Intern Report 9/22/15 – Alcoholic hepatitis

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.

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