Back to Mild to Moderate Aminotransferase Elevation

Introduction

Acute alcoholic hepatitis can be severe and life-threatening, despite mild-to-moderate elevation of liver aminotransferases. Patients need to be monitored closely for the development of hepatic dysfunction (coagulopathy) and hepatic failure (encephalopathy).

History

Common presenting signs and symptoms of acute alcoholic hepatitis include fever, anorexia, hepatomegaly, jaundice, and/or right upper quadrant abdominal pain that occur in the setting of recent intense alcohol ingestion. In severe alcoholic hepatitis, patients will develop complications of portal hypertension, namely variceal hemorrhage, ascites and/or hepatic encephalopathy.

Physical examination

The followings may be present:

• Jaundice
• Right upper quadrant tenderness
• Tender hepatomegaly
• Ascites
• Stigmata of chronic liver disease (most patients with acute alcoholic hepatitis have underlying cirrhosis)

Laboratory investigation

There are no routine laboratory tests specific to acute alcoholic hepatitis. The following findings are suggestive of alcoholic hepatitis:

• AST/ALT ratio of greater than 2 with aminotransferases less than 300 U/L
• Elevated GGT (sensitive but not specific)