Question 1 of 10

    Alcoholic Hepatitis

    Mallory body high mag cropped[1]

    The disease originates from this process: Poison.

    Presentation

    Mild cases of alcoholic hepatitis usually are asymptomatic. As the disease progresses, the damage to the liver increases and the following signs and symptoms are evident:

    Skin
    Pruritus
    • Patients may present with jaundice, pruritus, abnormal laboratory findings (eg, thrombocytopenia, hypoalbuminemia, coagulopathy), or complications of portal hypertension, such as variceal bleeding, ascites, or hepatic encephalopathy.[clevelandclinicmeded.com]
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  • Eyes
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  • hematological
    Easy Bruising
    • bruising Dupuytren’s contracture Neuromuscular Tremor Memory loss / cognitive impairment Peripheral myopathy- degradation of muscle Epilepsy Wernicke-Korskoff syndrome Cardiovascular Hypertension Cardiomyopathy Hyperdynamic circulation Bone Rib fractures[almostadoctor.co.uk]
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  • cardiovascular
    Tachycardia
    • […] vomiting blood or material that looks like coffee grounds bloody or dark black or tarry bowel movements (melena) abnormally dark or light skin redness on feet or hands paleness light-headedness or fainting, especially with upright posture rapid heart rate (tachycardia[ihv.org]
    • Alcoholic hepatitis can also lead to intensified hangovers and withdrawals… Symptoms Of Alcoholic Hepatitis And Alcohol Withdrawals Mild to moderate symptoms include: Irritability Anxiety Headache Sweating Tachycardia Hand tremors with clammy skin Severe[drugrehab.org]
    • Physical Exam: VS: T 98.9 HR 104 RR 19 BP 117/67 O2 99% RA Gen: Well-appearing obese female in no acute distress HEENT: PERRL, marked scleral icterus, sublingual icterus, MMM, no lesions CV: Tachycardia, regular rhythm, normal S1/S2, no M/R/G Lungs: CTAB[ddxof.com]
    • Fever, tachycardia and tachypnea, leukocytosis (sometimes extreme with a white blood cell count 50,000), altered mental status, abdominal pain, and distension may accompany severe AH.[gastroenterologyandhepatology.net]
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  • musculoskeletal
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  • gastrointestinal
    Nausea
    • The symptoms of mild alcoholic hepatitis tend to be more severe: Anorexia Nausea Abdominal pain Weight loss Drugs Tags: Gastroenterology Liver[almostadoctor.co.uk]
    • Other symptoms include: Heavy fluid retention Confusion Liver and Kidney failure Tender abdominal region Weight loss Vomiting Nausea Treatment for Alcoholic Hepatitis Treatment for alcoholic hepatitis means stopping drinking alcohol immediately.[alcoholmastery.com]
    • Symptoms may include: Abdominal tenderness or pain Nausea Vomiting blood or material that looks like coffee grounds Spider-like blood vessels in the skin Ascites - fluid build-up in the abdominal cavity Poor appetite Jaundice - yellowing of the skin and[northwell.edu]
    • […] loss of appetite nausea swollen abdomen or increased abdominal circumference (from enlarged liver) jaundice abdominal pain and tenderness fever ascites (fluid collection in the abdomen) unintentional weight gain (because of fluid collection) mental confusion[ihv.org]
    • […] impairment Jaunice (yellowing of skin and eyeso Hypertension Abdominal swelling (edema) and pain Abnormal brain function (also associated with fatality) Confusion Swollen veins Weight loss Vomiting Less serious signs include: Appetite changes Dry mouth Nausea[justbelieverecovery.com]
    Vomiting
    • You vomit or have severe nausea.[myhealth.alberta.ca]
    • You vomit several times in a row.[drugs.com]
    • Other symptoms include: Heavy fluid retention Confusion Liver and Kidney failure Tender abdominal region Weight loss Vomiting Nausea Treatment for Alcoholic Hepatitis Treatment for alcoholic hepatitis means stopping drinking alcohol immediately.[alcoholmastery.com]
    • Symptoms may include: Abdominal tenderness or pain Nausea Vomiting blood or material that looks like coffee grounds Spider-like blood vessels in the skin Ascites - fluid build-up in the abdominal cavity Poor appetite Jaundice - yellowing of the skin and[northwell.edu]
    • However, the rate of adverse events attributed to pentoxifylline was similar to placebo except for epigastric pain and vomiting which was greater in the treatment group than placebo.[qxmd.com]
    Abdominal Pain
    • […] loss of appetite nausea swollen abdomen or increased abdominal circumference (from enlarged liver) jaundice abdominal pain and tenderness fever ascites (fluid collection in the abdomen) unintentional weight gain (because of fluid collection) mental confusion[ihv.org]
    • Symptoms include abdominal pain, fatigue, and weight loss.[alcoholawareness.org]
    • Among which may include: Loss of appetite Nausea and vomiting Abdominal pain and tenderness Yellowing of the skin and whites of the eyes (jaundice) Fever Abdominal swelling due to fluid accumulation (ascites) Mental confusion Fatigue Alcohol-induced hepatitis[the-alcoholism-guide.org]
    • The symptoms of mild alcoholic hepatitis tend to be more severe: Anorexia Nausea Abdominal pain Weight loss Drugs Tags: Gastroenterology Liver[almostadoctor.co.uk]
    • Symptoms include of alcoholic hepatitis include: Loss of appetite Nausea Vomiting Abdominal pain and tenderness Fever Jaundice Mental confusion Back to Top Is alcoholic hepatitis different from "fatty liver?"[upmc.com]
    Loss of Appetite
    • loss of appetite nausea swollen abdomen or increased abdominal circumference (from enlarged liver) jaundice abdominal pain and tenderness fever ascites (fluid collection in the abdomen) unintentional weight gain (because of fluid collection) mental confusion[ihv.org]
    • Alcoholic Hepatitis Symptoms In the stage of acute alcoholic hepatitis, there may be nausea, loss of appetite, gradual loss of weight, jaundice and other symptoms of liver dysfunction (prolonged prothrombin time, hypoalbuminemia, ascites, and hepatic[quitalcohol.com]
    • Among which may include: Loss of appetite Nausea and vomiting Abdominal pain and tenderness Yellowing of the skin and whites of the eyes (jaundice) Fever Abdominal swelling due to fluid accumulation (ascites) Mental confusion Fatigue Alcohol-induced hepatitis[the-alcoholism-guide.org]
    • Diagnosis Hepatitis of all kinds causes notable discomfort, loss of appetite, nausea, pain in the liver, and usually jaundice (turning yellow).[medical-dictionary.thefreedictionary.com]
    • Symptoms include of alcoholic hepatitis include: Loss of appetite Nausea Vomiting Abdominal pain and tenderness Fever Jaundice Mental confusion Back to Top Is alcoholic hepatitis different from "fatty liver?"[upmc.com]
    Abdominal Tenderness
    • Symptoms may include: Abdominal tenderness or pain Nausea Vomiting blood or material that looks like coffee grounds Spider-like blood vessels in the skin Ascites - fluid build-up in the abdominal cavity Poor appetite Jaundice - yellowing of the skin and[northwell.edu]
    • Symptoms may include: abdominal tenderness or pain nausea vomiting blood or material that looks like coffee grounds spider-like blood vessels in the skin ascites - fluid build-up in the abdominal cavity poor appetite jaundice-yellowing of the skin and[beaumont.org]
    • Symptoms The most common sign of alcoholic hepatitis is yellowing of the skin and whites of the eyes (jaundice) Other signs and symptoms include: Loss of appetite Nausea and vomiting Abdominal tenderness Fever, which is often low-grade Fatigue and weakness[mayoclinic.org]
    Diarrhea
    • Common symptoms are weakness, anorexia, weight loss, nausea, vomiting and diarrhea.[euroliver.org]
    • The more damage there is, the more you’ll experience these initial symptoms: A loss of appetite Fatigue Diarrhea Nausea/vomiting Dry mouth Pain/swelling in the abdomen Fever Jaundice or icterus which is the yellowing of skin or eyes Negative changes in[northpointrecovery.com]
    Clay-Colored Stool
    • The excess bilirubin can also lead to other symptoms such as pale or clay-colored stools, dark urine, and generalized itching.[giassoc.org]
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  • Face, Head & Neck
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  • Entire body system
    Fever
    • Other common signs and symptoms include fever, ascites, and proximal muscle loss.[ncra.org]
    • You might also have a fever, stomachache, or liquid buildup in your belly, and you may lose weight .[webmd.com]
    • List features items like Fatigue, Fever and more![ranker.com]
    • (above 100 0 F): 13% Palpable hepatomegally Hepatic bruit: 59% Inclusion Criteria History of heavy alcohol abuse Admission for acute alcoholic hepatitis Jaundice One or more of the following: Palpable tender hepatomegaly Fever WBC 12,000 with left shift[wikijournalclub.org]
    • She also denies fevers/chills, increased abdominal girth, abdominal pain, changes in bowel habits or bloody/dark stools.[ddxof.com]
    Weight Loss
    • Symptoms include abdominal pain, fatigue, and weight loss.[alcoholawareness.org]
    • Other symptoms include: Heavy fluid retention Confusion Liver and Kidney failure Tender abdominal region Weight loss Vomiting Nausea Treatment for Alcoholic Hepatitis Treatment for alcoholic hepatitis means stopping drinking alcohol immediately.[alcoholmastery.com]
    • loss Fatigue Feeling ill Diagnosis In addition to complete medical history and physical exam, diagnostic procedures for alcoholic hepatitis may include the following: Specific lab blood tests, such as the following: Liver function studies Blood cell[northwell.edu]
    • The following are the most common symptoms of alcoholic hepatitis: Belly (abdomen) tenderness or pain over the liver Nausea Vomiting blood or material that looks like coffee grounds Poor appetite Yellowing of the skin and eyes (jaundice) Weight loss Tiredness[uchealth.org]
    Anemia
    • Signs and Tests: A CBC may show anemia and other abnormalities.[ihv.org]
    • Bleeding complications, anemia, and liver failure can become life-threatening.[healthline.com]
    • Other common and nonspecific laboratory abnormalities include anemia and leukocytosis.[clevelandclinicmeded.com]
    Malaise
    • Wernicke-Korskoff syndrome Cardiovascular Hypertension Cardiomyopathy Hyperdynamic circulation Bone Rib fractures on CXR Spinal osteoporosis (particularly in men) Generally, patients with fatty liver have few symptoms, however they may notice nausea and malaise[almostadoctor.co.uk]
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  • Liver, Gall & Pancreas
    Jaundice
    • The cardinal sign of alcoholic hepatitis is the rapid onset of jaundice.[ncra.org]
    • Yellowing of the skin and eyes (jaundice).[gastro.org]
    • Diagnosis Hepatitis of all kinds causes notable discomfort, loss of appetite, nausea, pain in the liver, and usually jaundice (turning yellow).[medical-dictionary.thefreedictionary.com]
    • Alcoholic hepatitis can vary from mild with only liver enzyme elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time , and even liver failure.[en.wikipedia.org]
    • The jaundice results from the excess bilirubin in the blood.[giassoc.org]
    Hepatomegaly
    • . # Alcoholic hepatitis: Rapid onset of jaundice, tender hepatomegaly, and elevation of transaminases (AST ALTx2) in the setting of chronic alcohol use suggestive of alcoholic hepatitis.[ddxof.com]
    • Physical examination: Bp 140/80mmHg, Ultrasound of Abdomen showed hepatomegaly with enlarged liver measuring 19.1 cm in the midclavicular line and hepatic steatosis and gallbladder sludge without evidence of wall thickening or pericystic fluid.[bloodjournal.org]
    • Jaundice Hepatomegaly RUQ tenderness/mild pain (due to swelling of the liver capsule) Ascites Hepatic bruit Encephalopathy Fever Ecchymoses E.[clinicaladvisor.com]
    • 59% Varices: 80% Splenomegaly: 21% Fever (above 100 0 F): 13% Palpable hepatomegally Hepatic bruit: 59% Inclusion Criteria History of heavy alcohol abuse Admission for acute alcoholic hepatitis Jaundice One or more of the following: Palpable tender hepatomegaly[wikijournalclub.org]
    • The diagnosis of acute alcoholic hepatitis will be based on clinical features and testing including hepatomegaly, jaundice, fever, leukocytosis, compatible liver biochemistries in the context of heavy alcohol consumption.[clinicaltrials.gov]
    Scleral Icterus
    • Physical Exam: VS: T 98.9 HR 104 RR 19 BP 117/67 O2 99% RA Gen: Well-appearing obese female in no acute distress HEENT: PERRL, marked scleral icterus, sublingual icterus, MMM, no lesions CV: Tachycardia, regular rhythm, normal S1/S2, no M/R/G Lungs: CTAB[ddxof.com]
    • Evaluate for jaundice (evaluate for scleral icterus, skin and sublingual jaundice).[clinicaladvisor.com]
    Liver Tenderness
    • tenderness Pancreatic pain Skin rash All of the above In alcoholic hepatitis, the liver is usually enlarged.[ncra.org]
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  • Jaw & Teeth
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  • Immune System
    Splenomegaly
    • […] characteristics Demographics: Male: 71% Age: 42.4 years Medical data: Days of treatment: 21.5 Days before randomization: 3.9 Previous decompensation: 24% Hepatic encephalopathy: 8% Creatinine above 2.4 mg/dL: 6.1% Ascites: 76% Edema: 59% Varices: 80% Splenomegaly[wikijournalclub.org]
    • Do a thorough abdominal exam, evaluating for hepatomegaly and/or splenomegaly, hepatic bruit, RUQ tenderness suggesting swelling of liver capsule, ascites.[clinicaladvisor.com]
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  • Workup

    Diagnosis of alcoholic hepatitis begins with a detailed history about alcohol consumption. This is one of the most important evidence suggesting the development of alcoholic liver disease. In addition, the following diagnostic procedures are employed for detecting liver damage:

    • Complete blood count to determine presence of anemia and other abnormalities.
    • Tests such as total albumin, bilirubin and international normalized ratio to assess liver function.
    • C-reactive protein serum determination has 99% specificity rating [8].
    • Imaging studies such as CT scan and MRI of the liver to study the extent of damage to the organ.
    • Blood tests to rule out other causes of liver damage.

    When the above mentioned tests fail to draw out a confirmed diagnosis then liver biopsy may be done.

    Pathology

    Biopsy
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  • Laboratory

    Urine
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  • Serum
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  • Treatment

    The following methods are carried out for treating alcoholic hepatitis:

    • Discontinuing alcohol consumption forms the basis of treatment regime. 
    • A diet that is rich in carbohydrates and calories is given to minimize the protein breakdown and reverse the effects of malnutrition. If the patient is not in a condition to take food by mouth then tube feeding is employed. In such cases, high nutrient liquid diet is prepared for patients on tube feeding. 
    • Along with this, medications are given to reduce the liver inflammation and also reverse the effects of liver damage.
    • Liver transplant is done in severe cases for patients who have attained end stage liver disease [9].

    Prognosis

    The prognosis of the disease would depend on extent of damage to the liver and the severity of the symptoms. If the disease has been diagnosed in the initial stages and the individual stops intake of alcohol, then with proper treatment plan the result would certainly be favorable.

    However, if individuals continue to abuse their body with alcohol intake then recovery process would slow down and individuals will gradually develop end stage liver disease. In such situations, the toxins would no longer be filtered from the body causing coma and finally leading to death. Severe alcoholic hepatitis carries a general mortality rate of up to 66% [4]. The Glasgow Alcoholic Hepatitis Scoring (GAHS) is currently being used as a prognostic tool which deems to be up to 81% accurate in predicting a 28 day outcome [5].

    Complications

    Complications of alcoholic hepatitis occur when individuals do not stop drinking alcohol. The following are the secondary conditions noticed amongst individuals with alcoholic liver disease:

    Complications

    Intrahepatic Cholestasis
    Fever
    • Other common signs and symptoms include fever, ascites, and proximal muscle loss.[ncra.org]
    • You might also have a fever, stomachache, or liquid buildup in your belly, and you may lose weight .[webmd.com]
    • List features items like Fatigue, Fever and more![ranker.com]
    • (above 100 0 F): 13% Palpable hepatomegally Hepatic bruit: 59% Inclusion Criteria History of heavy alcohol abuse Admission for acute alcoholic hepatitis Jaundice One or more of the following: Palpable tender hepatomegaly Fever WBC 12,000 with left shift[wikijournalclub.org]
    • She also denies fevers/chills, increased abdominal girth, abdominal pain, changes in bowel habits or bloody/dark stools.[ddxof.com]
    Acute Pancreatitis
    • Occasionally, death can be caused by shock induced by fat thrombosis in the lung, very low blood sugar level, or acute pancreatitis.[zhangclinicnyc.com]
    • About this tool In a validation study by the same author, patients with GI bleeding requiring transfusions, diabetes requiring insulin, infection requiring treatment, clinical and laboratory diagnosis of acute pancreatitis, a history of recent head trauma[qxmd.com]
    • pancreatitis, and renal failure.[the-hospitalist.org]
    • Contraindications to corticosteroid therapy include active gastrointestinal bleeding, renal failure, acute pancreatitis, active tuberculosis, uncontrolled diabetes and psychosis [ 29 ] .[oapublishinglondon.com]
    • Most recent trials of corticosteroids for alcoholic hepatitis have excluded patients with certain coexisting conditions, such as gastrointestinal bleeding, active infection, diabetes, viral hepatitis, or acute pancreatitis, and therefore the applicability[clevelandclinicmeded.com]
    Jaundice
    • The cardinal sign of alcoholic hepatitis is the rapid onset of jaundice.[ncra.org]
    • Yellowing of the skin and eyes (jaundice).[gastro.org]
    • Diagnosis Hepatitis of all kinds causes notable discomfort, loss of appetite, nausea, pain in the liver, and usually jaundice (turning yellow).[medical-dictionary.thefreedictionary.com]
    • Alcoholic hepatitis can vary from mild with only liver enzyme elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time , and even liver failure.[en.wikipedia.org]
    • The jaundice results from the excess bilirubin in the blood.[giassoc.org]
    Hypoglycemia
    • Diabetes or other Endocrine issues Follow for hypoglycemia if fulminant hepatic liver failure.[clinicaladvisor.com]
    Hepatic Encephalopathy
    • Signs and symptoms of alcoholic hepatitis include jaundice , ascites (fluid accumulation in the abdominal cavity ), fatigue and hepatic encephalopathy ( brain dysfunction due to liver failure ).[en.wikipedia.org]
    • […] hepatitis Jaundice One or more of the following: Palpable tender hepatomegaly Fever WBC 12,000 with left shift Hepatic encephalopathy Hepatic systolic bruit Maddrey discriminant factor 32 [4] , [5] Exclusion Criteria Concomitant bacterial infection Active[wikijournalclub.org]
    • Alcoholic hepatitis ranges from mild (confined to lab abnormalities) to severe liver dysfunction with jaundice, hepatic encephalopathy, ascites, bleeding esophageal varices, abnormal blood clotting and coma.[medical-dictionary.thefreedictionary.com]
    Peptic Ulcer
    • Hospital Medicine Infectious Diseases Neurology Oncology and Hematology Pediatrics and Adolescent Medicine Psychiatry Women’s Health Topics: Aging / Geriatrics Allergy / Asthma Arthritis/Rheumatic Disease Breast Cancer Depression / Anxiety Diabetes GERD / Peptic[jwatch.org]
    • Upper gastrointestinal bleeding does occur but is usually due to gastric erosions or peptic ulceration on a backgroung of coagulopathy Infections are very common.[euroliver.org]
    Anemia
    • Signs and Tests: A CBC may show anemia and other abnormalities.[ihv.org]
    • Bleeding complications, anemia, and liver failure can become life-threatening.[healthline.com]
    • Other common and nonspecific laboratory abnormalities include anemia and leukocytosis.[clevelandclinicmeded.com]
    Hypoalbuminemia
    • Hypoalbuminemia is a medical condition where levels of albumin in blood serum are abnormally low.[quitalcohol.com]
    • . - Mild elevation in alkaline phosphatase Albumin (frequent hypoalbuminemia) Prothrombin time/international normalized ratio (INR) (frequent coagulopathy) Complete blood count (CBC) with differential (frequent leukocytosis with neutrophilia, often occult[clinicaladvisor.com]
    • . - Prolongation of the prothrombin time and hypoalbuminemia reflect poor hepatic synthetic function. - Leukocytosis is common and a count of polymorphonuclear leukocytes greater than 5500/mm3 could be associated with a better response to the corticotherapy[euroliver.org]
    • Patients may present with jaundice, pruritus, abnormal laboratory findings (eg, thrombocytopenia, hypoalbuminemia, coagulopathy), or complications of portal hypertension, such as variceal bleeding, ascites, or hepatic encephalopathy.[clevelandclinicmeded.com]
    Ascites
    • Convert to ICD-10-CM : 571.1 converts approximately to: 2015/16 ICD-10-CM K70.10 Alcoholic hepatitis without ascites Approximate Synonyms Acute alcoholic liver disease Alcoholic hepatitis Alcoholic hepatitis w ascites Alcoholic hepatitis with ascites[icd9data.com]
    • K7010Alcoholic hepatitis without ascites K7011Alcoholic hepatitis with ascites K702Alcoholic fibrosis and sclerosis of liver K7030Alcoholic cirrhosis of liver without ascites K7031Alcoholic cirrhosis of liver with ascites K7040Alcoholic hepatic failure[cms.gov]
    • Background A 58-year-old man initially presented with new onset jaundice, ascites, cachexia, edema, and encephalopathy.[hepatitis.va.gov]
    • Signs and symptoms of alcoholic hepatitis include jaundice , ascites (fluid accumulation in the abdominal cavity ), fatigue and hepatic encephalopathy ( brain dysfunction due to liver failure ).[en.wikipedia.org]
    Hypomagnesemia
    • […] and alanine aminotransferase levels elevated, usually 300 U/L; AST/ALT ratio 2:1 Hematologic Anemia Leukocytosis or leukopenia Thrombocytopenia Increased serum globulin levels Metabolic Elevated blood ammonia level Hyperglycemia Respiratory alkalosis Hypomagnesemia[clevelandclinicmeded.com]
    Chronic Liver Disease
    • Alcoholic hepatitis represents a complex disease of the liver and is often a precursor to chronic liver disease or cirrhosis.[hospitals.jefferson.edu]
    • Alcoholic hepatitis is a complex problem and can lead to chronic liver disease and cirrhosis.[northwell.edu]
    • Management of the complications of chronic liver disease may be needed.[ihv.org]
    • Alcoholic hepatitis is a complex problem and is a precursor to chronic liver disease and cirrhosis.[beaumont.org]
    • These cells to hepatocytes with Mallory bodies. [2] If chronic liver disease is also present: Fibrosis Cirrhosis – a progressive and permanent type of fibrotic degeneration of liver tissue.[en.wikipedia.org]
    Fatty Liver
    • liver disease alcohol hepatitis c treatment guidelines i have fatty liver treatment for alcoholic fatty liver hepatitis c genotype etoh cirrhosis cure for hepatitis c non alcoholic fatty liver treatment acute hepatitis c alcoholic hepatitis treatment[youtube.com]
    • Fatty liver and mild alcoholic hepatitis usually recover if you can manage this.[patient.info]
    • No laboratory test is diagnostic of fatty liver.[clevelandclinicmeded.com]
    • Pathology The first sign is fatty liver.[almostadoctor.co.uk]
    • This condition is called "fatty liver."[upmc.com]
    Dupuytren Contracture
    • ’s contracture Neuromuscular Tremor Memory loss / cognitive impairment Peripheral myopathy- degradation of muscle Epilepsy Wernicke-Korskoff syndrome Cardiovascular Hypertension Cardiomyopathy Hyperdynamic circulation Bone Rib fractures on CXR Spinal[almostadoctor.co.uk]
    • Physical Examination and Laboratory Findings In Alcoholic Liver Disease Physical Examination Constitutional Fever Skin Spider angioma Parotid and lacrimal gland enlargement Palmer erythema Jaundice Decreased body hair Gynecomastia Musculoskeletal Dupuytren’s[clevelandclinicmeded.com]
    • On examination, the liver may be enlarged and tender, and a hepatic bruit has been reported. 13 Other classic signs of liver disease such as parotid enlargement, Dupuytren contracture, dilated abdominal wall veins, and spider nevi can be present, but[mdedge.com]
    Portal Hypertension
    • Serious complications are associated with advanced disease such as alcoholic encephalopathy (damage to brain tissue) and portal hypertension (high blood pressure within the liver).[ihv.org]
    • It progresses to become pericellular and massive in the central area and may cause occlusion of the central veins with production of portal hypertension without cirrhosis.[meddean.luc.edu]
    • Portal hypertension which can cause spleen enlargement.[northpointrecovery.com]
    • Hepatocytes are classically ballooned, which causes compression of the sinusoid and reversible portal hypertension.[clevelandclinicmeded.com]
    Viral Hepatitis
    • The differential diagnosis of alcoholic hepatitis includes nonalcoholic steatohepatitis, acute or chronic viral hepatitis, drug-induced liver injury, fulminant Wilson’s disease, autoimmune liver disease, alpha-1 antitrypsin deficiency, pyogenic hepatic[ncra.org]
    • The symptoms are similar to those of viral hepatitis.[giassoc.org]
    • Experiences with viral hepatitis at Brooke Army Hospital during the years 1951–1953.[link.springer.com]
    • .- ) viral hepatitis ( B15-B19 ) alcoholic (acute) (chronic) K70.10 ICD-10-CM Codes Adjacent To K70.10 K67 Disorders of peritoneum in infectious diseases classified elsewhere K68 Disorders of retroperitoneum K68.1 Retroperitoneal abscess K68.11 Postprocedural[icd10data.com]
    • Alcoholic Hepatitis Treatment and Management National Center for Biotechnology Information – Definition, epidemiology and magnitude of alcoholic hepatitis National Institute on Alcohol Abuse and Alcoholism – Alcohol Alert National Institute on Drug Abuse – Viral[drugrehab.org]
    Hepatitis A
    • hepatitis with discriminant function score 32.[en.wikipedia.org]
    • Gepubliceerd op 24 dec. 2016 Causes Symptoms and Treatment of Alcoholic hepatitis treatment alcoholic hepatitis is alcoholic hepatitis reversible hepatitis c genotype 1a stages of liver damage due to alcohol hepatitis c treatment treatment for hepatitis[youtube.com]
    Hepatitis B
    • b antigen treating fatty liver naturally liver disease due to alcohol hepatitis b vaccine hepatitis b shot hepatitis a vaccine is hepatitis c curable definition of alcoholic treatment for hepatitis b living with hepatitis c patient counselling for alcoholic[youtube.com]
    • Hepatitis B and C are bloodborne diseases.[healthline.com]
    • Recruiting 18 NO Healthy Volunteers Chronic hepatitis B virus clinical epidemiology in a representative sample of zambian adults Recruiting 18 - 99 Years Old Healthy Volunteers OK Chronic hepatitis B virus infection in zambia Recruiting 18 - 99 Years[patientwing.com]
    • Milk thistle for alcoholic and/or hepatitis B or C liver diseases--a systematic cochrane hepato-biliary group review with meta-analyses of randomized clinical trials.[emedicine.medscape.com]
    • (Hepatitis B can also cause cirrhosis, and can be prevented with vaccination).[alcoholawareness.org]
    Hepatitis C
    • […] hepatitis treatment chronic hepatitis c chronic nonalcoholic liver disease cure hepatitis c complications of fatty liver hepatitis c antibody hep c cure fat cells in liver hepatitis c genotype 3 hepatitis c viral load hepatitis b antigen treating fatty[youtube.com]
    • Hepatitis C involves long-term liver inflammation due to infection with the hepatitis C virus, or HCV.[livestrong.com]
    • For any patient with cirrhosis, having two active processes working against the liver, such as drinking plus hepatitis C, or hepatitis C plus hepatitis B, is going to make the cirrhosis worse.[hepatitis.va.gov]
    • Protect yourself against hepatitis C: Hepatitis C is a serious liver infection caused by a virus.[drugs.com]
    • Protect yourself from hepatitis C.[mayoclinic.org]
    Hepatorenal Syndrome
    • (See the chapter "Hepatorenal syndrome") B.[clinicaladvisor.com]
    • At 4 weeks, pentoxifylline was associated with a 22% absolute reduction in mortality during the initial hospitalization, most of which was due to a decreased incidence of hepatorenal syndrome.[wikijournalclub.org]
    • This is felt due to reduction in the risk of developing hepatorenal syndrome.[qxmd.com]
    • Prednisolone 40mg p.o. daily (controversial, some benefit in subgroup with Maddrey 32) Ascites: Sodium restriction, diuretics Encephalopathy: Lactulose, rifaximin Hepatorenal syndrome: albumin, vasopressors Nutritional support Interpretation of Liver[ddxof.com]
    • We have experience of seven nonresponder patients (median age 49 years), with clinical evidence of SAH and type 1 hepatorenal syndrome, receiving a transjugular intrahepatic portosystemic shunt and then being successfully transplanted.[jrenhep.com]
    Leukocytosis
    • Leukocytosis with neutophilic predominance has been reported to correlates with degree of injury.[bloodjournal.org]
    • Common laboratory findings in alcoholic hepatitis Leukocytosis with shift to the left AST 2 to 3 times higher than ALT (ALT usually 100 IU/L) Increased serum bilirubin level; correlates with severity Prolonged prothrombin time; correlates with severity[euroliver.org]
    • The diagnosis of acute alcoholic hepatitis will be based on clinical features and testing including hepatomegaly, jaundice, fever, leukocytosis, compatible liver biochemistries in the context of heavy alcohol consumption.[clinicaltrials.gov]
    • Evaluation of Alcoholic Hepatitis: 1,2 Clinical features: Rapid onset jaundice Tender hepatomegaly Fever Ascites Proximal muscle loss Encephalopathy Labs: AST ALT (x2), generally 300IU/mL Leukocytosis Total serum bilirubin INR Creatinine associated with[ddxof.com]
    • Clinically there is jaundice and elevation of alkaline phosphatase but no fever or leukocytosis like in alcoholic hepatitis.[meddean.luc.edu]

    Etiology

    Excessive alcohol consumption causes alcoholic hepatitis. When the alcohol is broken down by the liver, it produces various toxic compounds that cause scarring of the liver tissues. This in turn causes the liver to swell giving rise to alcoholic hepatitis. In addition, other factors are also known to participate in causation of this liver disease. These include:

    • Genetic factors [2]
    • Live disorders like hepatitis C can pave way for development of alcoholic hepatitis.
    • Malnutrition
    • Acetaminophen intake [3]

    Epidemiology

    In the US, alcoholic hepatitis is known to affect about 2 million individuals. Women are more affected by this condition as compared to male, essentially because of the difference in the way body breaks down alcohol in both sexes. The incidence of alcoholic hepatitis strikes about 25 to 30% of the total population.

    Sex distribution
    Age distribution

    Pathophysiology

    The exact physiology behind the association of alcohol and liver disease is not completely understood. With the little information that is available; it can be postulated that the byproduct of alcohol breakdown produces toxic compounds such as acetaldehyde that is injurious to the liver. The toxicogenic components cause irreversible scaring of the liver tissues leading to inflammation of the organ. This further leads to destruction of the liver cells and gradually the healthy cells of the liver are replaced by knots or web-like scars. This eventually causes loss of liver functioning paving way for development of liver cirrhosis.

    Prevention

    The only way to prevent alcoholic hepatitis is to limit alcohol intake as far as possible [10]. It is also necessary to stay away from infectious diseases such as hepatitis C which increases chances of developing alcoholic hepatitis.

    Summary

    Alcoholic hepatitis is a condition characterized by inflammation of the liver due to excessive alcohol consumption [1]. Individuals who consume moderate to excess alcohol fall easy prey to this liver disease. It is necessary to avoid alcohol consumption once the disease has developed; failure to do so can cause serious life threatening complications. Malnutrition and malabsorption of nutrients contribute towards development of alcoholic hepatitis amongst the drinker’s population.

    Patient Information

    Definition

    Alcoholic hepatitis is a liver disease characterized by inflammation of the liver amongst the population who excessively drink alcohol, and have been doing so for several years. Once individuals develop this disease they are advised against alcohol consumption. Failure to adhere to this can cause liver cirrhosis, followed by coma and death.

    Cause

    Excessive alcohol consumption is the major factor contributing to alcoholic hepatitis. The breakdown of alcohol by the liver causes production of toxin compounds which are not eliminated from the body. Such series of events causes alcoholic hepatitis.

    Symptoms

    In mild cases of alcoholic hepatitis, the individuals usually experience no signs and symptoms. When the condition takes a severe turn, the symptoms include loss of appetite, undue fatigue, weight loss due to malnutrition, nausea accompanied by vomiting, fever, confusion, and jaundice, swelling in abdomen due to accumulation of fluid and abdominal pain

    Diagnosis

    Diagnosis of alcoholic hepatitis begins with a history of alcohol intake. An array of medical tests is ordered to diagnose the condition. These include blood tests to determine presence of anemia, liver function tests, CT scan and MRI of the liver and liver biopsy.

    Treatment

    The individuals are advised against alcohol intake to arrest further liver damage. Medications are employed to reduce liver inflammation and correct malnutrition. In addition, nutrient rich food along with nutrimental supplements should be provided. Efforts should be channelized to avoid alcohol intake and individuals should be constantly monitored in this aspect.

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    References

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    8. Vanbiervliet G, Le Breton F, Rosenthal-Allieri MA, Gelsi E, Marine-Barjoan E, Anty R, et al. serum C-reactive protein: A non-invasive marker of alcoholic hepatitis. Scand J Gastroenterol. Dec 2006; 41:1473-9.
    9. Immordino G, Gelli M, Ferrante R, et al. Alcohol abstinence and orthotopic liver transplantation in alcoholic liver cirrhosis. Transplant Proc. May 2009; 41(4):1253-5.
    10. O'Shea RS, Dasarathy S, McCullough AJ. Alcoholic liver disease. Hepatology. Jan 2010; 51(1):307-28.

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