- progressive jaundice
- weight loss
- nausea and vomiting
- abdominal pain
- AST typically 2-6x upper limit of normal
- AST/ALT ratio >2
- bilirubin frequently raised
- screen for HBV, HCV, HIV
- abdominal US to exclude other causes of jaundice
- consider transjugular liver biopsy
>32 indicates poor outcome.
- prednisolone 40mg OD
- or pentoxifylline (a phosphodiesterase inhibitor and TNF alpha inhibitor) 400mg TDS if patient septic
- ? enteral feeding
- ? n-acetylcysteine in patients with severe disease receiving steroids
- careful monitoring of renal function
- careful watching for infection and prompt treatment if present
- GI bleeds requiring transfusion occur in around 20%
- encephalopathy occurs in around 20%
- hepatorenal syndrome
Amini, M. and Runynon, B. Alcoholic hepatitis 2010: A clinicians guide to diagnosis and therapy. World J Gastroenterol. 2010; 16(39): 4905-4912.
European Association for the Study of the Liver. EASL Clinical Practical Guidelines: Management of alcoholic liver disease. J Hepatology. 2012. 57: 399-420.
Menachery, J. and Duseja, A. Treatment of decompensated alcoholic liver disease. Int J Hepatol. Epub 2011; Jul 12.