Alcoholic Hepatitis

Question 1

What is alcoholic hepatitis?

Answer 1

Toxic inflammatory damage to the liver, associated with chronic excessive alcohol intake.

Question 2

What is the pathophysiology of alcoholic hepatitis?

Answer 2

• Fatty liver changes

- Reactive oxygen species and neutrophil-mediated damage to hepatocytes

Question 3

How would alcoholic hepatitis present?

Answer 3

• Right hypochondrial pain
• Jaundice
• Hepatomegaly + tenderness
• Stigmata of CLD

In severe cases:

• Splenomegaly
• Signs of advanced liver disease = CAVE
• Fever + Tachycardia

Question 4

How would you investigate alcoholic hepatitis?

Answer 4

Bloods:
o FBC – ↑WCC ↓Hb ↑MCV ↓platelets
o ↓ BM
o ↑ PT – sensitive marker of liver damage

U+Es - ↓urea ↓K+

LFTs
o ↑↑ AST ↑ALT
o ↑GGT ↑AlkP
o ↓ Alb ↑Bili

Liver screen - ↑IgM ↑IgA

USS abdo – fatty changes/rule out DDx

Biopsy
o Neutrophil infiltration
o Ballooning (death of hepatocytes)
o Perivenular fibrosis
o Mallory bodies

Question 5

Which LFT marker is really important in alcoholic hepatitis?

Answer 5

AST is raised more than ALT

Question 6

How would you manage alcoholic hepatitis?

Answer 6

• Alcohol abstinence + detox
• Nutrition - B12, thiamine, folate, phosphate
• Monitor for refeeding syndrome
• Steroids for immunosuppresssion

Question 7

What are some possible complications of alcoholic hepatitis?

Answer 7

• Cirrhosis
• Acute alcoholic hepatitis (medical emergency)
• Hepatorenal syndrome