Alcoholic hepatitis 2010: A clinician’s guide to diagnosis and therapy

Table 1 Questions to ask patients with suspected alcoholic hepatitis

When did you first start to drink alcohol?

How many days per week do you usually drink?

How many years have you been drinking on a regular or daily basis?

How many times have you been arrested for driving under the influence of alcohol?

How many times have you been arrested for public intoxication?

What type of alcohol do you usually drink? Beer? Wine? Hard liquor?

How many drinks of each type of alcohol do you drink on an average day?

Do you usually drink at home? Bars?

Have you been through an alcohol rehabilitation program? What type-inpatient or outpatient? How many times?

Have there been prolonged times when you drank no alcohol?

When was your last drink?

Table 2 Symptoms and signs of alcoholic hepatitis

	%
Common Presenting Symptoms of Alcoholic Hepatitis[10-13]
Anorexia	27-77
Nausea and vomiting	34-55
Abdominal pain	27-46
Weight loss	29-43
Physical Examination Findings
Hepatomegaly	71-81
Ascites	35
Encephalopathy (from asterixis to coma)	18-23
Gastrointestinal bleeding requiring transfusion	23
Jaundice	37-100
Malnutrition	56-90
Hepatic bruit	59

Table 3 International ascites club criteria for hepatorenal syndrome[37]

Cirrhosis with ascites

Serum creatinine > 1.5 mg/dL (> 133 μmol/L)

No improvement in serum creatinine (< 1.5 mg/dL) after at least 2 d with diuretic withdrawal, and volume expansion with intravenous albumin. The recommended dose is 1 g/kg of body weight per day up to a maximum of 100 g/d

Absence of shock

No current or recent treatment with nephrotoxic drugs

Absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/d, microhematuria (> 50 red blood cells per high power field) and/or abnormal renal ultrasonography

Table 4 Use of oxandrolone for alcoholic hepatitis

Dose	Oxandrolone 40 mg orally daily
Duration of therapy	30 d maximum
Circumstances for use	Maddrey score ≥ 80 on admission
	No improvement in Maddrey score or MELD after 10-14 d of pentoxifylline

MELD: Model for end-stage liver disease.