Blog
Alcoholic hepatitis
Covenant Metabolic Specialists Health Library
Covenant Metabolic Specialists
Physician Reviewed
Dec 3, 2025
Alcoholic hepatitis is an acute inflammation of the liver caused by prolonged, heavy alcohol use. It ranges from mild, reversible disease to severe, life-threatening liver failure. Early recognition, complete alcohol cessation, and aggressive medical support dramatically improve outcomes.
What is Alcoholic Hepatitis?
Alcoholic hepatitis (AH) develops when chronic or binge drinking damages liver cells, triggering inflammation and scarring. While some patients remain asymptomatic, severe AH can progress rapidly to cirrhosis, portal hypertension, or acute-on-chronic liver failure. Mortality in severe cases can exceed 30 % within 90 days, underscoring the need for urgent care and alcohol abstinence.
Symptoms
Persistent jaundice (yellow eyes/skin)
Right-upper-quadrant pain or tenderness
Fever and general malaise
Fatigue and muscle wasting
Loss of appetite and unintentional weight loss
Nausea or vomiting
Dark urine, pale stools
Swelling of legs or abdomen (ascites)
Easy bruising or bleeding
Confusion (hepatic encephalopathy) in advanced disease
Causes
Excessive alcohol intakeโtypically > 3 drinks/day for women or > 4 for men over years
Repeated binges even in otherwise moderate drinkers
Synergistic insults: obesity, hepatitis C, HIV, or exposure to hepatotoxins amplify risk
Risk Factors
Drinking > 8 standard drinks/day or > 14/week (men) or > 7/week (women)
Female sex (greater alcohol susceptibility)
Genetic variants affecting alcohol metabolism (e.g., PNPLA3)
Malnutrition, especially proteinโcalorie deficiency
Smoking or anabolic-steroid use
Coexisting viral hepatitis or metabolic syndrome
Diagnosis
History & exam: quantity, duration, pattern of alcohol use; signs of chronic liver disease
Lab panel: AST > ALT with AST:ALT โ 2:1, elevated bilirubin, INR, and leukocytosis
Discriminant Function (DF) or MELD score: gauges severity and steroid eligibility
Imaging (ultrasound/CT): excludes biliary obstruction, assesses cirrhosis
Liver biopsy (select cases) confirms diagnosis when etiology is uncertain
Treatments
Immediate alcohol abstinence is the cornerstoneโideally supported by medically supervised detox and addiction services.
Severity Core Interventions
Mildโmoderate Alcohol cessation, high-protein diet, vitamins (B1, B6, folate), manage electrolytes; consider outpatient follow-up.
Severe (DF โฅ 32 or MELD โฅ 20) Inpatient care; prednisolone 40 mg/day ร 28 days (if no sepsis or GI bleed); pentoxifylline when steroids contraindicated; strict infection surveillance; early transplant referral.
Complications Treat ascites (diuretics, paracentesis), encephalopathy (lactulose/rifaximin), variceal bleeding (banding, ฮฒ-blockers).
Liver transplantation is the definitive option for selected patients who achieve sustained abstinence but develop irreversible liver failure.
Prevention
Avoid or quit alcoholโeven โsocialโ drinking can rekindle inflammation after recovery.
Vaccinate against hepatitis A and B.
Maintain healthy weight and balanced nutrition.
Screen regularly for liver function if you have a history of heavy drinking.
Seek early help for alcohol use disorder (AUD); medications like naltrexone or acamprosate can support sobriety.
Our Take
We treat alcoholic hepatitis on two fronts: liver rescue and alcohol recovery. Steroids may cool the fire, but nothing heals without full sobriety and nutrition. At Covenant, we combine hepatology with addiction medicineโbecause saving the liver only matters if we save the person too.
