Alcoholic hepatitis

Clinical Manifestations

• Occurs in middle-aged patients with heavy daily alcohol use
• They often stop drinking as a result of symptoms, sometimes for 2-3 weeks prior to presentation
• Present with jaundice and malaise, with or without anorexia, fever, and right upper quadrant pain or tenderness
• Bloodwork shows increased ALT (usually less than 500)
  • ALT usually less than AST, in contrast to other causes of hepatitis

Management

• Supportive care including management for alcohol withdrawal, hydration, nutritional support
• Calculate Maddrey discriminant function
• Consider glucocorticoids for Maddrey of 32 or higher
  • Prednisolone 40 mg p.o. daily, preferred over prednisone
  • Methylprednisolone 32 mg IV daily, as alternative
  • Duration is 28 days followed by a 16 day taper (decrease by 10 mg every 4 days until 10 mg, then by 5 mg every 3 days)
  • Stopped early if no biochemical response within the first week (either Maddrey score or bilirubin)
• For those who have an indication for glucocorticoids but who cannot receive them, pentoxifylline 400 mg p.o. tid1