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Alcoholic hepatitis

  • An acute inflammation of the liver caused by excessive alcohol intake. It’s characterised by liver dysfunction and hepatocellular necrosis.
  • Alcohol: Typically seen in individuals with a long history of heavy drinking. Amount and duration of alcohol intake, genetics, and diet can influence susceptibility.
Clinical Features
  • Rapid onset jaundice.
  • Anorexia, nausea, and vomiting.
  • Abdominal pain (usually in the right upper quadrant).
  • Fever.
  • Hepatomegaly.
  • Ascites and signs of liver failure in severe cases.
  • Bloods: Raised bilirubin, raised transaminases (with AST typically greater than ALT, often in a 2:1 ratio), elevated gamma-glutamyltransferase (GGT), and leucocytosis.
  • Alcohol levels: Might be elevated.
  • Liver biopsy: Gold standard for diagnosis but not always necessary. Shows hepatocyte ballooning, neutrophil infiltration, and Mallory bodies.
  • Imaging: Ultrasound or CT may show hepatomegaly and exclude other pathologies.
  • Abstinence from alcohol: Primary intervention and is essential for improvement.
  • Corticosteroids: Used for severe alcoholic hepatitis, reduces inflammation. Typically prednisolone.
  • Nutritional support: Many patients are malnourished.
  • Supportive care: Addressing complications like ascites, encephalopathy, and bleeding varices.
  • Maddrey’s discriminant function: A score to determine severity and prognosis.
  • Continued alcohol consumption has a poor prognosis.
  • Abstinence can lead to complete recovery or progression to cirrhosis in some cases.
  • Liver failure.
  • Portal hypertension.
  • Hepatic encephalopathy.
  • Ascites.
  • Variceal bleeding.

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