Severe Alcoholic Hepatitis Lecture

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Fifty vocabulary flashcards covering signs, laboratory findings, scoring, pharmacologic treatments, dosing, contraindications, and adverse effects related to severe alcoholic hepatitis.

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50 Terms

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Jaundice

Yellow discoloration of skin and sclera that can appear within three months in alcoholic hepatitis patients.

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Anorexia

Loss of appetite commonly reported as a symptom of alcoholic hepatitis.

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Fever

Elevated body temperature that may accompany acute alcoholic hepatitis episodes.

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Right upper-quadrant abdominal pain

Pain over the liver area typical of alcoholic hepatitis presentations.

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Abdominal distension

Visible swelling of the abdomen, often caused by fluid accumulation in liver disease.

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Ascites

Pathologic buildup of peritoneal fluid leading to abdominal distension in advanced liver disease.

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Proximal muscle weakness

Loss of strength in shoulder or hip girdle muscles due to wasting in chronic liver illness.

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AST (Aspartate Aminotransferase)

Liver enzyme that rises moderately in alcoholic hepatitis.

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ALT (Alanine Aminotransferase)

Liver enzyme elevated alongside AST but usually to a lesser extent in alcoholic hepatitis.

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AST/ALT ratio >1

Laboratory pattern highly suggestive of alcoholic liver injury.

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Serum bilirubin

Blood pigment that becomes elevated in alcoholic hepatitis, contributing to jaundice.

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Gamma-glutamyl transferase (GGT)

Cholestatic enzyme elevated in many patients with alcoholic hepatitis.

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INR (International Normalized Ratio)

Coagulation test that prolongs when liver synthetic function is impaired.

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Neutrophilic leukocytosis

Increase in white blood cells with neutrophil predominance seen on labs for alcoholic hepatitis.

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Maddrey Discriminant Function (MDF)

Scoring system that predicts short-term mortality in alcoholic hepatitis.

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MDF score >32

Value indicating high early mortality and the need for consideration of glucocorticoid therapy.

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MDF score <32

Value signifying low early mortality; patients usually managed with supportive care alone.

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Severe alcoholic hepatitis

Clinical entity defined by MDF >32 or hepatic encephalopathy requiring pharmacologic treatment.

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Glucocorticoids

First-line anti-inflammatory drugs for severe alcoholic hepatitis; suppress cytotoxic pathways.

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Pentoxifylline

Oral drug that inhibits TNF synthesis, used when steroids are contraindicated in alcoholic hepatitis.

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Beta-blockers discontinuation

Recommendation to stop these agents because they heighten acute kidney injury risk in severe alcoholic hepatitis.

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Prednisolone

Preferred oral glucocorticoid that does not require hepatic activation.

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Prednisone

Glucocorticoid prodrug requiring liver conversion, therefore avoided in alcoholic hepatitis.

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Methylprednisolone

Intravenous glucocorticoid alternative for patients unable to take oral medication.

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Prednisolone 40 mg daily

Standard oral dose given for 28 days in patients with MDF >32 or encephalopathy.

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Methylprednisolone 32 mg IV daily

Equivalent daily intravenous dose for severe alcoholic hepatitis therapy.

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28-day treatment course

Recommended duration for glucocorticoid or pentoxifylline therapy in severe alcoholic hepatitis.

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Prednisolone taper

Gradual dose reduction schedule to prevent adrenal crisis after a full steroid course.

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HPA axis suppression

Decreased endogenous steroid production caused by prolonged glucocorticoid use.

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Contraindication: infection/sepsis

Active systemic infection that precludes glucocorticoid therapy.

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Contraindication: gastrointestinal bleed

Recent or ongoing GI hemorrhage that disallows steroid use.

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Contraindication: renal insufficiency (<30)

Severe kidney dysfunction that makes glucocorticoid therapy unsafe.

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Emotional lability

Rapid mood swings that can occur as a side effect of prednisolone.

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Skin atrophy

Thinning and fragility of skin resulting from prolonged steroid exposure.

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Osteoporosis

Loss of bone density enhanced by chronic glucocorticoid therapy.

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Diabetes

Steroid-induced or worsened hyperglycemia associated with prednisolone use.

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Insomnia

Difficulty sleeping frequently reported with systemic steroid therapy.

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Weight gain

Increase in body weight due to fluid retention and appetite stimulation by steroids.

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Prednisolone adverse effects

Collective term for emotional lability, infection risk, osteoporosis, diabetes, insomnia, and weight gain.

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Pentoxifylline mechanism

Inhibition of tumor necrosis factor (TNF) synthesis, reducing inflammation in alcoholic hepatitis.

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Pentoxifylline 400 mg TID

Standard dosing of pentoxifylline three times daily for 28 days.

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No taper needed

Instruction that pentoxifylline can be discontinued abruptly after completing therapy.

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ICAM-1 reduction

Glucocorticoid action that lowers leukocyte adhesion in hepatic sinusoids, dampening inflammation.

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Tumor necrosis factor (TNF)

Pro-inflammatory cytokine elevated in alcoholic hepatitis and targeted by pentoxifylline.

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Acute kidney injury risk

Potential renal complication intensified by beta-blocker use in severe alcoholic hepatitis.

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Glucocorticoid contraindications

Conditions such as sepsis, GI bleed, or renal failure that prohibit steroid use.

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Hepatic encephalopathy

Neuropsychiatric manifestation of liver failure qualifying a patient for steroid therapy.

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Intravenous route

Method of administration for methylprednisolone when oral intake is not feasible.

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Short-term mortality

Early death risk predicted by high MDF scores in alcoholic hepatitis.

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Supportive measures

Basic care—nutrition, abstinence, monitoring—used when MDF is below 32.