词条 | Alcoholic hepatitis |
释义 |
| name = Alcoholic hepatitis | synonyms = | image = Mallory body high mag cropped.jpg | caption = Micrograph showing a Mallory body, a histopathologic finding associated with alcoholic hepatitis. H&E stain. | field = Gastroenterology | pronounce = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} Alcoholic hepatitis is hepatitis (inflammation of the liver) due to excessive intake of alcohol.[1] It is usually found in association with fatty liver, an early stage of alcoholic liver disease, and may contribute to the progression of fibrosis, leading to cirrhosis. Signs and symptoms of alcoholic hepatitis include jaundice, ascites (fluid accumulation in the abdominal cavity), fatigue and hepatic encephalopathy (brain dysfunction due to liver failure). Mild cases are self-limiting, but severe cases have a high risk of death. Severe cases may be treated with glucocorticoids. Signs and symptomsAlcoholic hepatitis is characterized by a myriad of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen (ascites), and modest elevation of liver enzyme levels (as determined by liver function tests). Alcoholic hepatitis can vary from mild with only liver enzyme elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and even liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both severe categories is 50% within 30 days of onset. Alcoholic hepatitis is distinct from cirrhosis caused by long-term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Some alcoholics develop acute hepatitis as an inflammatory reaction to the cells affected by fatty change. This is not directly related to the dose of alcohol. Some people seem more prone to this reaction than others. This is called alcoholic steatonecrosis and the inflammation probably predisposes to liver fibrosis. PathophysiologySome signs and pathological changes in liver histology include:
If chronic liver disease is also present:
DiagnosisThe diagnosis is made in a patient with history of significant alcohol intake who develops worsening liver function tests, including elevated bilirubin and aminotransferases. The ratio of aspartate aminotransferase to alanine aminotransferase is usually 2 or more.[3] In most cases, the liver enzymes do not exceed 500. The changes on liver biopsy are important in confirming a clinical diagnosis. ManagementClinical practice guidelines have recommended corticosteroids.[4] People should be risk stratified using a MELD Score or Child-Pugh score.
See also
References1. ^{{Cite web|url=https://medlineplus.gov/ency/article/000281.htm|title=Alcoholic liver disease: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=2017-01-02}} 2. ^1 2 {{cite book | title=Robbins Pathologic Basis of Disease| last=Cotran|author2=Kumar, Collins| publisher=W.B Saunders Company| location=Philadelphia| isbn=0-7216-7335-X | year=1998}} 3. ^{{cite journal |vauthors=Sorbi D, Boynton J, Lindor KD |title=The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease |journal=Am. J. Gastroenterol. |volume=94 |issue=4 |pages=1018–22 |year=1999 |pmid=10201476|doi=10.1111/j.1572-0241.1999.01006.x}} 4. ^1 {{cite journal |vauthors=McCullough AJ, O'Connor JF |title=Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology |journal=Am. J. Gastroenterol. |volume=93 |issue=11 |pages=2022–36 |year=1998 |pmid=9820369|doi=10.1111/j.1572-0241.1998.00587.x}} 5. ^{{cite journal |vauthors=Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O |title=Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial |journal=Gastroenterology |volume=119 |issue=6 |pages=1637–48 |year=2000 |pmid=11113085 |doi=10.1053/gast.2000.20189 }} (ACP Journal Club synopsis) 6. ^{{cite journal |vauthors=De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P |title=Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial |journal=World J. Gastroenterol. |volume=15 |issue=13 |pages=1613–9 |year=2009 |pmid=19340904 |pmc=2669113 |doi= |url=http://www.wjgnet.com/1007-9327/full/v15/i13/1613.htm}} 7. ^{{cite journal |vauthors=Thursz MR, Richardson P, Allison M, Austin A, Bowers M, Day CP, Downs N, Gleeson D, MacGilchrist A, Grant A, Hood S, Masson S, McCune A, Mellor J, O'Grady J, Patch D, Ratcliffe I, Roderick P, Stanton L, Vergis N, Wright M, Ryder S, Forrest EH |title=Prednisolone or pentoxifylline for alcoholic hepatitis |journal=N. Engl. J. Med. |volume=372 |issue=17 |pages=1619–28 |year=2015 |pmid=25901427 |doi=10.1056/NEJMoa1412278 |url=}} External links{{Medical resources| DiseasesDB = | ICD10 = {{ICD10|K|70|1|k|70}} | ICD9 = {{ICD9|571.1}} | ICDO = | OMIM = | MedlinePlus = 000281 | eMedicineSubj = | eMedicineTopic = 101 | MeshID = D006519 }}{{Gastroenterology}}{{alcohealth}}{{DEFAULTSORT:Alcoholic Hepatitis}} 4 : Hepatitis|Inflammations|Alcohol abuse|Health effects of alcohol |
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