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Hepatitis and Cirrhosis Similarities and Differences

Alcohol is consumed by approximately 75% of the population of the United States, with a 7% incidence of alcoholism. In addition, alcohol accounts for approximately 100,000 deaths in the U.S. each year, with nearly 20% of those deaths attributable to alcoholic cirrhosis. Alcohol abuse rates are higher for men than women, and alcohol abuse presents a serious public health and social problems, all of which are preventable.

The liver is a large organ that lies up under the ribs on the right side of the belly (abdomen). It helps filter waste from the body. It also makes bile to help digest food and stores sugar that the body uses for energy. Long-term alcohol abuse or alcoholism can lead to dangerous alcohol liver damage.

Alcoholic Hepatitis vs Cirrhosis
Chronic alcohol use can affect the liver in many ways, leading to conditions such as alcoholic hepatitis, fatty liver, and cirrhosis.

Excessive alcohol consumption could result in fatty liver disease or steatosis, alcoholic hepatitis, and eventually cirrhosis. Alcoholic hepatitis is a severe syndrome of alcoholic liver disease characterized by rapid onset of jaundice, malaise, tender hepatomegaly, and subtle features of systemic inflammatory response. Alcoholic hepatitis usually progresses to cirrhosis if drinking is continued. For those who discontinue alcohol, hepatitis returns to normal within a few months, but the cirrhosis that has already occurred does not reverse.

About 20% to 40% of those who drink alcohol in heavy amounts and have fatty liver eventually develop liver inflammation, which is known as alcoholic steatohepatitis. Alcoholic steatohepatitis is a diagnosis based on liver histology, while AH is a clinical diagnosis. The amount of alcohol ingested is the most critical risk factor for developing chronic liver disease. However, even shorter durations of alcohol abuse could lead to alcoholic hepatitis.

There are three types of liver disease related to alcohol consumption: fatty liver, alcoholic hepatitis, or cirrhosis. Fatty liver disease occurs after acute alcohol ingestion and is generally reversible with abstinence. Fatty liver is not believed to predispose a person to any chronic liver disease if abstinence or moderation is maintained. Alcoholic hepatitis is an acute form of alcohol-induced liver injury that happens with consuming a large quantity of alcohol over a prolonged period.

Alcoholic hepatitis can range in severity from asymptomatic derangement of biochemistries to liver failure and death. Cirrhosis involves replacing the normal hepatic parenchyma with extensive thick bands of fibrous tissue and regenerative nodules, resulting in the clinical manifestations of portal hypertension and liver failure.

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General Symptoms of Liver Diseases

Liver disease symptoms may be present with hepatitis, cirrhosis, or any other conditions that result in dysfunction of or damage to the liver. These may include:

Itching Skin

Chronic itching (pruritis) is common with liver disease and is due to bile salts, which build up in the skin. This itching usually occurs without a rash.

Jaundice

Yellowish discoloration of the skin and the whites of the eyes (the sclera), is a common symptom of liver disease but has many possible causes. Jaundice happens due to a build-up of bilirubin, a yellow pigment in the blood (hyperbilirubinemia). Jaundice can develop rapidly and dramatically (as with acute hepatitis or bile duct obstruction) or instead develop gradually and subtly.

Vomiting of Blood

Vomiting of blood can be related to liver disease in several ways. One of the more ominous is esophageal varices. Esophageal varices are essentially varicose veins in the esophagus. Varicose veins in the legs develop due to poor blood flow in the legs, causing blood to back up and pool, while blood flow to the esophagus may increase due to damage to the liver, which causes portal hypertension and increased blood pressure in the liver. Portal hypertension is much more common with cirrhosis than hepatitis, as scarring acts as a “kink in the hose” for blood vessels traveling through the liver.

Enlarged Breasts in Male Patients

Enlarged breasts, referred to as gynecomastia, are common with liver disease due to an increase in estrogen caused by liver dysfunction.

An Enlarged Liver

In hepatitis, the liver often becomes tender and enlarged and can be felt below the ribs in the right upper quadrant of the abdomen. With cirrhosis, the liver often becomes small and firm and may feel like a rock when it is felt in the upper abdomen.

Ascites, or Fluid in the Abdomen

Ascites can cause abdominal swelling and bloating and when severe, can result in shortness of breath due to the pressure of the abdomen pushing upward on the chest cavity.

Alcoholic Hepatitis vs Cirrhosis
The liver damage was done by alcoholic cirrhosis symptoms generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited.

Fatigue

Chronic tiredness, the kind of tiredness that does not respond to a good night of rest, is extremely common in both hepatitis and cirrhosis.

More symptoms of acute hepatitis are possible, including bleeding gums, edema (or swelling) in your legs, sleep reversal and other sleep disorders, and loss of consciousness.

Mental Confusion or Forgetfulness

One of the primary functions of the liver is to “detoxify” the blood, that is, to remove toxins and other substances from the blood. When the function of the liver is compromised, these toxins can build up in the bloodstream. Hepatic encephalopathy is a condition characterized by lethargy, confusion, abnormal muscle movements, amnesia, and often a dramatic personality change. It is sometimes mistaken for Alzheimer’s disease, but is, in some cases, at least partly reversible.

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Differentiation Between Alcoholic Hepatitis and Alcoholic Cirrhosis

Symptomatology

Alcoholic Hepatitis

  • Patients with alcoholic hepatitis have been abusing alcohol till the time of presentation; they look more ill and are symptomatic present to a physician
  • Jaundice is usually one of the most common symptoms. Some common modes of presentation are jaundice – 50% of the patients, ascites in 30 – 60%, and splenomegaly – 15% of the patients.
  • Fever (even high grade) is seen in up to 50% of the subjects.
  •  Symptoms of variceal bleeding and hepatic encephalopathy are uncommon.

Alcoholic Cirrhosis

  • Patients with alcoholic cirrhosis may not have abused alcohol for many years prior to presentation; most of them are well-compensated, with only one-third being symptomatic.
  • Ascites are usually the common symptom. Some common modes of presentation are 40%, dilated abdominal wall veins – 60%, and splenomegaly – 25% of the patients.
  • High-grade fever is not seen (unless there is superadded infection).
  • Variceal bleeding and hepatic encephalopathy are quite common.

Investigations

Alcoholic Hepatitis

  • Polymorphonuclear leucocytosis (upto) 20,000/mm3) is quite common.
  • Platelet function is depressed, but there may not be thrombocytopenia. There is no evidence of hypersplenism.
  • SGOT and SGPT are elevated upto 300 to 400 IU with SGOT/SGPT ratio > 2.
  • The highest levels of rising gamma-glutamyl transpeptidase, glutamate dehydrogenase, and tumor necrosis factor are seen in alcoholic hepatitis.
  • Most of the elevated enzymes fall back to normal levels within 1 week of abstinence.
  • Isotope liver scan may show a total absence of radiotracer uptake by the hepatic parenchyma (“Medical hepatectomy”) with avid uptake by the spleen and the bone marrow of vertebrae and the ribs. After a period of recovery, the liver scan may show normal tracer uptake.
  • Liver biopsy histology:
    • Three obligatory features for the histologic diagnosis are – ballooning degeneration of hepatocytes, with areas of necrosis, inflammatory cell infiltrates predominantly
  • 20% of alcoholics show features of hepatitis 18.3% of alcoholics show features of cirrhosis (6.7%) or in combination with cirrhosis (13.4%).8 Alcoholic hepatitis rarely is seen as an isolated pathology on liver biopsy. On most occasions, it is seen in combination with either fatty liver or cirrhosis.

Alcoholic Cirrhosis

  • Polymorphonuclear leucocytosis though seen may not be as high as in alcoholic hepatitis.
  •  Both platelet function and number are reduced and there is evidence of hypersplenism.
  •  SGOT and SGPT are usually normal.
  • There is a mild to moderate rise in gamma-glutamyl transpeptidase and glutamate dehydrogenase in alcoholic cirrhosis.
  • No significant fall in enzyme levels is seen over a period of time, even if abstinent.
  •  Isotope liver scan shows inhomogeneous tracer distribution in the liver, with left lobe uptake greater than the right lobe, colloid shift to the spleen (“Hot spleen”), and visualization of the bone marrow of the vertebrae. The liver scan picture does not show improvement over time.
  • Liver biopsy histology:
    • On liver biopsy the following features are seen- parenchymal necrosis, regeneration, scarring
  • 18.3% of alcoholics show features of cirrhosis on biopsy; 5% as only cirrhosis and 13.4% in combination with alcoholic hepatitis. Thus alcoholic cirrhosis may be the only pathology alcoholic cirrhosis may be the only pathology

Management

Alcoholic Hepatitis

  • Alcoholic hepatitis is usually reversible
  • Treatment consists of abstinence and proper nutritional support. Liver transplantation is not recommended at this stage.

Alcoholic Cirrhosis

  • Alcoholic cirrhosis is generally considered to be an irreversible lesion once it is established.
  • Apart from abstinence and treatment of complications, liver transplantation may be a viable option.

Prognosis

Alcoholic Hepatitis

  • Though high initial in-hospital mortality of about 50%, the long-term prognosis of those who abstain from alcohol is very good.

Alcoholic Cirrhosis

  • Though initial in-hospital mortality may not be high (but depends on the mode of decompensation), long term prognosis is presentation and degree of hepatic dismal with nearly 50% 5-year mortality

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Treatment – Alcoholic Hepatitis vs Cirrhosis

Individuals with alcoholic hepatitis (AH) may also experience alcohol withdrawal symptoms. Mild to moderate symptoms include irritability, sweating, anxiety, headache, tachycardia, and hand tremors with clammy skin. Severe symptoms include delirium tremens (DTs) in which the patient is confused and may have visual hallucinations along with convulsions, agitation, and fever.

Alcoholic Hepatitis vs Cirrhosis
Alcoholic hepatitis is distinct from cirrhosis caused by long-term alcohol consumption. 

The goal of treatment is to restore some or all normal functioning to the liver by addressing the underlying issue of alcohol abuse. You will need to stop drinking alcohol. To do this, you may need to be in an alcohol treatment program. Sometimes you may also need to change your diet. 

Scarring of the liver is permanent. But the liver is often able to repair some of the damage caused by alcohol so you can live a normal life. Alcoholism is one of the primary causes of liver damage. Alcohol-associated liver disease is the leading cause of chronic liver disease. 

Chronic alcohol use will result in a progression from steatosis to alcoholic hepatitis and then finally to alcoholic cirrhosis. The complications associated with alcoholic liver damage can be severe. Significant alcoholic cirrhosis can increase the risk for liver cancer, other cancers, kidney failure, and dementia.

Medically Assisted Detox

Usually, the first step in inpatient alcohol treatment is medically assisted detox. Doctors and addiction specialists monitor clients’ vital signs while alcohol exit the system. Depending on the type of substance a person is detoxing from, withdrawal symptoms may differ.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medicine and medical expertise to lessen cravings and withdrawals.

Behavioral Therapies, Dual Diagnosis

Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) can improve the behavior of the individual. CBT targets negative and maladaptive thought patterns as it promotes positive emotions and beliefs, while DBT helps clients address conflicting impulses so they can make healthy choices. Both therapies treat substance abuse, anxiety disorders, and other mood issues. Therapy also empowers clients to identify, avoid and mitigate cues that trigger drug cravings.

Individual and Group Counseling

Alcoholism and mental health counseling occur in both individual and group settings. One-on-one treatment sessions may address unresolved trauma, unconscious conflicts, and specific struggles, while group sessions often involve training in life skills, stress management, conflict resolution, and social connections. Group counseling also gives clients the chance to share their thoughts and experiences to develop social support, which is essential for lasting recovery.

During your rehabilitation, the staff from the We Level Up treatment facility will help you identify what caused your alcoholism and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your alcoholism. Sometimes, the pressures and problems in your life lead you to rely on alcohol to help you forget about them momentarily.

Please, do not try to detox on your own because the alcohol detox process can be painful and difficult without medical assistance. If you or someone you know is experiencing some early signs of liver disease, don’t wait and ask for medical help before it gets chronic like alcoholic hepatitis and alcoholic cirrhosis, it is important to intervene early. Learn more about alcoholic hepatitis vs cirrhosis. Call We Level Up inpatient rehab today.

Alcoholic Hepatitis vs Cirrhosis
Quitting drinking can make an enormous difference in alcohol-related cirrhosis, and treatment of alcoholic hepatitis may help to prevent cirrhosis and its many complications
Sources

[1] NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/

[2] NCBI – https://pubmed.ncbi.nlm.nih.gov/16508292/

[3] NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124878/