Alcoholic hepatitis

Question 1

What is alcoholic hepatitis?

Answer 1

Inflammation and necrosis of hepatocytes caused by excessive alcohol intake, it is a stage in the progression of alcoholic liver disease.

Question 2

What are the risk factors for alcoholic hepatitis?

Answer 2

Chronic heavy alcohol
Hep C
Female
Cigarette
Obese, >65
Hispanic
Genetics

Question 3

What is the epidemiology of alcholic hepatitis?

Answer 3

Harmful use of alcohol resulted in 3 million deaths worldwide. ALD is common and has high risk.

Question 4

What are the signs and symptoms of alcoholic hepatitis?

Answer 4

Abdominal pain
Hepatomegaly
Ascites
Weight change
Cachexia
Anorexia
Fatigue
(jaundice, asterixis, ascites, hepatic mass, palmar erythema, splenomegaly, venous collaterals, haematemesis and melaena, spider naevi)

Question 5

What investigations might you do to identify alcoholic hepatitis?

Answer 5

Bloods

Hepatic US

Question 6

What may you see in the blood results or on US in alcoholic heptatitis?

Answer 6

Bloods
Serum AST/ ALT/ ALP/ BR/ GGT (All elevated)
Serum albumin (low)
FBC (Anaemia, leukocytosis, thrombocytopenia, high MCV)
Serum AST/ALT ratio
U/E
Cr
INR/PT
Hepatic ultrasound
Enlargement or fatty

Question 7

What is the management of alcoholic heptatitis?

Answer 7

Alcohol management 
Risk factor management
Nutritional support
Immunisations
Steroids
Sodium restriction and diuretics
Pentoxifylline
Liver transplant

Question 8

What are the possible complications of alcoholic hepatitis?

Answer 8

Hepatic encephalopathy
GI bleed (varices)
Portal Hypertension
Coagulopathy
Renal failure
Hepatorenal syndrome
Hepatocellular carcinoma
Sepsis

Question 9

What is the prognosis of alcoholic hepatitis?

Answer 9

Maddrey’s Discriminant Function
Some damage (cirrhosis) may be irreversible
High mortality