Acute alcoholic hepatitis: Difference between revisions
| Line 33: | Line 33: | ||
==Diagnosis== | ==Diagnosis== | ||
Diagnosis is difficult and relies on a good history (1). | |||
#History of significant alcohol intake | #History of significant alcohol intake | ||
#Clinical evidence of liver disease | #Clinical evidence of liver disease | ||
#Supporting laboratory abnormalities | #Supporting laboratory abnormalities | ||
*May be nondiagnostic in patients with mild disease or early cirrhosis | |||
==Work Up== | |||
===Laboratory=== | |||
*CBC | |||
**Leukocytosis with elevated ANC | |||
*Chemistry including magnesium and phosphate | |||
*LFTs | |||
**Elevated AST/ALT (characteristically >2:1 and < 500 IU/L) | |||
**GGT alone is less reliable (low sensitivity and specificity) | |||
*Coagulation factors | |||
**Elevated PT/INR | |||
*Lipase if suspect pancreatitis | |||
*Consider hepatitis panel | |||
===Imaging=== | |||
Consider transabdominal ultrasound if concern for: | |||
*Biliary obstruction | |||
*Budd-Chiari syndrome | |||
*Hepatic or biliary neoplasms | |||
==Management== | ==Management== | ||
Revision as of 22:03, 19 January 2016
Background
Acute alcoholic hepatitis is inflammatory liver disease secondary to alcohol use.
- spectrum from hepatic steatosis to alcoholic hepatitis to cirrhosis
- history of (usually chronic) alcohol abuse (~80 grams of ethanol daily for 5 years (2))
- ranges from subclinical cases to severe multisystem dysfunction
Clinical Features
Symptoms
- abdominal pain
- N/V
- weight loss / fatigue / anorexia
Signs
- RUQ tenderness
- jaundice
- fever
- hepatomegaly
- ascites
- encephalopathy
- spider angioma
- GI bleed/varices
- malnutrition
- symptoms of alcohol withdrawal
Cirrhosis is found in 50-60% of cases of alcoholic hepatitis (2).
Differential Diagnosis
- viral hepatitis
- acetaminophen toxicity
- alcoholic pancreatitis
- gallstones
- Budd-Chiari syndrome
Diagnosis
Diagnosis is difficult and relies on a good history (1).
- History of significant alcohol intake
- Clinical evidence of liver disease
- Supporting laboratory abnormalities
- May be nondiagnostic in patients with mild disease or early cirrhosis
Work Up
Laboratory
- CBC
- Leukocytosis with elevated ANC
- Chemistry including magnesium and phosphate
- LFTs
- Elevated AST/ALT (characteristically >2:1 and < 500 IU/L)
- GGT alone is less reliable (low sensitivity and specificity)
- Coagulation factors
- Elevated PT/INR
- Lipase if suspect pancreatitis
- Consider hepatitis panel
Imaging
Consider transabdominal ultrasound if concern for:
- Biliary obstruction
- Budd-Chiari syndrome
- Hepatic or biliary neoplasms
Management
Abstinence from alcohol, nutritional supplementation (thiamine, folate
Disposition
See Also
External Links
References
- Amini, Maziyar; Runyon, Bruce. "Alcoholic Hepatitis 2010: A clinician's Guide to Diagnosis and Therapy." World of Gatstroenterol 2010 October 21; 16(39):4905-4912
- Basra, Gurjot,et. al. "Symptoms and Signs of Acute Alcoholic Hepatitis." World J Hepatol. 2011 May 27; 3(5): 118–120.