Alcoholic hepatitis

Question 1

what is the definition of AH?

Answer 1

Inflammatory injury of the liver caused by chronic excess drinking.

Question 2

What is the aetiology and risk factors?

Answer 2

heavy drinking

fatty liver –> hepatitis –> cirrhosis.

Changes:
Steatosis- formation of fat
Cholestasis - this is when the bile is stopped flowing through the liver to the duodenum.
Giant mitochondria
Degeneration and necrosis of the hepatocytes
Centrilobular ballooning

Question 3

what is the epidemiology?

Answer 3

10-35% of heavy drinkers will develop it

Question 4

what are the symptoms of AH?

Answer 4

Mild - this will often be unsymptomatic and undetected.
Mild grade fever. 
Right hypochondriac pain
Malaise
Epigastric pain

More severe:
Jaundice
Swollen ankles
GI bleeding
abdominal tenderness and swelling

Question 5

what are the signs of AH?

Answer 5

Heptosplenomegaly
febrile
spider naevi 
gynaecomastia
dupytren's contracture
easy bruising
acites
encephalopathy
malnourished
palmar erythema 
parotid enlargement

Question 6

what are the investigations for AH?

Answer 6

FBC - increased WCC, decreased platelets, high mcv and low hb.
INCREASED PT IS VERY SENSITIVE.
U and Es- markers of dehydration
Ultrasound - to rule out any malignancies
LFTS- low albumin
Liver biopsy
EEG - to look for signs of encephalopathy
upper GI endoscopy - looking for varices

Question 7

what is the management for AH?

Answer 7

Acute
Thiamine
Vitamin C and other multivitamins (can be given as Pabrinex)
Monitor and correct K+, Mg2+ and glucose
Ensure adequate urine output
Treat encephalopathy with oral lactulose or phosphate enemas – decrease ammonia generation by bacteria
Ascites - manage with diuretics (spironolactone with/without furosemide)
Therapeutic paracentesis (removing fluid)
Glypressin and N-acetylcysteine for hepatorenal syndrome
Nutrition
Via oral or NG feeding is important
Protein restriction should be avoided unless the patient is encephalopathic
Nutritional supplementation and vitamins (B group, thiamine and folic acid) should be started parenterally initially, and continued orally
Steroid Therapy - reduce short-term mortality for severe alcoholic hepatitis

Question 8

What are the complications of AH?

Answer 8

cirrhosis
heptorenal syndrome(cirrhosis + renal failure + ascites)
acute liver decompensation

Question 9

what is the prognosis for AH?

Answer 9

if alcohol continues will develop cirrhosis in 1-3 years
first month = 10 %
first year= 40%

To calculate prognostic score can use Maddrey’s discriminant function or Glasgow alcoholic hepatitis score