Alcoholic Hepatitis

Question 1

What is the presentation?

Answer 1

Jaundice
Encephalopathy
Infection common
Decompensated hepatic function: low albumin and raised prothrombin time

Question 2

How is it diagnosed?

Answer 2

Raised bilirubin
Raised GGT and AlkP
Alcohol history
Exclude other causes e.g. viral hepatitis

Question 3

What is the treatment?

Answer 3

Supportive
Treat infection
Treat encephalopathy
Treat alcohol withdrawal (i.e. remove alcohol!)
Protect against GI bleeding
Airway protection/ITU care

Question 4

When should (oral) steroids (prednisolone) be used?

Answer 4

Use steroids only if grading severe

Glasgow Alcoholic Hepatitis Score > 9

Question 5

What is the main negative of using steroids?

Answer 5

Increases the chance of a GI bleed
This is especially bad in these patients due to oesophageal varices as a result of portal hypertension (i.e. they are already at an increased risk of a GI bleed)

Question 6

What nutritional support should be given to these patients?

Answer 6

100% patients with alcoholic hepatitis are malnourished, 33% severely
2 yr Survival 15% vs 70% if well nourished
Thiamine (IV): reduced levels of this can cause permanent brain damage
Frequent feeds, high energy

Question 7

What is the prognosis?

Answer 7

Dependant on abstinence or ongoing alcohol consumption
Steatohepatitis -> Cirrhosis
Present any sign of decompensating liver disease 70% mortality in 5 years
Present with encephalopathy 64% 1 year mortality