Alcoholic Hepatitis

Question 1

definition of alcoholic hepatitis

Answer 1

inflammation of the liver tissue due to chronic, heavy alcohol consumption

Question 2

difference between alcoholic hepatitis and cirrhosis

Answer 2

cirrhosis is permanent scarring of liver tissue due to chronic alcohol consumption. alcoholic hepatitis is inflammation and may be reversible

Question 3

3 stages of alcohol liver disease (ALD)

Answer 3

1. steatosis (fatty liver)
2. alcoholic hepatitis
3. cirrhosis

Question 4

risk factors

Answer 4

STRONG: chronic, heavy alcohol drinking (15-20 years), preexisting liver disease (hepatitis C) and female sex

WEAK: obesity, smoking and some gene polymorphisms and age >65years

Question 5

what gene polymorphism increases the chances of alcoholic hepatitis development

Answer 5

tumour necrotic factor alpha (TNF-a)

Question 6

two enzymes involved in alcohol detoxification

Answer 6

alcohol dehydrogenase and cytochrome P450

Question 7

epidemiology; what % of heavy drinkers develop alcoholic hepatitis

Answer 7

20-35%. females are more at risk

Question 8

presenting symptoms can be split into what 3 categories

Answer 8

no presenting symptoms, mild, severe

Question 9

mild alcoholic hepatitis presenting symptoms

Answer 9

nausea, malaise, right hypochondriac pain, epigastric pain and low-grade fever

Question 10

severe alcoholic hepatitis presenting symptoms

Answer 10

hepatomegaly, jaundice, abdominal discomfort, ankle oedema and GI bleeding, appetite loss (weight loss), anorexia

Question 11

why may someone with alcoholic hepatitis experience weight loss

Answer 11

High tumour necrosis factor (TNF)-alpha and inflammatory response is associated with ALD and can lead to loss of appetite and weight loss

Question 12

signs of alcohol EXCESS (examination)

Answer 12

malnourished,
Palmar erythema  
Dupuytren's contracture  
Facial telangiectasia 
Parotid enlargement  
Spider naevi  
Gynaecomastia  
Testicular atrophy  
Hepatomegaly  
Easy bruising

Question 13

signs of severe alcoholic hepatitis (examination)

Answer 13

Febrile (in 50% of patients)  
Tachycardia  
Jaundice  
Bruising  
Encephalopathy (e.g. liver flap, drowsiness, disorientation) 
Ascites  
Hepatomegaly  
Splenomegaly

Question 14

investigations to consider

Answer 14

bloods, ultrasound, upper GI endoscopy, liver biopsy, EEG (slow wave can indicate encephalopathy)

Question 15

Blood tests and findings

Answer 15

FBC; low Hb, high MCV, high WCC and low platelet count
LFT’s; high AST, ALT, ALP AND GGT, high bilirubin and low albumin
Urea and Electrolytes; urea and K+ low

Question 16

why may an ultrasound be performed

Answer 16

to identify malignancy

Question 17

1st line management of alcoholic hepatitis

Answer 17

alcohol abstinence and alcohol withdrawal support.
PLUS weight management and smoking cessation
PLUS nutritional supplements and multivitamins
PLUS immunisation

Question 18

what nutritional supplementation and multivitamins are recommended for alcoholic hepatitis management

Answer 18

zinc, thiamine, vit B and C and folic acid. if enough calories aren’t being taken in by the patient, enteral feeding tubes should be considered

Question 19

immunisation against what is necessary?

Answer 19

influenza and pneumococcal. consider Hep A and B vaccinations too

Question 20

why may steroids such as prednisolone be considered in the management of alcoholic hepatitis

Answer 20

may reduce short-term mortality

Question 21

what are the possible complications of alcoholic hepatitis

Answer 21

acute liver decompensation, hepatorenal syndrome and cirrhosis

Question 22

mortality rates

Answer 22

first month - 10%
first year - 40%
can progress to cirrhosis if alcohol consumption continues for 1-3 years