Description
Management of alcoholic hepatitis involves a comprehensive approach aimed at halting disease progression, managing symptoms, and promoting liver recovery. The cornerstone of treatment involves complete alcohol cessation to prevent further liver damage and promote healing. Patients often have malnutrition, so nutritional therapy with a focus on adequate protein intake and vitamin supplementation is crucial. Corticosteroids like prednisolone may be prescribed in severe cases to reduce liver inflammation and improve survival rates. In severe cases unresponsive to medical therapy, liver transplantation may be considered, although strict criteria must be met. Diuretics may be used cautiously to manage ascites while monitoring for renal function. Prophylactic measures such as beta-blockers may be used to reduce the risk of variceal bleeding.
Résumé
- Alcoholic liver disease (ALD) is a significant cause of liver-related deaths. A standard drink contains 10 grams of alcohol. Heavy episodic or binge drinking poses a higher risk of liver damage than regular moderate consumption. The DSM-5 criteria for alcohol use disorder (AUD) involves assessing various factors such as alcohol intake, cravings, and the impact of alcohol on social life and health.
- Diagnosis of ALD involves evaluating alcohol consumption history along with clinical and biological abnormalities suggestive of liver impairment. Specific criteria include harmful alcohol use, signs of liver disease, elevated transaminase levels (AST/ALT), and the exclusion of other liver diseases. A key indicator in alcoholic hepatitis is an AST/ALT ratio greater than one, due to alcohol's mitochondrial toxicity and its effect on vitamin B6 metabolism.
- Screening for ALD includes liver function tests (LFTs), ultrasound, tests to rule out other liver diseases, and assessment of synthetic liver function through INR/PT. Endoscopy may be needed if platelet count is low or fibrosis scan score is high. Liver biopsy can be useful, especially in cases with confounding factors like diabetes, to determine the main cause of liver injury.
- Non-invasive markers like FIB-4, ELF score, transient elastography (FibroScan), and MR elastography are used to assess liver fibrosis. Symptomatic alcoholic hepatitis is diagnosed by jaundice, recent alcohol consumption, elevated bilirubin, elevated AST and ALT (AST/ALT ratio >1.5:1), and exclusion of other liver conditions. Prognostic scoring systems include Maddrey's Discriminant Function (MDF), MELD score, and Glasgow Alcoholic Hepatitis Score.
- Treatment for alcoholic hepatitis depends on the severity. Moderate cases may involve enrollment in clinical trials, while severe cases (MDF > 32 or MELD > 20) may be eligible for glucocorticoids. Abstinence from alcohol is crucial for all ALD patients and should be emphasized through repeated counseling.
Exemple de certificat
À propos des intervenants
Dr Sriram Srikakulapu
Médecin consultant en gastroentérologie, hôpitaux Yashoda, Hyderabad
Divulgation financière
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