcohol affect how the body responds to HCV, it also affect how well antiviral medications work against the virus. Alcohol inhibits the effects of antiviral medications, including interferon.1
Alcohol increases the ability of HCV to mutate into quasi species. An increase in the number of HCV quasi species is associated with increased resistance to treatment and poor responses to interferon-based therapy.1