Alcoholic hepatitis Flashcards
What is alcoholic hepatitis
Inflammatory response - neutrophilic infiltrationa d CK release leading to jaundice, coagulopathy and encepahlopathy
Symptoms of alcoholic hepatitis
Jaundice
RUQ pain
Hepatomegaly - common - rarely tender
Palmar erythema
Clubbing
Peripheral oedema
Dupyrtens contracture
Purutiis
Xanthomas
Spider angiomas
Oestrogenic effects - loss hair, libido, gynaecomastia and testicular atrophy, amenorr.
Portal HPTN
What does AST:ALT ratio normally show in aucte alcoholic hepatitis
ratio of >3 strongly suggests alcoholic hepatitis
AST - 100-200
ALT - normal or mildly raised
Ratio >2
LFTs in alcholic hepatitis
AST:ALT ratio of 2->3
GGT raised
ALP may be noraml
What does unconjugated vs conjugated bilirubin differentiate between
Liver disease = conjugated
#Haemolysis or gilberts = unconjugated
What is found in liver biopsy in alcoholic heoatitis
Mallory denk bodies #Neutrophil rich + necorsis
Hepatocyte ballooning
Investigations to order for alcoholic liver disease
Vital hepatitis serology
#Serum caeruloplasmin, iron, transferrin + ferritin
Anti-mitochondrial antibod
Alpha1 antiptrypisin levels
What does testing anit mitochondrial anitbody rule out
Pirmary biliary cirrhosis
First line for delirium tremens
Oral lorazepam
Quick acting benzo eg lorazepam for withdrawal seizures
What is the standard treatment of alcoholic acute hepatitis
Glucocorticoids eg prednisolone
Improce short term survual
How identify patinets with severe alcoholic hepatitis
Maddreys discriminant function
What maddreys DF level predicts high mortality in 90 dyas and what suggests
> 32
Liver biopsy considered and corticosteroid initiates
Alternatie to glucocortocids if CI (when CI) in alcoholic hepatitis
Pentoxifylline
CI to prednisolone - hep B, TB, other serious infection)
COmplications
Same as any other liver disease eg
Hepatorenal syndrome
HCC
Portal HPTN
Hepatic encephalopathy
What diet shoul be implemented in alcoholic hepatitis
High protein diet
