Alcoholic Hepatitis Solicitors - Medical Negligence Compensation Solicitors
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Alcoholic Hepatitis Medical Overview
Alcoholic hepatitis involves worsening inflammation of the liver associated with drinking heavily over a long period of time. The exact cause of the disease isn't known. People begin with having an inflamed and enlarged liver, known as hepatomegaly. The white blood cell count is elevated and there are many white blood cells in the liver. There is high blood pressure in the portal venous system. You can get impairment of the liver and associated jaundice. In severe cases, the ammonia level increases so that you can get alcoholic encephalopathy and even coma. This is associated with death in many cases. The progression of alcoholic hepatitis is cirrhosis of the liver but if one can resolve the disease, it takes several weeks to get better from the disease.
There appears to be an association between genetics, nutritional factors, metabolic factors, environment and immunological factors in the development of the disease of alcoholic hepatitis. Immunology appears to play a large role in who gets alcoholic hepatitis and who does not. There does appear to be a genetic component regarding alcoholic hepatitis. Malnutrition also plays a role in the disease and those who do not eat properly tend to get alcoholic hepatitis more readily. The metabolite of alcohol is acetaldehyde and both ethanol and acetaldehyde damage the liver cell membranes. Free radicals are generated and there is oxidative injury to the liver cells. Even after you stop drinking, the immune system continues the hepatitis for many months. The immunoglobulin A class of antibodies is increased in alcoholic hepatitis that are directed against proteins related to acetaldehyde.
Cytokines like tumour necrosis factor-alpha or TNF-alpha can cause programmed cell death in liver cells and is in high concentrations in alcoholic liver disease as well as several cytokines. There may be a coexisting viral liver disease in alcoholic hepatitis. Tylenol use and alcoholic hepatitis are related as well.
Alcohol abuse is the most common cause of severe liver disease in Australia. It affects greater than 200,000 Australians or about 1 percent of people. Many have mild disease and do not seek medical attention. In the short term, it is not very lethal; however, if you have hepatic encephalopathy, the mortality rate rises to about 50 percent. Only about 5 percent of those with mild disease actually die. The average rate of mortality in one study, including those with hepatic encephalopathy, was about 66 percent. Risk factors for dying included an elevated prothrombin time, female gender, older age and having a high white blood cell count.
The diagnosis of alcoholic hepatitis can be made with a thorough history and physical examination. The history includes looking for underlying alcoholism with heavy alcohol use. Nonspecific nausea, vomiting and malaise can be found as well as a history of intermittent fever. The doctor may note an increase in liver size with a tender liver. Levels of ammonia can indicate the presence or incipient hepatic encephalopathy. CT scan or ultrasound of the liver can show an increase in liver size. A biopsy of the liver can show inflammation and white blood cells in the liver, which is often fatty in nature. Blood tests will show an increase in liver enzymes and an increase in bilirubin. Jaundice may be present in the eyes or in the skin. Spleen enlargement can be seen if there is an increased pressure in the portal venous system. People with alcoholic hepatitis also have spider veins under their skin and enlarged veins in the skin of the abdomen.
Treatment of alcoholic hepatitis includes support of the patient's respiration and metabolic system. The person may need to be on a respirator if they have alcoholic encephalitis. The patient must stop alcohol intake and nutrition must be maximized. Vitamin K must be used if the patient has a bleeding disorder with an elevated protime. Treatment of GI tract bleeding should be managed in the hospital ICU. Corticosteroids are used to treat inflammation of the liver and hepatic encephalopathy. The goal is to reduce the liver inflammation and stop progression to cirrhosis.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here