Clinical features and diagnosis of alcoholic hepatitis

Alcoholic hepatitis is a severe form of alcoholic liver disease that usually presents with rapid onset of jaundice. It is associated with marked neutrophilia, fever, liver pain and tenderness, and occasionally, encephalopathy and ascites.

Alcoholic hepatitis has a characteristic pattern of liver biochemistry:

• reversal of the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio, with AST concentration two to three times higher than ALT (but the concentration of each enzyme is generally less than 300 units/L)
• elevated bilirubin
• elevated gamma glutamyltransferase (GGT).

In patients with very high aminotransferase concentrations, other causes of liver disease (eg paracetamol overdose, acute viral hepatitis) are more likely and require investigation.

Alcoholic hepatitis can often be diagnosed clinically, although liver biopsy is characteristic. Liver biopsy is generally recommended in patients with severe alcoholic hepatitis if prednisolone treatment is being considered, particularly if there is doubt about the diagnosis.