Alcoholic hepatitis
Download
1 / 27

Alcoholic hepatitis - PowerPoint PPT Presentation


  • 314 Views
  • Uploaded on

Alcoholic hepatitis. How is Alcoholic hepatitis diagnosed?. History of recent excessive alcohol ingestion Serum bilirubin more than 80umol/l ALT <300 IU (or AST<500 IU) Exclusion of autoimmune, chronic viral or malignant liver disease.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Alcoholic hepatitis' - kiet


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

How is alcoholic hepatitis diagnosed
How is Alcoholic hepatitis diagnosed?

  • History of recent excessive alcohol ingestion

  • Serum bilirubin more than 80umol/l

  • ALT <300 IU (or AST<500 IU)

  • Exclusion of autoimmune, chronic viral or malignant liver disease


Characteristic features of alcoholic hepatitis but not necessary for diagnosis
Characteristic features of alcoholic hepatitis (but not necessary for diagnosis)

  • Pyrexia,

  • Hepatomegaly,

  • A hepatic bruit,

  • Ascites,

  • Encephalopathy,

  • AST: ALT ratio greater than 1.5,

  • Peripheral leucocytosis.


How accurate is a clinical diagnosis of alcoholic hepatitis
How accurate is a clinical diagnosis of Alcoholic hepatitis? necessary for diagnosis)

  • An accuracy of about 80% has been quoted for the clinical diagnosis of alcoholic hepatitis when compared with histology.



  • Approximately 50-60% will also have established cirrhosis. the prognosis or treatment?

  • There is no evidence that co-existing cirrhosis worsens the short term outcome of patients with alcoholic hepatitis, indicating that it is the acute inflammatory process which is primarily responsible for the poor prognosis of these patients.








  • mDF should be used in patients with severe alcoholic hepatitis in whom the diagnosis is certain. Severity is defined as a DF> 32 and/or hepatic encephalopathy > 32 and/or hepatic encephalopathy was associated with a 65% 28-day survival

  • <32 had a survival of 93%.


  • Patients with mDF should be used in patients with severe alcoholic hepatitis in whom the diagnosis is certain. Severity is defined as a DF> 32 and/or hepatic encephalopathy >32 and treated with steroids had a 28 day survival of 84.6% compared with 65.1% for placebo treated patients.



What is the steroid dose and duration
What is the steroid dose and duration? in patients with severe alcoholic hepatitis who also have

  • Prednisolone 40 mg daily for four weeks followed by a taper.

  • Careful monitoring for evidence of infection, gastrointestinal bleeding, glucose intolerance, or renal failure is essential while the patient is on prednisolone therapy.


How do you assess response
How do you assess response? in patients with severe alcoholic hepatitis who also have

  • Any fall in serum bilirubin after one week of corticosteroid treatment is indicative of treatment response and good prognosis.




  • What is GAHS? sepsis and a low threshold for the use of antibiotics is required.


Criticism of mdf
Criticism of mDF sepsis and a low threshold for the use of antibiotics is required.

  • mDF relies on the absolute value of the PT

  • The presence of encephalopathy has often been included when making a treatment decision, in addition to just calculating the mDF.

  • mDF was highly sensitive in the prediction of death from alcoholic hepatitis but lacked specificity. This was dramatic as it incorrectly predicted the outcome at 28 days after admission in 51% of cases.

  • They also suggests that even with a mDF greater than or equal to 32, patients with a GAHS less than nine do not benefit from such treatment.




  • One hundred one patients with severe alcoholic hepatitis (Maddrey discriminant factor > or = 32) entered a 4-week double-blind randomized trial of PTX (400 mg orally 3 times daily) vs. placebo

    Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial". Gastroenterology119 (6): 1637–48



Summary
Summary (46.1%) of the 52 patients who received placebo died during the index hospitalization (P = 0.037; relative risk, 0.59; 95% confidence interval, 0.35-0.97).

  • Non cirrhotic vs cirrhotic

  • Typical blood test

  • Assess severity

  • Treatment with steroid and pentoxyphylline

  • Nutrition and alcohol detox


ad