Acute alcoholic hepatitis: Difference between revisions
| Line 60: | Line 60: | ||
==Management== | ==Management== | ||
*Control of withdrawal symptoms | |||
*Nutritional support for malnutrition: especially thiamine, folate, pyridoxine, magnesium, phosphate, glucose, and protein | |||
High risk, severe cases | |||
*Steroids | |||
*Pentoxifylline | |||
==Prognosis== | |||
*Maddrey Discriminant Function score ([http://www.mdcalc.com/maddreys-discriminant-function-for-alcoholic-hepatitis/ MDF]) | |||
*Model for End-Stage Liver Disease score ([http://www.mdcalc.com/meld-score-model-for-end-stage-liver-disease-12-and-older/ MELD]) | |||
*High risk: MDF ≥ 32, MELD ≥ 18, or presence of hepatic encephalopathy | |||
==Disposition== | ==Disposition== | ||
Revision as of 22:06, 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
Labs
- 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
- Control of withdrawal symptoms
- Nutritional support for malnutrition: especially thiamine, folate, pyridoxine, magnesium, phosphate, glucose, and protein
High risk, severe cases
- Steroids
- Pentoxifylline
Prognosis
- Maddrey Discriminant Function score (MDF)
- Model for End-Stage Liver Disease score (MELD)
- High risk: MDF ≥ 32, MELD ≥ 18, or presence of hepatic encephalopathy
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.