Alcoholic Hepatitis

Question 1

What is alcoholic hepatitis?

Answer 1

Inflammatory liver injury caused by chronic heavy intake of alcohol.

Question 2

Describe the epideimiology of alcoholic hepatitis

Answer 2

10-35% of heavy drinkers develop this form of liver disease.

Question 3

What bloods should be taken in alcoholic hepatitis?

Answer 3

FBC: Low Hb, High MCV, High WCC, Low platelets.
LFT: High transminases, High BR, Low albumin, High ALP, High GGT
U+Es: Low Urea + K+ (unless significant renal impairment)
Clotting: Prolonged PT = sensitive marker

Question 4

What other investigations should be done in alcoholic hepatitis?

Answer 4

USS: exclude ddx (e.g. malignancies).
Upper GI endoscopy: identify varices.
Liver biopsy: Percutaneous or transjugular (in coagulopathy) to exclude other causes of hepatitis.
EEG: slow-wave activity indicates encephalopathy.

Question 5

Describe the acute management of alcoholic hepatitis

Answer 5

Thiamine, Vitamin C + other multivits (Pabrinex)
Monitor + correct K+, Mg2+ + glucose
Ensure adequate urine output
Encephalopathy: oral lactulose or phosphate enemas
Ascites: diuretics (spironolactone +/- furosemide)
Therapeutic paracentesis
Glypressin + N-acetylcysteine for hepatorenal syndrome

Question 6

What other management strategies for alcoholic hepatitis are needed?

Answer 6

Nutrition: Via oral or NG feeding
Protein restriction avoided unless encephalopathic
Nutritional supplements + vitamins (B group, thiamine + folic acid) parenterally initially + continued orally
Steroids: reduce short-term mortality for severe alcoholic hepatitis

Question 7

List 3 complications of alcoholic hepatitis

Answer 7

Acute liver decompensation
Hepatorenal syndrome
Cirrhosis

Question 8

What is the prognosis in alcoholic hepatitis

Answer 8

Mortality:
1st month = 10%
1st year = 40%
If alcohol intake continues, most progress to cirrhosis in 1-3 years

Question 9

What may be aparent in the history of a patient with alcoholic hepatitis?

Answer 9

F tend to present with more florid illness than M
Hx of heavy alcohol intake (15–20 years of XS intake)
Possible trigger events (e.g. aspiration pneumonia or injury).

Question 10

What is hepatorenal syndrome?

Answer 10

Development of renal failure in pts with advanced chronic liver disease because of abnormalities in blood vessel tone in the kidneys

Question 11

What are the 3 stages of alcoholic liver disease?

Answer 11

Alcoholic fatty liver (reversible)
Alcoholic hepatitis (reversible if mild)
Alcohol related cirrhosis

Question 12

Describe presentation of alcoholic fatty liver

Answer 12

Asymptomatic

Hepatomegaly

Question 13

Give 5 features of presentation of alcoholic hepatitis

Answer 13

Anorexia
D+V
Febrile (mild)
Tender hepatomegaly
JAUNDICE

Question 14

Give 4 additional features of presentation of alcohol related cirrhosis

Answer 14

ASCITES
Bruising
Splenomegaly
Spider naevi

Question 15

What A-J of chronic liver disease may be seen in alcoholics?

Answer 15

Asterixis, Ascites, Ankle oedema, Atrophy of testicles
Bruising
Clubbing/ Colour change of nails (leuconychia)
Dupuytren’s contracture
Encephalopathy / palmar Erythema
Foetor hepaticus
Gynaecomastia
Hepatomegaly
Increase size of parotids + itchy skin
Jaundice