alcoholic hepatitis

Level of alcohol induced liver disease: steatosis, steatohepatitis, severe steatohepatitis (alcoholic hepatitis)
ANI index can be used to determine whether alcoholic or nonalcoholic liver disease: https://www.mayoclinic.org/medical-professionals/transplant-medicine/calculators/the-alcoholic-liver-disease-nonalcoholic-fatty-liver-disease-index-ani/itt-20434726

Symptoms

Labs: mildly elevated AST:ALT ratio > 2, high GGT, high INR, thrombocytopenia, elevated MCV
clinical diagnosis: evidence of porrtal HTN with hx of consistent alcohol intake
US or CT: steatosis, cirrhosis, portal hypertension
Severity determined by Maddrey score: MDF score = 4.6 (prothrombin time – control prothrombin time) + total bilirubin (mg/dL)
Can also use MELD score > 20 = moderate/severe disease
Score of 32 or greater or hepatic encephalopathy defined as severe cases

Nonsevere, MDF < 32: supportive, no prednisolone
thiamine, alcohol treatment
Pentoxifylline not effective, do not use
Severe: prednisolone (STOPAH trial showing improved 28 day mortality)
- CI includes active infection, UGIB, AKI, HCV/HBV, multiorgan failure
Assess response on day 7 with Lille score, discontinue if no response >0.45
Lille score less than 0.45: continue prednisolone for 28 days

Alcohol abstinence can result in significant stabilization of liver function and reversal of portal hypertension.
Liver transplantation is reserved for appropriate candidates who are at low risk for alcohol relapse.

not quite acute liver failure yet
hx of alcohol use + more recent heavy alcohol
may have ascites 2/2 underlying liver disease
look for lab findings
cholestatic picture. High bili, low transaminases
rule out other causes of ALF: viral panel, anti smooth muscle, autoimmune hepatitis