Alcohol-Related Hepatitis

Key points

• Alcohol-related hepatitis is a serious condition that can make you very unwell and shorten your life 

• It happens from drinking too much alcohol 

• Symptoms can be sudden and severe 

• It can slowly get better if alcohol intake is stopped – but cirrhosis may have already developed 

• The earlier you are diagnosed and treated the better your chance of getting back to good health if you avoid all alcohol 

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What is alcohol–related hepatitis? 

Alcohol-related hepatitis is inflammation (swelling and damage) of the liver caused by drinking too much alcohol.  

Even one episode of binge drinking (drinking a lot in a short time) can sometimes cause it. 

Alcohol-related hepatitis can be mild. It is possible to reverse the condition in the early stages by stopping alcohol. 

But alcohol-related hepatitis is often severe and even life-threatening. It usually happens in people who have been heavy drinkers for many months to years. 

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Why did I get alcohol-related hepatitis?

You’re more likely to get alcohol- related hepatitis if: 

• You drink large amounts of alcohol regularly
  (around 8–10 standard drinks a day for men and 4–6 standard drinks a day for women) See the Australian Guidelines for more information on standard drinks.

• You’ve been drinking heavily for many years 

• You have poor nutrition or are overweight 

• You are female (women are more affected at lower levels of drinking) 
• You drink a lot in a short time (binge drinking) 

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What are the symptoms of alcohol related hepatitis? 

Symptoms of alcohol-related hepatitis may be mild and non-specific. They could include: 

•  mild pain in the upper right side of your belly,  

•  feeling tired  

• nausea 

Severe or acute alcohol-related hepatitis can occur rapidly. They might include: 

• Yellow skin or eyes (jaundice) 

• Pain in the upper right side of the belly 

• Nausea, vomiting, or loss of appetite 

• Feeling tired or weak 

• Fever 

• Swollen belly or legs 

• Confusion or difficulty thinking clearly 

• Dark urine or pale stools 
• Weight loss 

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 Complications 

Alcohol-related hepatitis can result in severe and lasting liver damage, which can lead to serious health complications.  

Over time, scars begin to replace normal liver tissue. This interferes with how the liver works. Early cirrhosis may be able to be reversed if you stop drinking but more advanced scarring can’t be reversed. It’s the final stage of alcohol-associated liver disease. 

Cirrhosis can quickly progress to liver failure once it develops.  

Other potential complications of alcoholic hepatitis may include: 

• Internal, or variceal, bleeding: Because of the increased pressure in the liver veins (portal hypertension), the blood vessels in your oesophagus (food pipe) can become swollen. These are called varices. If they become too big, they can burst and bleed. If this happens, you may vomit up red or black blood, or you may notice that your poo has become black and sticky or tarry. This is a medical emergency.

• Malnutrition: Nutritional issues are common with alcohol-associated hepatitis, as symptoms can affect appetite and limited liver function can affect the absorption of food and lead to muscle wasting. Furthermore, people who drink excessive alcohol may not be eating a healthy and nutritious diet even before becoming unwell.  

• Ascites and oedema: This refers to a build-up of fluid in the abdomen (belly) or legs that can occur when the liver is not working properly. As the fluid accumulates, it can cause discomfort and difficulty breathing. 

• Infections: People may also experience infections. For example, people may experience peritonitis, which refers to an infection of ascitic fluid in the belly. Without prompt treatment, this can lead to life-threatening septic shock. 

• Hepatic encephalopathy: Is a state of confusion. It can happen when your liver is not able to filter toxins like it normally would. This leads to toxins like ammonia being present in your bloodstream. Eventually the toxins enter your brain and cause confusion.  

• Liver cancer:  Liver disease due to excessive alcohol use can increase the risk of liver cancer. 

• Organ failure: In addition to damaging the liver, alcohol-associated hepatitis can also affect blood flow to the kidneys. This is known as hepatorenal syndrome. Without treatment, these organs may fail. 

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How is alcohol-related hepatitis diagnosed? 

If your doctor suspects you have alcohol-related hepatitis, they may: 

• Recommend urgent admission to hospital. 

• Ask about your alcohol use and symptoms. It is important to be very honest about your alcohol use. The earlier you are diagnosed and treated the better your outcome. 

• Do blood tests to check your liver. 

• Order a scan of your liver such as an ultrasound, CT or MRI. 

• Do a liver biopsy (a tiny sample of your liver tissue is taken and checked under a microscope to find out what is causing damage). 

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How is alcohol related hepatitis treated? 

The goal of treatment is to prevent permanent damage to the liver and allow it to begin healing and functioning more normally 

1. Stop drinking alcohol
   This is the most important step. If you have alcohol-related hepatitis, it’s very important to stop drinking alcohol completely and forever. This is the only way your liver might heal or prevent the condition from getting worse or coming back. If you can completely avoid alcohol, in time your liver may heal some or even all its damage from alcohol. To help you stop drinking, you may need to be involved in a treatment program with help from anti-craving medication, and have ongoing, long-term support to help you keep off alcohol. It is very important to stop drinking under medical supervision to prevent severe withdrawal symptoms and side effects. If you keep drinking, you are much more likely to develop serious and possibly life-threatening health problems. 
2. Good nutrition
   Many people with alcohol-related hepatitis are undernourished. Your doctor may suggest:
   • A high-protein, high-calorie and low salt diet  
   • Vitamin supplements (especially B vitamins and thiamine) 
   • Sometimes, feeding through a tube is needed if you’re very sick 
3. Medications
   In severe cases, doctors may give: 
   • Steroid medicine to reduce liver inflammation
   • Other treatments to help support your liver and manage or reduce the risk of complications
4. Liver transplant
   Alcohol-related hepatitis may be a fatal condition if your liver is badly damaged and you continue to get worse. In a small number of people with severe acute alcohol-related hepatitis that is not responding to medical treatment, a liver transplant might be considered.  A high likelihood of life-long abstinence from alcohol is a requirement and people being considered for liver transplant must meet strict criteria and pass through an extensive evaluation process.  

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What next?

Alcohol-related hepatitis can be a very serious condition and can lead to death.  If you regularly drink outside of the recommended guidelines or binge drink you are at risk of this condition. 

If you have had alcohol-related hepatitis it is important not to drink any more alcohol. You should also eat a healthy diet and maintain a healthy weight. It can take 6-12 months or even longer to recover from alcohol-related hepatitis, so it is important to keep up with regular medical appointments to make sure you are staying healthy and recovering properly. 

If you need help to stop or reduce alcohol use, there are many supports available in Australia: 

• Liver Foundation Nurse Led Support Line 1800 841 118 

• Alcoholics Anonymous 1300 222 222
• Alcohol and Drug Foundation 
• National Alcohol and Other Drug Hotline 1800 250 015 
• Hello Sunday Morning (a website aimed to help with decreasing alcohol intake and remaining sober. With tips, personal stories and programs to follow this is a great website for you and your support network to delve into. There is an app available through Hello Sunday Morning called Daybreak. This has been developed to help you track and change your relationship with alcohol. This Australian built app offers non-judgemental peer support, personal improvement activities and is completely anonymous)
• Sober in the Country (a national charity supporting rural communities to decrease or stop alcohol use)
• SMART Recovery (an evidence based recovery method grounded in Cognitive Behavioural Therapy that supports people with substance dependencies to live a balanced life)