What You Must Know About Alcoholic Hepatitis
Alert to Alcoholic hepatitis
Daily Mirror Health Line
Compiled by Naveen Jayawardena
Monday, May 12, 2008
Alcohol has long been associated with serious liver diseases such as hepatitis – inflammation of the liver. But the relationship between drinking and alcoholic hepatitis is complex. Only a small percentage of heavy drinkers develop alcoholic hepatitis, yet the disease can occur in people who drink only moderately or binge just once. And though damage from alcoholic hepatitis often can be reversed in people who stop drinking, the disease is likely to progress to cirrhosis and liver failure in people who continue to drink. For them, alcoholic hepatitis may be fatal.
- Genetic factors. Having mutations in certain genes that affect alcohol metabolism may increase your risk of alcoholic liver disease as well as of alcohol-associated cancers. Genetic factors may account for half of any person’s susceptibility to alcohol-related disease.
- Other types of hepatitis. Long-term alcohol abuse worsens the liver damage caused by other types of hepatitis, especially hepatitis C. If you have hepatitis C and also drink – even moderately – you are more likely to develop cirrhosis than is someone who doesn’t drink.
- Other diseases. People who drink alcohol are more likely to develop alcoholic hepatitis if they also have another disease that affects the liver, such as diabetes or iron overload (hemochromatosis) – a disorder in which the body stores too much iron.
- Obesity. Although most researchers agree that obesity makes alcoholic liver disease worse, exactly why this is so isn’t clear. It may be that alcohol causes fatty tissue to produce certain hormones and cytokines – immune system proteins that increase inflammation.
- Malnutrition. Many people who drink heavily are malnourished, either because they eat poorly – often substituting alcohol for food – or because alcohol and its toxic byproducts prevent the body from properly absorbing and metabolizing nutrients, especially protein, certain vitamins and fats. In both cases, the lack of nutrients contributes to liver cell damage. It was once thought that malnutrition, rather than alcohol, caused alcoholic liver disease. Now, the relationship between the two appears more complicated. But it’s certain that drinking leads to malnutrition, which damages the liver and contributes to some of the serious complications of alcoholic liver disease.
- Alcohol use. Consistent heavy drinking or binge drinking is the primary risk factor for alcoholic hepatitis, though it’s hard to precisely define heavy drinking. Some experts believe that four or more drinks a day for men and two or more a day for women greatly increase the risk of liver damage. Moderate drinking is usually defined as no more than two drinks a day for men and one for women. But because people vary greatly in their sensitivity to alcohol, that amount may not actually be moderate for everyone. Whether certain types of alcohol cause more harm than others also is a matter of debate. Some experts believe that wine is less damaging than hard liquor is, although it may be that wine drinkers generally tend to have healthier lifestyles.
- Age. The effects of alcoholic hepatitis are most likely to show up after years of heavy drinking, but symptoms of disease can develop in people as young as 20.
- Your sex. Women are two to three times as likely to develop alcoholic liver disease as men are. It takes less alcohol to harm the liver in women, and when liver disease occurs, it progresses more quickly than it does in men. This disparity may result from differences in the way alcohol is absorbed and broken down. Because women tend to metabolize alcohol more slowly, their livers are exposed to the higher blood concentrations of alcohol for longer periods of time – with potentially greater toxicity. The slow rate of alcohol metabolism in women may be due to lower levels of stomach enzymes that break down alcohol, the effects of estrogen or even the size of a woman’s liver.
- Genetic factors. Researchers have discovered a number of genetic mutations that affect the way alcohol is metabolized in the body. Having one or more of these mutations may increase the risk of alcoholic liver disease and liver cancer.
- Increased blood pressure in the portal vein. Blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. If scar tissue blocks normal circulation through the liver, this blood backs up, leading to increased pressure within the vein.
- Enlarged veins (varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels in the stomach and esophagus. These blood vessels are thin walled, and because they’re filled with more blood than they’re meant to carry, they’re likely to bleed.
- Fluid retention. Alcoholic liver disease can cause large amounts of fluid to accumulate in your abdominal cavity (ascites).
- Bruising and bleeding. Alcoholic hepatitis interferes with the production of proteins that help your blood clot and with the absorption of vitamin K, which plays a role in synthesizing these proteins. As a result, you may bruise and bleed more easily than normal. Bleeding in the gastrointestinal tract is particularly common.
- Jaundice. This occurs when your liver isn’t able to remove bilirubin – the residue of old red blood cells – from your blood. Eventually, bilirubin builds up and is deposited in your skin and the whites of your eyes, causing a yellow color.
- Hepatic encephalopathy. A liver damaged by alcoholic hepatitis has trouble removing toxins from your body – normally one of the liver’s key tasks. The buildup of toxins such as ammonia can damage your brain, leading to changes in your mental state, behavior and personality.
- Cirrhosis. This serious condition, which is an insidious and irreversible scarring of the liver. Cirrhosis frequently leads to liver failure, which occurs when the damaged liver is no longer able to adequately function.
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