Alcoholic hepatitis

Question 1

define alcoholic hepatitis?

Answer 1

• inflammatory liver injury caused by chronic heavy intake of alcohol

Question 2

what are the three main forms of alcoholic liver disease?

Answer 2

• alcoholic fatty liver
• alcoholic hepatitis
• chronic cirrhosis

Question 3

what is the maximum number of units men and women should drink?

Answer 3

• they shouldnt drink more than 14 units a week

Question 4

which questionnaire can screen for harmful alcohol use?

Answer 4

• audit

Question 5

what are some histo features of alcoholic hepatitis?

Answer 5

• build up of fat
• centrilobular ballooning
• necrosis of hepatocytes
• Neutrophilic inflammation
• Mallory-hyaline inclusions

Question 6

epidemiology of alcoholic hepatitis?

Answer 6

10-35% of heavy drinkers

Question 7

presenting symptoms of mild alcoholic hepatitis?

Answer 7

• can be a mild illness with the following:
• nausea
• malaise
• epigastric pain
• right hypochondrial pain
• fever

Question 8

presenting symptoms of moderate alcoholic hepatitis?

Answer 8

• jaundice
• abdo swelling
• swollen ankles

Question 9

what are the signs of alcohol excess?

Answer 9

• palmer erythema
• Dupuytren’s contracture
• telangiectasia
• Spider naevi
• gynaecomastia
• hepatomegaly
• tachycardia
• jaundice
• bruising
• ascites
• hepatomegaly
• splenomegaly

Question 10

what might the LFTs show?

Answer 10

• high AST and ALT
• specifically AST: ALT >2:1
• high GGT
• high ALP later on
• low albumin

Question 11

what might FBC show?

Answer 11

• low Hb
• high MCV
• high WCC
• low platelets

Question 12

when might Us and Es be deranged?

Answer 12

hepatorenal syndrome

Question 13

other investigations into alcoholic liver disease?

Answer 13

• USS: early fatty changes
• Upper GI endoscopy: investigate varices
• Liver biopsy
• EEG

Question 14

management plan for alcoholic hepatitis?

Answer 14

• thiamine
• vitamin replacement
• correct electrolytes
• treat encephalopathy
• manage ascites
• nutrition
• lots of protein

Question 15

acute management?

Answer 15

• steroid treatment can improve short term prognosis

Question 16

complications of alcoholic hepatitis?

Answer 16

• Acute liver decompensation
• hepatorenal syndrome
• cirrhosis

Question 17

prognosis of alcoholic hepatitis?

Answer 17

• if alcohol intake continues will progress to cirrhosis in 1-3 years