What is Alcoholic Hepatitis?

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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The liver is a rather important organ. It is a vital organ, meaning we could not live without one. Its name is perfect. The liver is responsible for detoxification, metabolism, protein synthesis, digestion, and up to 496 other bodily functions. It’s bigger than the stomach, spleen, and gall bladder combined. No artificial organ exists to replace the liver, which is one heck of a statement in today’s day and age. Liver failure often leads to death. The liver is essentially made up of very specialized tissues.

Hepatitis is the inflammation of these liver tissues. There are five types of hepatitis, A through E. Food and/or water contamination causes types A and E. Type B is mainly a sexually transmitted disease, and type C is most commonly transmitted during shared intravenous drug use. Type D only develops with the occurrence of type B, an offshoot of sorts, and type D is the most deadly form of hepatitis. There is also another form of hepatitis, known as alcoholic hepatitis, which is an inflammation of liver tissue caused by alcohol abuse.

Alcoholic hepatitis can be deadly, and is a stepping stone on the way to cirrhosis and worse yet, liver cancer. Let’s talk about what causes alcoholic hepatitis, what the symptoms are, and how it can be treated and prevented.

Liver Working Overtime

When you drink an alcoholic beverage, one-third of the liquid goes into your stomach and the other two-thirds ends up in your small intestine. The alcohol itself is absorbed into your blood from there. Your kidneys filter some alcohol out, but the remainder is sent to your liver. Here, the alcohol is metabolized, or broken down, into a chemical called acetaldehyde, which is toxic. Your body knows it’s bad for you, so the acetaldehyde is burned as fuel for the body instead of fat like usual.

Drink too much, and two things happen: the fat that should be used by the body gets stored in your liver, and excess acetaldehyde damages liver cells.

Too much fat in the liver causes fatty liver disease. Symptoms include abdominal pain, fatigue, and weight loss. Fatty liver disease cannot be cured. Symptoms can last an entire lifetime. More than 3 million Americans suffer from it every year. Obesity and diabetes can cause fatty liver disease, but it is most commonly associated with excessive drinking. Although not necessarily caused by fatty liver disease, continuing to drink with fatty liver disease can cause alcoholic hepatitis.

Alcoholic Hepatitis

Over time, acetaldehyde causes damage to liver cells. Eventually, due to the damage, the liver becomes inflamed. When the liver becomes inflamed, it cannot function properly. This is a condition known as alcoholic hepatitis. You do not have to be a heavy drinker to be at risk. In fact, all but occasional drinkers and non-drinkers are at risk.

alcoholic hepatitis

There are other possible factors that may contribute to alcoholic hepatitis, including malnutrition, consistently drinking without food intake, genetic factors concerning alcohol metabolism, and any other liver disorders. Severe cases can be fatal. Those with alcoholic hepatitis may experience one or more of the following symptoms:

  • Abdominal pain and/or bloating
  • Nausea and/or vomiting
  • Appetite loss
  • Weight loss
  • Jaundice
  • Fever
  • Mental confusion
  • Extreme fatigue
  • Male impotence and/or testicular shrinkage

The damage of alcoholic hepatitis can be reversed, but requires long-term abstinence from drinking. If you are even a moderate drinker, let alone a heavy drinker or alcoholic, and you have been diagnosed with alcoholic hepatitis, please seek professional treatment immediately. Over fifty people die every day from alcoholic liver disease, according to the Centers for Disease Control (CDC).


The best way to prevent any and all complications associated with alcohol is to, of course, not drink alcohol. However, in America, that’s like asking us not to eat cheeseburgers. The best thing you can do if you’re a responsible drinker is maintain a healthy diet, stay hydrated, and only drink in moderation.

Again, we cannot stress enough that you should seek professional treatment if you are at all dependent on alcohol, and especially if diagnosed with alcoholic hepatitis. This is a serious disease which can be fatal, and is more common than you might think. In the US there are over 500 cases per day on average.

Diagnosis and Treatment

To diagnose alcoholic hepatitis, a doctor must perform a series of tests, as well as analyze the patient’s health history and drinking habits. Tests include a complete blood count, a liver function test, a CT (computerized tomography) scan of the abdomen, and an ultrasound of the liver. Alcoholic hepatitis cannot be diagnosed without such tests.

If these tests do not show definite results, a liver biopsy must be performed. A biopsy consists of removing tissue for examination. It is a rather invasive surgery, and presents risks all on its own. Alcoholic hepatitis may be diagnosed by a biopsy, as well as any other liver diseases.

When it comes to treatment of alcoholic hepatitis, number one is to stop drinking. If you continue to consume alcohol with alcoholic hepatitis, the next step is cirrhosis, as we will see further on. Once the body is clear of alcohol, further treatment can begin.

Next comes hydration, nutrition, and stacking up on vitamins and minerals. More than likely if you have alcoholic hepatitis, you are also malnourished and dehydrated. Also, a doctor may prescribe steroids to reduce the swelling in the liver. According to Love Your Liver, “If heavy alcohol use is reduced and kept within recommended limits, alcoholic hepatitis usually reduces slowly over weeks to months, but often residual cirrhosis will remain.”

In severe cases, a liver transplant may be required. This surgery will not be performed if the patient cannot prove beyond a doubt that alcohol consumption has ceased. Sometimes six months of sobriety is required before even being considered for transplant. Imagine, though, what a slap in the face it would be to take a liver from someone who needed it only to damage it with alcohol all over again.

Next in Line (HE, Cirrhosis, Cancer, & Death…)


Hepatic encephalopathy, also known as HE, can occur as a result of severe alcoholic hepatitis. This is a brain disease caused when toxic substances, normally removed by the liver, end up reaching the brain. Symptoms include extreme confusion, altered levels of consciousness, coma, and even death. Treatment includes removal of toxins directly from the intestines.

liver cirrhosis

Liver Cirrhosis

This occurs when liver cells become so damaged that they literally get replaced by scar tissue. At this point, the liver has been inflamed so often and for so long that it becomes lumpy and hard. Blood and other bodily fluids can no longer easily pass through and be filtered. This is malfunction – more serious than improper function.

Cirrhosis can occur from continuing to drink with either fatty liver disease or alcoholic hepatitis. It can also occur from certain medications, abuse of other drugs, and gallstones, however it is most commonly associated with alcohol abuse. (Hepatitis B can also cause cirrhosis, and can be prevented with vaccination).

Cirrhosis can NOT be cured, just as with alcoholic hepatitis. The liver damage caused by cirrhosis cannot be reversed. Symptoms include:

  • High blood pressure and/or swollen blood vessels
  • Reddening of the palms
  • Increased breast size, infertility, loss of libido, testicular atrophy (in men)
  • Fluid in the abdomen
  • Jaundice
  • Abnormalities of the fingernails
  • Swelling of bone tissue
  • Hand-related deformities
  • Anorexia and/or unwanted weight loss

A long list of other less common symptoms of cirrhosis is available on Wikipedia. Essentially, the liver is scarred to the point of malfunction. Again according to Love Your Liver, linked above, “If you continue to drink at this stage [cirrhosis] you will accelerate damage to your liver and rapidly increase your chances of liver cancer as well as death.”

Liver Cancer

There are many different types of liver cancer. The type associated with alcohol-caused cirrhosis is called hepatocellular carcinoma, or HCC. It is the most common type of liver cancer. The scarring from cirrhosis can develop a cancerous tumor inside the liver. Aside from pre-existing liver conditions, alcohol use is the main risk factor for HCC.

Liver cancer is incurable. It can be treated with chemotherapy and/or radiation. Other options include liver transplant or removal of part of the liver. Symptoms are similar to those of cirrhosis, only more intense. Hepatitis types B and C are the most common causes of liver cancer.

Over seventy people die every day from liver cancer. More than twice as many men than women get diagnosed. Nearly 60% of those diagnosed will die within a year. After five years, that jumps to 83%. For advanced liver cancer, the only treatment is to “experience a quality of life similar to that of before their diagnosis, at least for some time.”

In Conclusion

This could all happen from drinking. Moderate to heavy drinking on a regular basis for a handful of years or any longer puts you directly at risk for liver complications. A detailed dietary guideline was issued in 2015 by the CDC, and part of it is dedicated to recommended alcohol intake. Women should only consume one drink per day, and men should only consume two per day. These are standard sized drinks, containing 0.6 fluid ounces of alcohol.

Standard drinks include: one 12 ounce beer with 5% alcohol, one 5 ounce glass of wine with 12% alcohol, or one 1.5 ounce glass or hard liquor with 40% alcohol. Keep this in mind next time you grab yourself a “tallboy” of beer with alcohol content above five percent. That 24 ounce can is literally more than two standard drinks.

One tallboy a day will NOT keep the doctor away.

Alcoholic hepatitis is basically the halfway mark from healthy liver to failed liver. None of the symptoms are pleasant, and in order to prevent further damage, immediate action must be taken.

Please, please, please seek professional alcohol-dependence treatment if need be. The early stages of alcoholic hepatitis may not be detectable without screening. If you are a heavy drinker, a problematic drinker, an alcoholic, or even someone who drinks moderately but wants to cut back, seek help. Quitting alcohol should never be attempted cold turkey, especially without assistance.

Take care of your liver, and you’ll live longer.

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