Alcoholic hepatitis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S
History
Denial is an important component of alcoholism, so appropriate questioning and honest responses are necessary to ascertain the appropriate history. CAGE questioning (Cut down, Annoyed, Guilty, Eye opener) has been shown to be useful in predicting significant alcoholism.
Symptoms
Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset.
- Abdominal pain--occurs in some, but should raise the suspicion for other processes, like pancreatitis or spontaneous bacterial peritonitis (SBP)
- Alcohol withdrawal
- Anorexia
- Ascites- Transient portal venous obstruction, in addition to fixed fibrosis, likely contributes, and so ascites may improve as hepatitis recovers
- Bleeding
- Encephalopathy
- Fever--if signficant, other sources should be ruled out
- Jaundice
- Many acute presentations occur in patients with some degree of chronic injury
- Nausea and vomiting
- Weight loss