Acute alcoholic hepatitis - Revision history

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2026-01-06T16:57:48Z

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Rossdonaldson1: /* Evaluation */

2024-02-07T23:36:29Z

Evaluation

← Older revision		Revision as of 23:36, 7 February 2024
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	==Evaluation==		==Evaluation==
			[[File:Auscities.png\|thumb\|Ascites appearance on ultrasound]]
			[[File:CirrhosisWithAscitesMark.png\|thumb\|Liver cirrhosis with ascites on CT]]
	===Work Up===		===Work Up===
	====Labs====		====Labs====

Kennybroccoli: /* Admit */

2022-12-06T02:27:57Z

Admit

← Older revision		Revision as of 02:27, 6 December 2022
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	***If '''Lille score >0.45''', considered as non-responder and prednisolone should be discontinued<ref name=Singal2018 />		***If '''Lille score >0.45''', considered as non-responder and prednisolone should be discontinued<ref name=Singal2018 />
	*[[Pentoxifylline]] - evidence does not support its use<ref>Mathurin P, Louvet A, Duhamel A, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. JAMA. 2013;310(10):1033-41.</ref>		*[[Pentoxifylline]] - evidence does not support its use<ref>Mathurin P, Louvet A, Duhamel A, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. JAMA. 2013;310(10):1033-41.</ref>
			*Discontinue nonselective beta blockers (e.g., propranolol) to lower incidence of AKI<ref> Sersté T, Njimi H, Degré D, Deltenre P, Schreiber J, Lepida A, Trépo E, Gustot T, Moreno C. The use of beta-blockers is associated with the occurrence of acute kidney injury in severe alcoholic hepatitis. Liver Int. 2015 Aug;35(8):1974-82. doi: 10.1111/liv.12786. Epub 2015 Feb 4. PMID: 25611961.</ref>

	==Disposition==		==Disposition==
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	===Admit===		===Admit===
	*High risk defined as MDF ≥ 32, MELD ≥ 18, or presence of [[hepatic encephalopathy]]		*High risk defined as MDF ≥ 32, MELD ≥ 18, or presence of [[hepatic encephalopathy]]
			*Admission should be considered for the above as well as any of the following complications:
			**Evidence of active infection
			**Renal failure
			**Severe coagulopathy and/or liver failure
			**Alcohol withdrawal/delirium tremens

	==Prognosis==		==Prognosis==

Rossdonaldson1: /* Prognosis */

2020-06-04T18:37:39Z

Prognosis

← Older revision		Revision as of 18:37, 4 June 2020
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	*Maddrey Discriminant Function score ([http://www.mdcalc.com/maddreys-discriminant-function-for-alcoholic-hepatitis/ MDF])		*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])		*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<ref>O'Shea RS, Dasarathy S, McCullough AJ (2010) Alcoholic liver disease. Hepatology 51: 307–328. doi: 10.1002/hep.23258</ref>		*High risk: MDF ≥ 32, MELD ≥ 18, or presence of [[hepatic encephalopathy]]<ref>O'Shea RS, Dasarathy S, McCullough AJ (2010) Alcoholic liver disease. Hepatology 51: 307–328. doi: 10.1002/hep.23258</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* Disposition */

2020-06-04T18:36:59Z

Disposition

← Older revision		Revision as of 18:36, 4 June 2020
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	==Disposition==		==Disposition==
	*Discharge		===Discharge===
	**Mild disease/low risk		*Mild disease/low risk
	**Nutritional assessment and intervention		*Nutritional assessment and intervention
	**Discuss [[alcohol]] use and recommend strict abstinence		*Discuss [[alcohol]] use and recommend strict abstinence
	*Admit
	**High risk defined as MDF ≥ 32, MELD ≥ 18, or presence of [[hepatic encephalopathy]]		===Admit===
			*High risk defined as MDF ≥ 32, MELD ≥ 18, or presence of [[hepatic encephalopathy]]

	==Prognosis==		==Prognosis==

Rossdonaldson1: /* Clinical Features */

2020-06-04T18:35:31Z

Clinical Features

← Older revision		Revision as of 18:35, 4 June 2020
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	==Clinical Features==		==Clinical Features==
			[[File:Jaundice08.jpg\|thumb\|Jaundice of the skin]]
	[[File:SpiderAngioma.jpg\|thumb\|Spider angioma]]		[[File:SpiderAngioma.jpg\|thumb\|Spider angioma]]
			[[File:Hepaticfailure.jpg\|thumb\|[[Ascites]] secondary to cirrhosis.]]
	===Symptoms===		===Symptoms===
	*[[Abdominal pain]]		*[[Abdominal pain]]

Rossdonaldson1 at 18:14, 4 June 2020

2020-06-04T18:14:52Z

← Older revision		Revision as of 18:14, 4 June 2020
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	*History of (usually chronic) [[alcohol Abuse\|alcohol abuse]] (~80 grams of ethanol daily for 5 years)		*History of (usually chronic) [[alcohol Abuse\|alcohol abuse]] (~80 grams of ethanol daily for 5 years)
	*Ranges from subclinical cases to severe multisystem dysfunction		*Ranges from subclinical cases to severe multisystem dysfunction

	*Presentation can range from mild abdominal pain, nausea and vomiting to acute liver failure
	*May have large palpable liver from fatty infiltration, or may have small nonpalpable liver secondary to cirrhosis from chronic disease
	*Will have moderate elevations in AST and ALT (levels >10x normal are unusual)
	**AST:ALT ration >2 is typical
	*May also have electrolyte abnormalities from malnutrition or [[alcoholic ketoacidosis]]

	==Clinical Features==		==Clinical Features==
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	**Supporting laboratory abnormalities		**Supporting laboratory abnormalities
	***May be nondiagnostic in patients with mild disease or early cirrhosis		***May be nondiagnostic in patients with mild disease or early cirrhosis
			*May also have electrolyte abnormalities from malnutrition or [[alcoholic ketoacidosis]]

	==Management==		==Management==

Rossdonaldson1 at 18:13, 4 June 2020

2020-06-04T18:13:36Z

← Older revision		Revision as of 18:13, 4 June 2020
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	*History of (usually chronic) [[alcohol Abuse\|alcohol abuse]] (~80 grams of ethanol daily for 5 years)		*History of (usually chronic) [[alcohol Abuse\|alcohol abuse]] (~80 grams of ethanol daily for 5 years)
	*Ranges from subclinical cases to severe multisystem dysfunction		*Ranges from subclinical cases to severe multisystem dysfunction

			*Presentation can range from mild abdominal pain, nausea and vomiting to acute liver failure
			*May have large palpable liver from fatty infiltration, or may have small nonpalpable liver secondary to cirrhosis from chronic disease
			*Will have moderate elevations in AST and ALT (levels >10x normal are unusual)
			**AST:ALT ration >2 is typical
			*May also have electrolyte abnormalities from malnutrition or [[alcoholic ketoacidosis]]

	==Clinical Features==		==Clinical Features==

Huad55: /* High risk, severe cases */

2020-05-04T03:50:16Z

High risk, severe cases

← Older revision		Revision as of 03:50, 4 May 2020
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	*Nutritional support for malnutrition: especially [[thiamine]], [[folate]], [[pyridoxine]], [[magnesium]], [[hypophosphatemia\|phosphate]], [[dextrose\|glucose]], and protein		*Nutritional support for malnutrition: especially [[thiamine]], [[folate]], [[pyridoxine]], [[magnesium]], [[hypophosphatemia\|phosphate]], [[dextrose\|glucose]], and protein

	===~~High risk, severe cases~~===		===Severe Alcoholic Hepatitis===
	*[[~~Steroids~~]]		*Defined as '''Maddrey's DF score ≥32'''<ref name=Singal2018>Singal AK, et. al. ACG clinical guideline: alcoholic liver disease. Am J Gastro. 2018; 113: 175-194.</ref>
	*[[Pentoxifylline]] - ~~may~~ not ~~provide any added benefit~~<ref>Mathurin P, Louvet A, Duhamel A, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. JAMA. 2013;310(10):1033-41.</ref>		**Confers mortality of 20-50% in 30 days
			*1st line therapy: '''[[Prednisolone]] 40mg PO qDay x4wks'''<ref name=Singal2018 />
			**Must assess response to treatment at 7 days with Lille score
			***If '''Lille score >0.45''', considered as non-responder and prednisolone should be discontinued<ref name=Singal2018 />
			*[[Pentoxifylline]] - evidence does not support its use<ref>Mathurin P, Louvet A, Duhamel A, et al. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. JAMA. 2013;310(10):1033-41.</ref>

	==Disposition==		==Disposition==