alcoholic hepatitis

• related: GI
• tags: #note

• Level of alcohol induced liver disease: steatosis, steatohepatitis, severe steatohepatitis (alcoholic hepatitis)
• ANI index can be used to determine whether alcoholic or nonalcoholic liver disease: https://www.mayoclinic.org/medical-professionals/transplant-medicine/calculators/the-alcoholic-liver-disease-nonalcoholic-fatty-liver-disease-index-ani/itt-20434726

Symptoms

• fever, jaundice, tender hepatomegaly, leukocytosis

Diagnosis

• Labs: mildly elevated AST:ALT ratio > 2, high GGT, high INR, thrombocytopenia, elevated MCV
• clinical diagnosis: evidence of porrtal HTN with hx of consistent alcohol intake
• US or CT: steatosis, cirrhosis, portal hypertension
• Severity determined by Maddrey score: MDF score = 4.6 (prothrombin time – control prothrombin time) + total bilirubin (mg/dL)
• Can also use MELD score > 20 = moderate/severe disease
• Score of 32 or greater or hepatic encephalopathy defined as severe cases

Treatment

• Nonsevere, MDF < 32: supportive, no prednisolone
• thiamine, alcohol treatment
• Pentoxifylline not effective, do not use
• Severe: prednisolone (STOPAH trial showing improved 28 day mortality)
  • CI includes active infection, UGIB, AKI, HCV/HBV, multiorgan failure
• Assess response on day 7 with Lille score, discontinue if no response >0.45
• Lille score less than 0.45: continue prednisolone for 28 days

Progonosis

• Alcohol abstinence can result in significant stabilization of liver function and reversal of portal hypertension.
• Liver transplantation is reserved for appropriate candidates who are at low risk for alcohol relapse.