Alcoholic Hepatits Flashcards
Define Alcoholic Hepatitis?
Inflammatory liver injury caused by chronic heavy intake of alcohol
What is the aetiology of Alcoholic Hepatitis?
One of the three forms of liver disease caused by excessive alcohol intake - the spectrum consists of:
- Alcoholic fatty liver (steatosis)
- Alcoholic Hepatitis
- Chronic cirrhosis
What are the histopathological features of Alcoholic Hepatitis?
Centrilobular ballooning Degeneration and necrosis of hepatocytes Steatosis Neutrophilic Inflammation Cholestasis Mallory-hyaline inclusions Giant mitochondria
What are Mallory-hyaline inclusions?
Eosinophilic intracytoplasmic aggregates of cytokeratin intermediate filaments
What is the epidemiology of Alcoholic Hepatitis?
Occurs in 10-35% of heavy drinkers
What are the presenting symptoms of Alcoholic Hepatitis?
May remain asymptomatic and undetected
May be mild illness with symptoms
More severe presenting symptoms
What are some of the symptoms of mild illness of Alcoholic Hepatitis?
Nausea Malaise Epigastric Pain Right hypochondral pain Low-grade fever
What are some of the symptoms of more severe illness for Alcoholic Hepatitis?
Jaundice
Abdominal discomfort or swelling
Swollen Ankles
GI bleeding
What history is needed for Alcoholic Hepatitis?
A long history of heavy drinking is required for the development of Alcoholic Hepatitis (around 15-20 years)
What can trigger Alcoholic Hepatitis?
Certain Events
For example: aspiration pneumonia, injury
What are the signs of Alcoholic Hepatitis on physical examination?
Signs of Alcohol Excess
Signs of Severe Alcoholic Hepatitis
What are the Signs of Alcohol Excess?
Malnourished Palmar Erythema Dupuytren's Contracture Facial Telangiectasia Parotid Enlargement Spider naevi Gynaecomastia Testicular atrophy Hepatomegaly Easy brusing
What are the signs of Severe Alcoholic Hepatitis?
Febrile (in 50% of patients) Tachycardia Jaundice Bruising Signs of Encephalopathy Ascites Hepatomegaly Splenomegaly
What are some of the signs of Encephalopathy?
e.g.
Liver Flap
Drowsiness
Disorientation
What bloods would you do for Alcoholic Hepatitis?
FBC
LFTs
U&Es
Clotting
What would you look for specifically on a FBC for Alcoholic Hepatitis?
Low Hb
High MCV
High WCC
Low platelets
What would you look for specifically on LFTs for Alcoholic Hepatitis?
High AST + ALT
High bilirubin
High ALP + GGT
Low albumin
What would you look for on U&Es for Alcoholic Hepatitis?
Urea and K+ tend to be low
What would you look for Clotting for Alcoholic Hepatitis?
Prolonged PT is a sensitive maker for significant liver damage
Why would we do a US for Alcoholic Hepatitis?
Check for other causes of liver impairment (e.g. malignancy)
Why would we do an Upper GI Endoscopy for Alcoholic Hepatitis?
Investigate varices
Why would we do a Liver Biopsy for Alcoholic Hepatitis?
Can help distinguish from other causes of hepatitis
What might you see on an EEG for Alcoholic Hepatitis?
Slow-wave activity indicates encephalopathy
What is the acute management plan for Alcoholic Hepatitis?
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
Ascites - manage with diuretics (spironolactone with/without furosemide)
Therapeutic paracentesis
Glypressin and N-acetylcysteine for hepatorenal syndrome
What nutritional management plan for Alcoholic Hepatitis?
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
How can we use Steroid Therapy for Alcoholic Hepatitis?
Reduce short-term mortality for severe alcoholic hepatitis
What is Hepatorenal Syndrome?
The development of renal failure in patients with advanced chronic liver disease
What is the aetiology of Hepatorenal Syndrome?
Thought to be arise because of abnormalities in blood vessel tone in the kidneys
Blood vessels in the kidney constrict because of the dilatation of blood vessels in the splanchnic circulation (supplying the intestines), which is mediated by factors released by the kidneys
The splanchnic vasodilation leads to reduced effective volume of blood detected by the juxtaglomarular apparatus, leading to activation of the RAS and vasoconstriction of vessels in the kidney
This leads to kidney failure
What are the possible complications of Alcoholic Hepatitis?
Acute Liver Decompensation
Hepatorenal Syndrome
Cirrhosis
What is the prognosis for patients with Alcoholic Hepatitis?
Mortality:
First month = 10%
First Year = 40%
If alcohol intake continues, most will progress to cirrhosis within 1-3 years
