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Alcoholic hepatitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]

Overview

Alcoholic Hepatitis should be differentiated from viral hepatitis, autoimmune hepatitis, non-alcoholic fatty liver disease, drug-induced liver injury, Wilson disease, cholestatic causes of liver disease, and cirrhosis.

Differentiating Alcoholic hepatitis from other Diseases

Alcoholic hepatitis can be differentiated from other liver diseases based on the presence of jaundice and other symptoms including fever and abdominal pain.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography

Classification of jaundice based on etiology Disease History and clinical manifestations Diagnosis
Lab Findings Other blood tests Other diagnostic
Family history Fever RUQ Pain Pruritis AST ALT ALK BLR Indirect BLR Direct Viral serology
Hepatocellular Jaundice Alcoholic

liver disease

Alcoholic hepatitis – -/+ -/+ – ↑↑ ↑ N ↑/N N – – –
Cirrhosis -/+ -/+ -/+ – ↑ ↑ ↑/N ↑/N ↑/N -/+ Low platelet Small liver on ultrasound
Jaundice Hemochromatosis + – -/+ – ↑ ↑ ↑/N ↑/N N – Ferritin ↑ Liver biopsy
Wilson’s disease + – -/+ – ↑ ↑ N ↑/N N – Serum cerulloplasmin ↑ Liver biopsy
Viral hepatitis – -/+ – – ↑ ↑ N ↑/N N + Specific viral antibody for each type –
Drug induced hepatitis – -/+ – – ↑ ↑ N ↑/N N – – –
Autoimmune hepatitis -/+ – – -/+ ↑ ↑ N ↑/N N – Anti-LKM antibody Liver biopsy
Cholestatic Jaundice Common bile duct stone -/+ – + + N N ↑ N ↑ – Dilated ducts on ultrasound CT/ERCP
Hepatitis A cholestatic type – -/+ + + N N ↑ N ↑ + HAV– AB Abdominal ultrasound
EBV / CMV hepatitis – -/+ + + N N ↑ N ↑ + Positive serology –
Primary biliary cirrhosis -/+ – -/+ + N/↑ N/↑ ↑ N ↑ – AMA positive Liver biopsy
Primary sclerosing cholangitis -/+ – -/+ + N/↑ N/↑ ↑ N ↑ – Beading on MRCP Liver biopsy
Pancreatic carcinoma + – -/+ – N/↑ N/↑ ↑ N ↑ – Mass on ultrasound CT scan for diagnosis

References

  1. ↑ Stickel F, Seitz HK (2013). “Update on the management of alcoholic steatohepatitis”. J Gastrointestin Liver Dis. 22 (2): 189–97. PMID 23799218.
  2. ↑ Mathurin P, Lucey MR (2012). “Management of alcoholic hepatitis”. J. Hepatol. 56 Suppl 1: S39–45. doi:10.1016/S0168-8278(12)60005-1. PMID 22300464.
  3. ↑ Hamberg KJ, Carstensen B, Sørensen TI, Eghøje K (1996). “Accuracy of clinical diagnosis of cirrhosis among alcohol-abusing men”. J Clin Epidemiol. 49 (11): 1295–301. PMID 8892498.
  4. ↑ Angeli P, Albino G, Carraro P, Dalla Pria M, Merkel C, Caregaro L, De Bei E, Bortoluzzi A, Plebani M, Gatta A (1996). “Cirrhosis and muscle cramps: evidence of a causal relationship”. Hepatology. 23 (2): 264–73. doi:10.1002/hep.510230211. PMID 8591851.
  5. ↑ Burra P, Germani G, Masier A, De Martin E, Gambato M, Salonia A, Bo P, Vitale A, Cillo U, Russo FP, Senzolo M (2010). “Sexual dysfunction in chronic liver disease: is liver transplantation an effective cure?”. Transplantation. 89 (12): 1425–9. doi:10.1097/TP.0b013e3181e1f1f6. PMID 20463637.
  6. ↑ Torruellas C, French SW, Medici V (2014). “Diagnosis of alcoholic liver disease”. World J. Gastroenterol. 20 (33): 11684–99. doi:10.3748/wjg.v20.i33.11684. PMC 4155359. PMID 25206273.
  7. ↑ Baraona E, Leo MA, Borowsky SA, Lieber CS (1975). “Alcoholic hepatomegaly: accumulation of protein in the liver”. Science. 190 (4216): 794–5. PMID 1198096.
  8. ↑ Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). “Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial”. Gastroenterology. 119 (6): 1637–48. PMID 11113085.
  9. ↑ Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA (1984). “Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis”. Am. J. Med. 76 (2): 211–22. PMID 6421159.
  10. ↑ Pirovino M, Linder R, Boss C, Köchli HP, Mahler F (1988). “Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations”. Klin. Wochenschr. 66 (7): 298–302. PMID 3131572.
  11. ↑ Dutta SK, Dukehart M, Narang A, Latham PS (1989). “Functional and structural changes in parotid glands of alcoholic cirrhotic patients”. Gastroenterology. 96 (2 Pt 1): 510–8. PMID 2910764.
  12. ↑ Van Thiel DH, Gavaler JS, Schade RR (1985). “Liver disease and the hypothalamic pituitary gonadal axis”. Semin. Liver Dis. 5 (1): 35–45. doi:10.1055/s-2008-1041756. PMID 3983651.
  13. ↑ Epstein O, Dick R, Sherlock S (1981). “Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease”. Gut. 22 (3): 203–6. PMC 1419499. PMID 7227854.
  14. ↑ Attali P, Ink O, Pelletier G, Vernier C, Jean F, Moulton L, Etienne JP (1987). “Dupuytren’s contracture, alcohol consumption, and chronic liver disease”. Arch. Intern. Med. 147 (6): 1065–7. PMID 3592873.
  15. ↑ Erlinger S, Benhamou J. Cirrhosis: clinical aspects. In: Mcintyre N, Benhamou J, Rizzetto M, editors. Oxford textbook of clinical hepatology. Oxford: University Press; 1991. p. 380.
  16. ↑ Groszman R, Franchis R. Portal hypertension. In: Schiff E, Sorrell M, Maddrey W, editors. Diseases of the liver. Philadelphia: Lippincot Williams & Wilkens; 1999. p. 415.

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