Patients with very mild hepatitis are often asymptomatic, hepatitis being detected only on biopsy.
Fatigue, anorexia and weight loss with pyrexia and tender hepatomegaly typifies mild hepatitis.
Moderate alcoholic hepatitis usually presents with vomiting, diarrhoea, an intercurrent infection - such as pneumonia or a urinary tract infection, or prolonged anorexia.
In severe alcoholic hepatitis, presentation is often with pyrexia, anorexia, and repeated vomiting. Right upper quadrant pain is common.
Examination usually reveals deep jaundice and tender hepatomegaly. An arterial bruit is heard over the liver in half of cases. Florid spider naevi are often evident. Ascites, hepatic encephalopathy, a bleeding diathesis and other signs of liver failure may be present. Many patients are malnourished and show signs of vitamin deficiency.
Paracetamol may precipitate severe alcoholic hepatitis.
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