It's Possible to Have Alcoholic Hepatitis and Not Know It

Gillian May
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As a former nurse, recovering alcoholic and daughter of a father who lost his life to alcoholic liver disease, I am committed to providing proper education about this sneaky and serious condition. Alcoholic liver disease accounts for up to 20% of all liver-related mortality and yet it remains misunderstood and underdiagnosed.

Alcoholic liver disease is the umbrella term for a group of liver-related diseases caused by alcohol. Most heavy drinkers think that liver issues won’t happen to them because the condition is so ignored and public education is lacking. Those who do understand the liver risks of heavy drinking think that liver symptoms will be obvious and they will have time to fix the issues should it ever arise. Sadly, this is false thinking.

Unfortunately, varying degrees of liver disease are very common among alcoholics and once serious symptoms begin to show up, it’s often too late. Also, the process of diagnosis is very complicated and thus, doctors often don’t catch the signs in their earlier stages.

Nonetheless, there are clear indicators that the liver is affected from heavy drinking, and the more that people are educated about this, the more this condition can be prevented. This is especially true for early liver disease indicators.

The condition my father actually died from is called cirrhosis and this happens once most of the liver cells are dead. What remains of the liver are usually fibrotic scars that can never be regenerated. This is important because the liver is actually highly regenerative, which means damaged cells can actually regenerate if the toxin is removed. However, in cirrhosis, liver cells no longer exist which leads to certain failure of the organ.

But before the liver reaches cirrhosis, the heavy drinker often has bouts of a condition called alcoholic hepatitis which is an acute inflammatory process that damages the cells of the liver. This condition is important to understand as it holds the key to early detection and prevention.

Alcoholic hepatitis is the process by which liver cells become damaged in the first place. This condition is usually not permanent and is treatable. But the main thing that heavy drinkers need to understand is that alcoholic hepatitis can be present without knowing it, however, there are likely symptoms that the person is experiencing. These symptoms have a wide variety of presentations which makes this condition confusing.

Some symptoms include:

  • Nausea and vomiting
  • Fever
  • Elevated white cell count
  • Elevated liver enzymes (but not always)
  • Jaundice (but not always)
  • Weakness and feeling very tired
  • Sometimes hepatic encephalopathy (brain-related symptoms)
  • Swelling (but not always)
  • Low blood pressure and tachycardia (but not always)

Usually, alcoholic hepatitis occurs after days or months of very heavy drinking. And even though there are almost always symptoms, the heavy drinker may just attribute them to a bad hangover, a flu, or something else. This means the symptoms are ignored and the liver continues to be damaged which paves the way towards the development of cirrhosis.

The only time that alcoholic hepatitis receives a diagnosis is when the symptoms are so acute and severe that the person needs to be hospitalized. Unfortunately, even in hospital, the symptoms can easily passed off as an infection of unknown origin. Many times heavy drinkers are treated for infection and sent home only to continue drinking and causing more liver damage.

The only way to ensure an accurate diagnosis is for the doctors to be made aware of the person's heavy drinking patterns. An experienced and thorough physician would find ways to obtain a truthful drinking history, but this can be very complicated as alcoholics are good at hiding their consumption. Unfortunately, without that history, the condition is likely to be misdiagnosed.

What makes alcoholic hepatitis easy to miss is that mild cases often resolve on their own. The heavy drinker gets better again and feels all is well, so they return to their regular drinking patterns and the cycle continues.

If you or anyone you know is a heavy drinker and has experienced these symptoms, even in mild form, know that alcoholic hepatitis was likely the cause. And the best mechanism for prevention of further liver damage is to ensure that doctors know the extent of the drinking history. Without that, they can’t order the complicated tests required to investigate liver issues. These tests are not easy to obtain or to work through which is why they are not ordered unless there is reason to believe that the liver is in trouble.

The first line of prevention is to understand the risks in the first place. Hopefully, articles like this can help broaden public education. Unfortunately, alcoholic liver disease is easy to miss, is costly to the health care system, and can be very complicated for the medical staff. This means that it’s common for doctors to dismiss and move on. However, the more that the general public is educated about this condition, the more they can advocate for proper care and diagnosis.

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I'm a former nurse turned freelance writer. I have extensive experience in administration, frontline care, and education in mental health, public health, and geriatrics. However, after 20 years, I needed a change and always wanted to write. I have personal and family experience in mental health and addictions, so I'm passionate about advocacy and education in those areas. I'm also a traveler, photographer, and artist. I funnel all my various expertise into my writing and hope to provide valuable content that is entertaining and educational. Join my email list if you want to read more of my work -


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