Alcoholic hepatitis Flashcards
Stepwise progression of alcoholic liver disease
- Alcohol related fatty liver
- Alcoholic hepatitis
- Cirrhosis
Alcohol related fatty liver
Drinking leads to a build-up of fat in the liver
If drinking stops this process reverse in around 2 weeks
Alcoholic hepatitis
Drinking over long period causes inflammation in liver sites
Binge drinking associated with same effect
Mild alcoholic hepatitis usually reversible with permanent abstinence
Cirrhosis
Liver made up of scar tissue rather than healthy liver tissue
Irreversible
Stopping drinking prevents further damage
Investigations findings
Gamma-GT is characteristically elevated
Ratio of AST:ALT normally >2 (>3 strongly suggestive of acute alcoholic hepatitis)
Elevated prothrombin time due to reduced synthetic function
U&Es may be deranged in hepatorenal syndrome
Complications of alcohol
Alcoholic liver disease
Cirrhosis and complications (hepatocellular carcinoma)
Alcohol dependence and withdrawal
WEnicke-Korsakoff syndrome
Pancreatitis
Alcoholic cardiomyopathy
Signs of liver disease
Jaundice
Hepatomegaly
Spider naevi
Palmar erythema
Gynaecomastia
Bruising due to abnormal clotting
Ascites
Caput medusae
Asterixis
US
May show fatty changes early described as ‘increased echogenicity’
Fibroscan can check elasticity
Endoscopy
Can assess for and treat oesophageal varices when portal hypertension suspected
CT and MRI scans
Can look for fatty infiltration of the liver, hepatocellular carcinoma, hepatosplenomegaly, abnormal blood vessel changes and ascites
Liver biopsy
NICE recommends when steroid treatment is being considered
General management
Stop drinking
Consider detox regime
Nutritional support with thiamine and high protein
Steroids short term
Pentoxyfilline sometimes used
Treat complications
Referral for liver transplant if severe disease and abstain from alcohol for 3 months
Steroid use
Glucocorticoids often used in acute episodes
Maddrey’s discriminant function used to determine who would benefit
