Teaching Pearls:

• Often present with jaundice, abdominal pain and distension, leukocytosis.
• Many patients may actually stop alcohol use a few weeks prior to admission due to worsening symptoms.
• Severe alcoholic hepatitis defined by DF>32
• First-line treatment for alcoholic hepatitis is ALWAYS alcohol cessation.
• Studies have shown that 6-month mortality could be as high as 40%.
• Medical management includes prednisolone or pentoxifylline. Prednisolone is preferred assuming there are no contraindications.
• Recent STOPAH trial in NJEM 4/2015 showed no additional benefit with combo of prednisolone + pentoxifylline compared to prednisolone alone. No benefit with pentoxifylline alone compared to placebo.
• Many patients with alcoholic hepatitis are also very malnourished. Hence these patients should be taking 1-1.5 grams protein/kg body weight daily.