Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key clinical features to differentiate alcoholic hepatitis from other forms of liver disease in primary care include:
- A history of harmful or hazardous alcohol consumption, typically exceeding 35 units per week for women and 50 units per week for men, is a critical distinguishing factor for alcoholic hepatitis compared to other liver diseases NICE CG100.
- Presentation with acute symptoms such as jaundice, tender hepatomegaly, and signs of systemic inflammation may suggest alcoholic hepatitis rather than chronic liver diseases like NAFLD or viral hepatitis NICE CG100.
- Laboratory findings often show elevated liver enzymes with a characteristic pattern: aspartate aminotransferase (AST) is typically elevated to a greater extent than alanine aminotransferase (ALT), often with an AST:ALT ratio greater than 2, which helps differentiate alcoholic hepatitis from other liver diseases NICE CG100.
- Exclusion of alternative causes of liver disease, including viral hepatitis, NAFLD, and autoimmune liver diseases, is essential in the diagnostic process NICE CG100,NICE NG49.
- Assessment of nutritional status and presence of malnourishment can support the diagnosis, as malnutrition is common in alcoholic hepatitis NICE CG100.
- Referral to a specialist for confirmation and consideration of liver biopsy may be necessary if diagnosis is uncertain or if severe disease requiring corticosteroid treatment is suspected NICE CG100.
In contrast, other liver diseases such as NAFLD are more commonly associated with metabolic risk factors like type 2 diabetes and obesity, and do not have a history of significant alcohol misuse NICE NG49. Cirrhosis from other causes may present with decompensated liver disease features but without the acute inflammatory picture typical of alcoholic hepatitis NICE NG50.