Alcoholic Hepatitis Flashcards
definition of alcoholic hepatitis
inflammation of the liver tissue due to chronic, heavy alcohol consumption
difference between alcoholic hepatitis and cirrhosis
cirrhosis is permanent scarring of liver tissue due to chronic alcohol consumption. alcoholic hepatitis is inflammation and may be reversible
3 stages of alcohol liver disease (ALD)
- steatosis (fatty liver)
- alcoholic hepatitis
- cirrhosis
risk factors
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
what gene polymorphism increases the chances of alcoholic hepatitis development
tumour necrotic factor alpha (TNF-a)
two enzymes involved in alcohol detoxification
alcohol dehydrogenase and cytochrome P450
epidemiology; what % of heavy drinkers develop alcoholic hepatitis
20-35%. females are more at risk
presenting symptoms can be split into what 3 categories
no presenting symptoms, mild, severe
mild alcoholic hepatitis presenting symptoms
nausea, malaise, right hypochondriac pain, epigastric pain and low-grade fever
severe alcoholic hepatitis presenting symptoms
hepatomegaly, jaundice, abdominal discomfort, ankle oedema and GI bleeding, appetite loss (weight loss), anorexia
why may someone with alcoholic hepatitis experience weight loss
High tumour necrosis factor (TNF)-alpha and inflammatory response is associated with ALD and can lead to loss of appetite and weight loss
signs of alcohol EXCESS (examination)
malnourished, Palmar erythema Dupuytren's contracture Facial telangiectasia Parotid enlargement Spider naevi Gynaecomastia Testicular atrophy Hepatomegaly Easy bruising
signs of severe alcoholic hepatitis (examination)
Febrile (in 50% of patients) Tachycardia Jaundice Bruising Encephalopathy (e.g. liver flap, drowsiness, disorientation) Ascites Hepatomegaly Splenomegaly
investigations to consider
bloods, ultrasound, upper GI endoscopy, liver biopsy, EEG (slow wave can indicate encephalopathy)
Blood tests and findings
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
why may an ultrasound be performed
to identify malignancy
1st line management of alcoholic hepatitis
alcohol abstinence and alcohol withdrawal support.
PLUS weight management and smoking cessation
PLUS nutritional supplements and multivitamins
PLUS immunisation
what nutritional supplementation and multivitamins are recommended for alcoholic hepatitis management
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
immunisation against what is necessary?
influenza and pneumococcal. consider Hep A and B vaccinations too
why may steroids such as prednisolone be considered in the management of alcoholic hepatitis
may reduce short-term mortality
what are the possible complications of alcoholic hepatitis
acute liver decompensation, hepatorenal syndrome and cirrhosis
mortality rates
first month - 10%
first year - 40%
can progress to cirrhosis if alcohol consumption continues for 1-3 years
