Intern Report 4/12 – AH

Teaching Points:

  • Clinical Manifestations
    • Patients present with worsening jaundice, abdominal distension, tender hepatomegaly with nausea and vomiting.
    • Many patients actually stop alcohol intake over the last several weeks due to their pro-inflammatory state of feeling malaise.
    • Amount of alcohol intake is the biggest risk factor to developing alcoholic hepatitis.
    • On average, patients present within their 4-5th decade in life. On average they drink about 100-120g EtOH daily for 10-20 years
      • Each standard EtOH drink – 14 grams
    • Patients may present with AST:ALT ratio >2, which is more specific for alcoholic liver disease.
      • AST can also be elevated in non-liver pathology, including cardiac, renal, rhabdo.
      • AST and ALT would should not be higher than 300-400 if this is solely due to alcohol-related liver disease.
  • Diagnosis includes assessing patient’s clinical history, laboratory data, and exclusion of other causes of hepatitis
    • Exclude viral hepatitis and drug-induced
    • Patients can present with leukocytosis with neutrophilic predominance, fevers, and abdominal discomfort
      • Important to exclude infections such as spontaneous bacterial peritonitis.
    • Liver biopsy notable for neutrophilic inflammation of hepatocytes, whereas all other causes of viral hepatitis is due to mononuclear infiltration.
  • Treatment
    • Most important intervention includes alcohol cessation.
    • Supportive care as patients can have multiple electrolyte abnormalities
    • Nutritional support with protein 1-1.5g/kg body weight
      • >90% of patients with AH have significant protein-calorie malnutrition
    • Medical Therapy for those with severe AH (DF>32) includes glucocorticoids (Prednisolone) but the evidence is rather weak.
    • Treatment – prednisolone 40mg daily for 4 weeks with a 2-3 week taper.
    • Associated with increased risk of infections and GI bleed.

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