Lvr

Alcoholic Hepatitis

search

Alcoholic Hepatitis, Alcoholic Liver Disease, Acute Alcoholic Hepatitis

  • Epidemiology
  1. Alcoholic Hepatitis seen in 33% of chronic Alcoholics
  • Precautions
  1. Acute Alcoholic Hepatitis, although often asymptomatic, may be severe and life threatening
  • Pathophysiology
  1. Chronic Alcoholic Hepatitis is a precursor to Cirrhosis
  2. Characteristics
    1. Hepatocyte Inflammation, degeneration, and necrosis
    2. Neutrophil and Lymphocyte infiltration
  • Symptoms
  • Acute Alcoholic Hepatitis
  • Signs
  • Acute Alcoholic Hepatitis
  1. Tender Hepatomegaly (80-90% of cases)
  2. Jaundice
  3. Ascites
  4. Splenomegaly
  5. Other chronic stigmata may be present (Spider angioma)
  • Labs
  1. Liver Function Tests
    1. Aspartate Aminotransferase (AST) increased to 100-300 U/L
      1. AST to ALT ratio = 2:1
    2. Alkaline Phosphatase elevated
    3. Gamma glutamyl transferase (GGT) markedly elevated
    4. Serum Bilirubin elevated
    5. Hypoalbuminemia
  2. Complete Blood Count
    1. White Blood Cell Count increased (mean 12.4k, but may range up to 20k)
    2. Mean Corpuscular Volume (MCV) elevated
  3. Other labs
    1. Prolonged INR (or ProTime)
  • Management
  1. See Prevention of Liver Disease Progression
  2. Alcohol Cessation
  3. Alcohol Withdrawal protocol
  4. Increased caloric and protein intake
  5. Vitamin Supplementation
    1. Thiamine
    2. Folate
    3. Multivitamin
  6. Corticosteroids (Prednisolone)
    1. Efficacy: Improves survival (n=61)
      1. Two month survival 88% versus 45% with Placebo
      2. Improved survival persists for 1 year
      3. No advantage after 1 year
    2. References
      1. Mathurin (1996) Gastroenterology 110:1847-53 [PubMed]
  • Prognosis
  1. Acute Alcoholic Hepatitis
    1. Maddrey Discriminant Function predicts patients at highest risk of death
    2. Mortality 10-15% from Acute Hepatitis
  2. Chronic Alcholic Hepatitis
    1. Cirrhosis develops in 50% of chronic Alcoholic Hepatitis patients