Short breif of ALD specific on Alcohol Hepatitis.

3. Introduction
• Definition
• Alcoholic Hepatitis is an inflammation of the liver that leads to liver cell damage and cell
death. inflammation of the liver that leads to liver cell damage and cell death cause by the
over intake of alcohol.
• Alcoholic hepatitis is often viewed as the intermediary step between fatty liver and
cirrhosis.

4. Introduction – Risk Factors
• Risk factor of alcoholic hepatitis are include:
• History of chronic heavy alcohol use
• Cigarette smoking
• Genetic predisposition
• Female Sex
• Obesity

6. Diagnosis
• Alcoholic Hepatitis investigation are based on:
• History taking + Clinical Presentation
• Laboratory findings
• Ultrasonography
• Liver biopsy

7. Diagnosis – History Taking & Clinical
Presentation
• History taking: History of Prolong Alcohol abuse.
• Male: > 60g alcohol per day
• Female: >40g alcohol per day
• Clinical Presentation:
• Ranges from mild to severe.
• A mild clinical presentation would be a patient presenting with fever, tremor, hepatagia
• A severe presentation would include jaundice, ascites, hepatic encephalopathy, and coagulopathy.
• Physical Examination may show tachycardia, tachypnea, fever, enlarged liver, and
signs of portal hypertension.

8. Diagnosis - Laboratory findings
• Liver function tests:
• Increase Transaminase :
• AST > 50 IU/L
• ALT > 30 IU/L
• Both AST and ALT: <400IU/L
• AST/ALT Ratio > 1.5
• Bilirubin > 3mg/dl
• Increased Alkaline phosphatase ( variable )
• Haematological
• WBC > 12,000
• Mild Anaemia ( Usually Marcrocytic )
• Thrombocytopenia

9. Diagnosis – Ultrasonography Finding
• The liver appears enlarged and diffusely hyperechoic.
• Helpful in excluding gallstones, bile duct obstruction and hepatic or biliary
neoplasm.
• Preferred study as inexpensive, noninvasive and widely avalible

10. Diagnosis – Liver Biopsy
• Accurate assessment of severity of liver damage
• Consider in patients in whom diagnosis is uncertain

11. Management
• For Mild patient:
• Patient Education
• Manage Alcoholic withdrawal Symptoms
• Multivitamin
• Bed rest
• High protein diet

12. Management – Medical Treatments
• For moderate to servere:
• Corticosteroids
• Acetylcysteine
• Nutritional Supports

13. Prognosis
• Patients with poor prognosis of Alcoholic Hepatitis include:
• Older Age
• Impaired Renal Function
• Encephalopathy
• Rise in the white blood cell count in the first 2 weeks of hospitalization
• Nearly 2/3 of patients with severe alcoholic hepatitis will die in hospital.

14. Reference
• Amboss – Alcoholic Hepatitis
• Amboss – Alcoholic Withdrawal Syndrome
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197869/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/
• https://emedicine.medscape.com/article/170539-overview?form=fpf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524956/