Possible Complications That May Occur With Alcoholic Hepatitis

There is a reason why doctors and scientists are fascinated by the liver. Other than the brain, it’s the most complex organ in the human body, responsible for over 500 functions. It produces proteins, enzymes, and hormones, filters our blood from toxins and other chemical substances, stores energy, and helps us to fight infections and disease.

The liver is a highly resilient organ with extraordinary regeneration capabilities, but prolonged alcohol abuse damages the liver before it has the chance to recover. That leads to the formation of alcoholic liver disease (ALD). ALD exists in three overlapping stages: alcoholic fatty liver disease, alcoholic hepatitis, and cirrhosis.

What is alcoholic hepatitis?

Alcoholic hepatitis (AH) is a manifestation of underlying alcoholic liver disease and presents causes alcohol-induced inflammation of liver tissue. It is accompanied by high morbidity and mortality, with one-month mortality rates as high as 50 percent. While its exact mechanism is still not clear, we know that it happens as a result of a complex interplay between alcohol metabolism, inflammation, and innate immunity. One of its characteristics is a rapid onset of jaundice (yellowing of the skin and whites of the eyes).

Alcoholic hepatitis is a more serious manifestation of ALD that happens in patients with fatty liver disease who also have certain risk factors like genetic predisposition, female sex, obesity, and middle age. Typically, patients who develop AH have at least a five year history of heavy drinking. Milder forms can go without symptoms and can be reversed if the person stops drinking.

Symptoms include:

• Jaundice
• Fatigue
• Fever
• Nausea and vomiting
• Upper right-quadrant pain
• Low blood pressure and tachycardia (fast heart rate)
• Leukemoid reactions (high white blood cell counts resembling those seen in leukemia)

These symptoms are nonspecific, which is why AH is often diagnosed only after the complications occur. According to a recent study about practice patterns in the US, most patients don't receive the recommended treatment for AH, most likely due to lack of recognition. Complications may be severe and include:

• Portal hypertension (increased pressure on the blood vessels of the liver) and varices
• Coagulopathy (bleeding disorder)
• Hepatic encephalopathy (a brain disorder)
• Hepatorenal syndrome (rapid deterioration of kidney function)
• Ascites (accumulation of the fluids in the stomach)

If you are diagnosed with alcoholic hepatitis and haven’t stopped drinking, you are at serious risk of developing some of the complications. As the alcoholic liver disease progresses, cirrhosis is likely to occur. Up to 20 percent of patients with alcoholic hepatitis develop cirrhosis, including patients who have abstained from alcohol.

Normal brain function depends on normal liver function: hepatic encephalopathy

The liver serves as a special filter that removes toxins normally present as metabolic byproducts from the blood. In healthy individuals, blood travels to the liver through the portal vein and leaves detoxified through hepatic veins. When there is substantial liver damage (like with alcoholic hepatitis or cirrhosis) the liver loses functional cells — and the capacity to remove toxins.

Moreover, in a phenomenon known as portal-systemic shunting, part of the blood that passes through the portal vein is diverted into the general circulation without passing through the liver. As a result, the level of toxic substances in the blood rises and toxins start affecting other organs.

Hepatic encephalopathy is a serious and potentially fatal brain disorder, which happens when neurotoxins like ammonia and manganese accumulate in the blood as liver function declines. Ammonia is normally present as a byproduct of many biochemical pathways. Because it's toxic, especially for the brain, the body breaks it down through the urea cycle that takes place in the liver. The most common therapy for hepatic encephalopathy is lowering blood ammonia levels.

As a complication of alcoholic hepatitis, it presents a very bad prognostic sign. In serious cases, it can result in patients falling into a hepatic coma that can be fatal.  

Symptoms include:

• Personality changes and confusion
• Difficulty thinking
• Poor concentration and memory
• Anxiety
• Depression
• Motor disturbances (shaky hands, slow movements)

Portal hypertension and varices

This complication is typical for cirrhosis, but can also happen with alcoholic hepatitis. As the liver tissue scars and hepatocytes (liver cells) start to swell, it gets harder for the blood to move through the liver which results in increased pressure in the liver's blood vessels. Since blood needs an additional way to leave the liver, new blood vessels called varices are formed. When the pressure is too high, varices can burst and bleed. The bleeding by itself is not severe, but it's long term and often leads to anemia.

Portal hypertension may lead to ascites, the abnormal buildup of fluid in the abdomen. At first, it can be treated with diuretics (water pills, drugs that cause excretion of water from the body), but as it progresses it requires drainage. This can lead to a serious complication called spontaneous bacterial peritonitis, ab infection of the fluid that can result in kidney failure and death.

A weaker liver means a weaker immune system

If the liver damage is severe, two things can occur:

• Immunodeficiency, which means your immune response is weakened and your body is more susceptible to infection.
• Systematic inflammation. An inflammation of the whole body, a very poor prognostic factor.

Conclusion

Alcoholic hepatitis is a serious manifestation of alcoholic liver disease that can be fatal. It comes with the risk of several complications that are especially likely if the person doesn’t stop drinking. Because the liver has incredibly important functions for the whole body, complications that come with liver damage reach far beyond the liver itself. That includes complications with organs such as the brain and the kidneys, blood disorders, and immune-system disorders.