Alcoholic hepatitis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]


Alcoholic Hepatitis should be differentiated from viral hepatitis, autoimmune hepatitis, non-alcoholic fatty liver disease, drug-induced liver injury, Wilson disease, cholestatic causes of liver disease, and cirrhosis.

Differentiating Alcoholic hepatitis from other Diseases

Alcoholic hepatitis can be differentiated from other liver diseases based on the presence of jaundice and other symptoms including fever and abdominal pain.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography

Classification of jaundice based on etiology Disease History and clinical manifestations Diagnosis
Lab Findings Other blood tests Other diagnostic
Family history Fever RUQ Pain Pruritis AST ALT ALK BLR Indirect BLR Direct Viral serology
Hepatocellular Jaundice Alcoholic

liver disease

Alcoholic hepatitis - -/+ -/+ - ↑↑ N ↑/N N - - -
Cirrhosis -/+ -/+ -/+ - ↑/N ↑/N ↑/N -/+ Low platelet Small liver on ultrasound
Jaundice Hemochromatosis + - -/+ - ↑/N ↑/N N - Ferritin Liver biopsy
Wilson's disease + - -/+ - N ↑/N N - Serum cerulloplasmin ↑ Liver biopsy
Viral hepatitis - -/+ - - N ↑/N N + Specific viral antibody for each type -
Drug induced hepatitis - -/+ - - N ↑/N N - - -
Autoimmune hepatitis -/+ - - -/+ N ↑/N N - Anti-LKM antibody Liver biopsy
Cholestatic Jaundice Common bile duct stone -/+ - + + N N N - Dilated ducts on ultrasound CT/ERCP
Hepatitis A cholestatic type - -/+ + + N N N + HAV- AB Abdominal ultrasound
EBV / CMV hepatitis - -/+ + + N N N + Positive serology -
Primary biliary cirrhosis -/+ - -/+ + N/↑ N/↑ N - AMA positive Liver biopsy
Primary sclerosing cholangitis -/+ - -/+ + N/↑ N/↑ N - Beading on MRCP Liver biopsy
Pancreatic carcinoma + - -/+ - N/↑ N/↑ N - Mass on ultrasound CT scan for diagnosis


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  9. Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA (1984). "Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis". Am. J. Med. 76 (2): 211–22. PMID 6421159.
  10. Pirovino M, Linder R, Boss C, Köchli HP, Mahler F (1988). "Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations". Klin. Wochenschr. 66 (7): 298–302. PMID 3131572.
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