Wednesday, August 12, 2015

Alcoholic Hepatitis


Today's morning report featured an interesting case of Alcoholic hepatitis.



There were multiple learning points including:
a)     Alcoholic hepatitis is a frequently under-diagnosed condition which has a high morbidity and mortality.  It is characterized by elevations in liver enzymes (typically with AST:ALT ratio greater than 2:1, though rarely over 300, fever, altered mentation, elevated bilirubin and elevated INR.  The diagnosis is made clinically based on the previous historical and laboratory elements and a clinical history consistent with alcohol abuse.  The alcohol ingestion may precede the development of hepatitis by weeks in some cases.  Maddrey’s discriminant function, based predominantly on the Prothrombin Time (not the INR) and the bilirubin level is useful in distinguishing whether or not the patient would benefit from corticosteroid therapy.
b)    Abdominal pain in a patient with known cancer has a wide differential including bony metastases/hypercalcemia.
c)     Gastrointestinal bleeding in a patient with suspected liver disease could be the result of variceal hemorrhage.


Further Reading:
Lucey, M. R., Mathurin, P., & Morgan, T. R. (2009). Alcoholic hepatitis. New England Journal of Medicine360(26), 2758-2769.
Thursz, M. R., Richardson, P., Allison, M., Austin, A., Bowers, M., Day, C. P., ... & Forrest, E. H. (2015). Prednisolone or Pentoxifylline for Alcoholic Hepatitis. New England Journal of Medicine372(17), 1619-1628.

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