Alcoholic Hepatitis Flashcards
What is alcoholic hepatitis?
Inflammation of the liver resulting from the effects of the long term excessive consumption of alcohol
What is the aetiology of alcoholic hepatitis?
Excess alcohol
May have genetic predisposition to having harmful effects of alcohol on liver
What is the pathophysiology of alcoholic hepatitis?
1) Alcohol related fatty liver (steatosis)
- Fat globules accumulating in cytoplasm due to hepatocytes having to divert resources from metabolising fats to metabolising alcohol
2) Alcoholic hepatitis
- Acetaldehyde (intermediate in alcohol metabolism) causes hepatocellular injury leading to inflammation
3) Cirrhosis
- Inflammation of liver by alcohol activates hepatic stellate cells which increase fibrosis and collagen synthesis by fibroblasts
- Mallory’s hyaline, an aggregate of filament that is found in hepatocytes, indicates irreversible changes to hepatocytes leading to cirrhosis
- Liver then made up of irreversible scar tissue rather than healthy liver tissue
What are some signs of alcoholic hepatitis?
Ascites
Hepatomegaly
Caput medusa
Splenomegaly
Skin- jaundice, spider naevi, easy bruising
Malnutrition- red tongue, muscle wasting
Endocrine- gynaecomastia, testicular atrophy, loss of body hair
Neuromuscular- tremor, encephalopathy, Wernicke-Korsakoff syndrome
What are some symptoms of alcoholic hepatitis?
Malaise
Nausea
Fever
What are some investigations for alcoholic hepatitis?
Bloods
- LFTs (AST>ALT, raised GGT)
- Prolonged PT, decreased albumin, increased bilirubin suggest cirrhosis
Ultrasound
- May show fatty changes early on
- Changes related to cirrhosis if present
What is the management of alcoholic hepatitis?
Abstinence of alcohol, consider detox regime
Nutritional support (thiamine) and high protein diet
Steroids for short term
Treat cirrhosis complications (fluid build up, portal hypertension, bleeding veins, etc)
Referral for liver transplant (must abstain from alcohol for 3 months prior)
