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The Critically Ill Cirrhotic Patient pp 161–191Cite as

Acute Alcoholic Hepatitis

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Abstract

Alcoholic hepatitis (AH) is a clinical syndrome characterized by the sudden development of jaundice in the setting of heavy alcohol use. In addition to jaundice, complications of end-stage liver disease such as variceal hemorrhage, ascites and spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy are common. Severe AH is a critical illness with a high short-term mortality as high as 50% at 1 month. As a result, patients with severe AH are frequently cared for in the intensive care unit both at presentation and during the course of care. Alcohol abstinence, nutritional support, and treatment of associated end-stage complications are the cornerstones of treatment, and dramatic improvement can occur over time. Corticosteroid therapy is of some modest benefit in severe AH without uncontrolled sepsis or gastrointestinal hemorrhage. However, corticosteroids increase the risk of infection in this highly vulnerable population and should be discontinued if there is no evidence of efficacy. Multiple organ failure, recently termed acute on chronic liver failure (ACLF), is common in severe AH and often the proximate cause of death in severe AH. Therefore, an understanding of the diagnosis and management of AH is essential for those practicing in a critical care setting.

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  1. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    John P. Rice

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  1. Texas A&M Health Science Center, Baylor University Medical Center, Dallas, TX, USA

    Robert S. Rahimi

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Rice, J.P. (2020). Acute Alcoholic Hepatitis. In: Rahimi, R. (eds) The Critically Ill Cirrhotic Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-24490-3_10

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