What are the key clinical features to differentiate alcoholic hepatitis from other forms of liver disease in a primary care setting?

Key clinical features to differentiate alcoholic hepatitis from other forms of liver disease in primary care include:

• A history of harmful or hazardous alcohol consumption, typically exceeding 35 units per week for women and 50 units per week for men, is a critical distinguishing factor for alcoholic hepatitis compared to other liver diseases ¹.
• Presentation with acute symptoms such as jaundice, tender hepatomegaly, and signs of systemic inflammation may suggest alcoholic hepatitis rather than chronic liver diseases like NAFLD or viral hepatitis ¹.
• Laboratory findings often show elevated liver enzymes with a characteristic pattern: aspartate aminotransferase (AST) is typically elevated to a greater extent than alanine aminotransferase (ALT), often with an AST:ALT ratio greater than 2, which helps differentiate alcoholic hepatitis from other liver diseases ¹.
• Exclusion of alternative causes of liver disease, including viral hepatitis, NAFLD, and autoimmune liver diseases, is essential in the diagnostic process ¹,³.
• Assessment of nutritional status and presence of malnourishment can support the diagnosis, as malnutrition is common in alcoholic hepatitis ¹.
• Referral to a specialist for confirmation and consideration of liver biopsy may be necessary if diagnosis is uncertain or if severe disease requiring corticosteroid treatment is suspected ¹.

In contrast, other liver diseases such as NAFLD are more commonly associated with metabolic risk factors like type 2 diabetes and obesity, and do not have a history of significant alcohol misuse ³. Cirrhosis from other causes may present with decompensated liver disease features but without the acute inflammatory picture typical of alcoholic hepatitis ².