Alcoholic Hepatatitis

Question 1

Define alcoholic hepatitis?

Answer 1

Inflammatory liver injury caused by chronic heavy alcohol intake

Question 2

What are the causes/risk factors of alcoholic hepatitis?

Answer 2

• Excessive alcohol intake for 10-15 years

* Presence of hepatitis C

Question 3

What are the symptoms of alcoholic hepatitis?

Answer 3

• Rapid onset jaundice
• Nausea
• Anorexia
• RUQ pain
• Drowsiness, confusion
• Fever
• Abdominal distension (ascites)

Question 4

What are the signs of alcoholic hepatitis?

Answer 4

• Febrile
• Tachycardia

Signs of chronic liver disease
• Jaundice
• Bruising
• Encephalopathy
• Ascites
• Hepatomegaly (tender)
• Splenomegaly
• Palmar erythema
• Dupuytren’s contracture
• Spider naevi
• Gynaecomastia

Question 5

What are the differential diagnoses for alcoholic hepatitis?

Answer 5

• Viral hepatitis
• Cholecystitis
• Hepatic vein thrombosis
• Acute liver failure

Question 6

What investigations are carried out for alcoholic hepatitis?

Answer 6

Bloods
• FBC: macrocytic anaemia, high WCC, low platelets
• LFTs: high AST and ALT (ratio>2, <500), high GGT, ALP, BR (300-500), low
Alb
• U&Es: hyponatraemia, look out for hepatorenal syndrome (high Cr)
• Clotting: prolonged PT (sensitive marker of liver damage)

MC&S blood, urine and ascites: infection?

USS – exclude malignancy, abscess etc.

OGD – check for varices

Liver biopsy – normally transjugular approach due to prolonged PT; type of hepatitis

EEG – slow wave activity indicates encephalopathy

Question 7

What is the management for alcoholic hepatitis?

Answer 7

Acute
• Thiamine, Vit C and multivitamins (IV)
• Monitor and correct K, Mg and glucose abnormalities
• Ensure adequate urine output
• Encephalopathy: oral lactulose and phosphate enemas
• Ascites: diuretics, paracentesis
• Hepatorenal syndrome: glypressin, N-acetylcysteine

Nutrition
• Oral or nasogastric feeding (high protein diet)
• Vitamin supplementation (IV then oral B vitamins, thiamine, folic acid)
• Encephalopathy: protein restriction

Steroid therapy
• 40mg/day for 4 weeks
• Reduces short term mortality in severe alcoholic hepatitis

Long term
• Stop drinking/reduce alcohol intake

Question 8

What are potential complications of alcoholic hepatitis?

Answer 8

• Acute liver decompensation
• Hepatorenal syndrome
• Cirrhosis

Question 9

What is the prognosis for patients with alcoholic hepatitis?

Answer 9

10% mortality in first month, 40% mortality in first year

Continued alcohol intake leads to cirrhosis within 1-3 years