Acute Alcoholic Hepatitis

Case: A 45-year-old woman has come to see you because she has been vomiting for several days and her husband thinks her
eyes look slightly yellow.

Task
a. Relevant history
b. Examiner for relevant physical findings and results of relevant investigation
c. Explain to the patient what you think is the diagnosis and your planned management

DIFFERENTIAL for causes of hepatocellular damage

- Hepatitis A/B
- Liver
- Infections
- Alcoholic hepatitis
- Drugs

History
- When did the vomiting start? Jaundice? Any previous episodes? Change in urine or bowel? Anorexia, sore throat,
weight loss or pruritus? Fever? History of travel outside australia? Vaccination? Abdominal pain? Contact with patients
with hepatitis or jaundice? Exposure to blood or blood products? Needle-stick injuries? Dietary history? Sexual history?
Drug history?
- PMHx/SADMA?

Physical Examination
- General appearance: jaundice, dehydration, BMI
- VS: stable
- Skin: needle marks
- ENT: sclera or under the tongue
- Chest and Heart
- Abdomen: mass, pulsations, liver span, tenderness, organomegaly

Investigations (AST>ALT alcoholic hepatitis rather than viral or drug-induced)

- Bilirubin 61 mmol/L (<20)
- AST 982 IU (<40)
- ALT 695 IU (<40)
- ALP 155 IU (<120)
- Total protein 51 g/L (50-65)
- Albumin 22 g/L (25-35)

Most common causes of jaundice in order: viral hepatitis, gallstones, pancreatic cancer, cirrhosis, pancreatitis and drugs

Always take full travel, drug, and hepatitis contact history in patients with jaundice