Alcoholic Hepatitis Vs. Cirrhosis | Similarities & Differences

The human liver is an astonishing organ with a wide range of functions vital for sustaining human life. Unfortunately, while it is extremely resilient, the human liver can be injured and eventually destroyed through substance abuse. 

Alcoholic hepatitis and cirrhosis as two related but distinct elements of alcohol-related liver disease.

What Is Alcoholic Hepatitis?

When the liver becomes swollen or inflamed, the condition is referred to as hepatitis (not to be confused with the hepatitis viruses, which cause hepatitis). When excessive alcohol consumption is the cause of stress on the liver, it’s known as alcoholic hepatitis. 

Alcohol-related fatty liver disease (or alcoholic steatosis/steatohepatitis) is a common cause of alcoholic hepatitis, as heavy alcohol use may lead to harmful excess fat depositing in the liver over time. 

In extreme cases, alcoholic hepatitis can be so severe as to cause liver failure in death.

What Is Alcoholic Cirrhosis?

If alcohol misuse continues over a long period of time, with or without hepatitis, the damage can become permanent. Hepatocytes (liver cells) experience necrosis (cell death), which can result in fibrosis (scarring).

This buildup of scar tissue will eventually interfere with proper liver function and cause the liver to shrink and harden, causing a wide range of harmful and potentially deadly health effects. 

This form of liver failure is known as cirrhosis of the liver, an extremely serious condition.

Similarities Between Alcoholic Hepatitis & Cirrhosis

Alcoholic hepatitis and alcoholic cirrhosis are both stages of alcoholic liver disease, which exist on a continuum. 

Alcohol abuse is the major risk factor for each, with many heavy drinkers experiencing some form of hepatitis or liver injury during their lives. 

Drug abuse, obesity, malnutrition, and infections such as hepatitis A, hepatitis B, and hepatitis C can also cause or contribute to different forms of liver disease.

Differences Between Alcoholic Hepatitis & Cirrhosis

The biggest differences between alcoholic hepatitis and cirrhosis have to do with the symptoms and reversibility of each condition.

Reversibility

Because hepatitis is an acute inflammation of liver tissue, it can often be reversed by simply dealing with the cause of the inflammation. In the case of alcohol, this means ceasing any further binge drinking and, ideally, giving up alcohol use entirely. 

Alcoholic cirrhosis, on the other hand, is not typically reversible. The damage that is done, is done. 

But, if an individual is able to give up any further alcohol intake it is possible to prevent further damage and limit some of the symptoms of cirrhosis. However, this likely depends on the degree of liver damage that has already occurred and the liver’s remaining ability to regenerate.

Symptoms

Hepatitis is confirmed by blood tests, which will show elevated ALT and AST liver enzyme levels. 

Symptoms of hepatitis may include:

• fatigue
• reduced appetite
• nausea and vomiting
• tenderness in the abdomen
• low fever

Liver cirrhosis, which is diagnosed by a liver biopsy, may cause symptoms including:

• fatigue
• jaundice, a yellowing of the skin and eyes due to high levels of bilirubin
• increased bruising and bleeding
• loss of appetite
• nausea
• edema, or swelling in the lower extremities
• weight loss
• itchy skin
• spider-like blood vessels on the skin
• reddening palms
• missed periods (women)
• low sex drive, testicular atrophy, and breast enlargement (men)

Complications Of Alcoholic Liver Disease

As cirrhosis increases, it may cause abnormally high blood pressure in the portal vein, a large vein that transfers blood from the intestines to the liver. 

Known as portal hypertension, this condition can be life-threatening, triggering several serious complications that may include:

• variceal bleeding, as veins (varices) in the gastrointestinal tract swell and bleed into the body cavity
• ascites, a buildup of fluid in the abdomen that can make it difficult to eat, drink, and move, potentially causing infections, kidney failure, and hernias if not managed
• hepatic encephalopathy, which causes personality changes, confusion, drowsiness, and slurred speech as toxins build up in the bloodstream and are carried to the brain, potentially triggering coma and death

Treatment Options 

If an individual has severe alcoholic hepatitis, they must stop drinking alcohol and give the liver an opportunity to heal. Liver inflammation can also be managed in the short term with medications including corticosteroids and, potentially, Pentoxifylline. 

Because cirrhosis is not reversible, the only available treatment is liver transplantation. However, in order to be eligible for the liver transplant waiting list, an individual must not drink alcohol for a set period of time and commit to sobriety for the rest of their life.

If you or a loved one are interested in receiving professional treatment for alcohol use disorder, please contact us today.