Alcoholic Hepatitis Differential Diagnoses

Updated: Sep 19, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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DDx

Diagnostic Considerations

Common considerations in alcoholic patients with jaundice include chronic pancreatitis with biliary strictures and pancreaticobiliary neoplasms.

A disorder histologically resembling alcoholic hepatitis can occur in patients who do not use alcohol. This syndrome, termed nonalcoholic steatohepatitis (NASH), is being recognized with increasing frequency. It occurs most frequently in the setting of obesity, hyperlipidemia, or type 2 diabetes mellitus. NASH is also observed in the setting of chronic parenteral hyperalimentation and in individuals who undergo jejunoileal bypass surgery for treatment of obesity. In most cases, NASH is indolent; however, in some individuals, it may progress insidiously to cirrhosis. NASH is currently believed to be responsible for a large fraction of cases of what was previously termed cryptogenic cirrhosis. In most patients with NASH, the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is less than 1, unless cirrhosis is present.

Changes in the mental status of patients with alcoholic hepatitis do not always imply the presence of hepatic encephalopathy. Other conditions (eg, subdural hematomas) should be excluded by obtaining a computed tomography (CT) scan of the brain.

Differential Diagnoses