Diagnosis Criteria for Alcoholic Hepatitis

1. Significant Alcohol Consumption History

A key factor in diagnosing alcoholic hepatitis is a history of heavy alcohol use. Typically, this involves consumption exceeding five years, with ethanol intake equivalent to at least 40g/day for men and 20g/day for women. Alternatively, recent excessive drinking within two weeks, surpassing 80g/day of ethanol, may also be considered. It is important to account for variables such as gender, genetic predisposition, and individual susceptibility. The ethanol amount can be calculated using the formula: ethanol amount (g) = volume of alcohol consumed (ml) × percentage concentration of ethanol × 0.8.

2. Non-Specific Clinical Symptoms

Patients may present with a range of non-specific symptoms or even be asymptomatic. Common manifestations include persistent right upper quadrant discomfort, loss of appetite, fatigue, weight loss, and jaundice. As the condition progresses, more severe signs such as hepatic encephalopathy, spider angiomas, and palmar erythema may appear.

3. Abnormal Liver Function Tests

Liver function tests often reveal elevated levels of AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma-glutamyl transferase), bilirubin, PT (prothrombin time), MCV (mean corpuscular volume), and CDT (carbohydrate-deficient transferrin). A hallmark of alcoholic liver disease is an AST to ALT ratio greater than 2, along with increased GGT and MCV levels. Although CDT testing is highly specific, it is not yet widely used in routine clinical practice. These abnormal values often decline significantly after alcohol cessation and may return to normal within four weeks.

4. Imaging Studies Show Characteristic Features

Diagnostic imaging techniques such as ultrasound, CT scan, MRI, or transient elastography typically reveal characteristic signs consistent with alcoholic liver damage. These findings support the diagnosis when correlated with clinical and laboratory data.

5. Exclusion of Other Liver Diseases

To confirm alcoholic hepatitis, it is essential to rule out other potential causes of liver injury, including acute viral hepatitis, drug-induced liver injury, and autoimmune liver diseases. This ensures an accurate diagnosis and appropriate treatment planning.