Alcoholic hepatitis (AH) is a severe, progressive, inflammatory, and cholestatic liver disease occurring in patients with long-term ethanol abuse.
Drinking multiple alcohol types, drinking alcohol between meal times, poor nutrition, female gender, obesity, Hispanic ethnicity, long-term ingestion of >10 to 20 g/ day of alcohol in women and >20 to 40 g/day in men.
_ Common presenting symptoms include:
-Rapid onset of jaundice
-Weight loss or malnourishment
-Complications of liver impairment (GI bleed; confusion, lethargy, ascites)
_ Findings on physical examination include:
-Hepatomegaly, with tender liver on palpation
-Jaundice and ascites
-Asterixis (a flapping tremor)
-Abdominal distention with shifting dullness (ascites)
_ Relevant questions may include:
When patients started drinking
Number of times patient drinks per day
How many years of regular/daily drinking
Types of alcohol
Home or bar drinking?
Rehabilitation for drinking?
Social problems (e.g., arrest for public intoxication or driving under the influence, marital discord due to alcoholism)
Elevated transaminase (AST >45 U/L but <300 U/L; AST:ALT ratio >2.0) but some patients may not have elevations in ALT, AST in early phases
S-bilirubin >2 mg/dl
Increased prothrombin time (PT)
Elevated gamma glutamyltransferase (GGT)
Carbohydrate-deficient transferrin (CDT) is a reliable marker for chronic alcoholism
Elevated C-reactive protein
Electrolyte disorder (hypokalemia, hypomagnesemia, low zinc, hypophosphatemia)
_ Treatment can be divided into three main components: