Alcoholic Hepatitis

Too Much

Step 1: View clinicals

A 45 year old man presents with fever, jaundice, abdominal distention, and anorexia for 4 days. He is a heavy drinker, having consumed half a bottle of whiskey almost every day, for over a decade. There is no history of blood transfusions, recreational drug use, or unsafe sexual contact. His medical and surgical histories are unremarkable.


Step 2: Order all relevant investigations

Complete Blood Count

WBC/DC: 11,200/mm3 (4,600-11,000) N: 70% L: 25% Hb: 11 g/dL (11-18) Platelets: 180,000/mm3 (150,000-450,000)

Liver Profile

ALT: 28 IU/L (7-47) AST: 132 IU/L (10-40) ALP: 238 IU/L (44-147) INR: 1.58 (0.9-1.1) PT (Test): 19 sec PT (Control): 12 sec Total Bilirubin: 7 mg/dL (0.3-1.9)

Diagnostic Paracentesis

WBC/DC: 20/mm3 PMN: 70% Gram stain: Negative Cytology: No malignant cells Amylase: 30 U/l (Serum Amylase: 64 U/l) Serum Ascites Albumin Gradient: 2.0 mg/dl (transudative)

Liver Biopsy

You realize that a liver biopsy is not indicated right now.


Step 3: Select appropriate management

Benzodiazepines
Corticosteroids
Pentoxifylline
Cessation of Drinking stat


Score: ★★☆