Patients discharged on corticosteroids require very careful coordination with outpatient providers as prolonged corticosteroid treatment courses can lead to serious complications and death. Critics of corticosteroid therapy in these patients often cite problems related to prolonged steroid use, especially in patients who do not respond to therapy.
Pentoxifylline, an oral phosphodiesterase inhibitor, is recommended by the ACG, especially if corticosteroids are contraindicated. This study demonstrated that patients who received pentoxifylline had decreased day mortality One small, randomized trial comparing pentoxifylline with prednisolone demonstrated that pentoxifylline was superior.
The recommended dose is mg orally three times daily TID for four weeks. Common side effects are nausea and vomiting. Pentoxifylline cannot be administered by nasogastric tubes and should not be used in patients with recent cerebral or retinal hemorrhage. Other therapies. Several studies have examined vitamin E, N-acetylcystine, and other antioxidants as treatment for alcoholic hepatitis. No clear benefit has been demonstrated for any of these drugs. Tumor necrosis factor TNF -alpha inhibitors e.
Patients are not usually considered for liver transplantation until they have at least six months of abstinence from alcohol as recommended by the American Society of Transplantation. Discharge considerations. No clinical trials have studied optimal timing of discharge. Careful outpatient follow-up and assistance with continued abstinence is very important. The patient fits the typical clinical picture of alcoholic hepatitis.
Cessation of alcohol consumption is the most important treatment and is accomplished by admission to the hospital. Because of his daily alcohol consumption, folate, thiamine, multivitamins, and oral vitamin K are ordered. Though he has no symptoms of alcohol withdrawal, a note is added about potential withdrawal to the handoff report. An infectious workup is completed by ordering blood and urine cultures, a chest X-ray, and performing paracentesis to exclude spontaneous bacterial peritonitis.
A dietary consult with calorie count is given, along with a plan to discuss with the patient the importance of consuming at least 2, calories a day is made.
Tube feedings will be considered if the patient does not meet this goal in 48 hours. If he is actively bleeding or infected, pentoxifylline mg TID for 28 days is favored due to its lower-side-effect profile. Due to the severity of his illness, a gastroenterology consultation is recommended. Alcoholic hepatitis is a serious disease with significant short-term mortality.
Show references AskMayoExpert. Alcoholic liver disease adult. Mayo Clinic; Friedman SL. Alcoholic hepatitis: Clinical manifestations and diagnosis. Accessed Oct. Alcohol-related liver disease. American Liver Foundation. What is a standard drink? National Institute on Alcohol Abuse and Alcoholism. Mellinger JL, et al. Transplantation for alcohol-related liver disease: Is it fair?
Alcohol and Alcoholism. Lee BP, et al. Early liver transplantation for severe alcoholic hepatitis: Moving from controversy to consensus. Current Opinion in Organ Transplantation. Weeks SR, et al. Liver transplantation for severe alcoholic hepatitis, updated lessons from the world's largest series. For this test, a small tissue sample is taken from the liver with a needle or during surgery. These samples are checked under a microscope to find out the type of liver disease.
You will need to stop drinking alcohol. To do thi, you may need to be in an alcohol treatment program. Sometimes you may also need to change your diet. Scarring of the liver is permanent. But the liver is often able to repair some of the damage caused by alcohol so you can live a normal life. You may be admitted to the hospital or treated on an outpatient basis.
There is no medicine to cure alcoholic hepatitis. Treatment involves easing the symptoms and keeping the disease from getting worse. Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.
Many people with alcoholic hepatitis are infected with the hepatitis C virus, and many have gallstones. They are also at increased risk for liver cancer. If you continue to drink alcohol, the liver will continue to be damaged. Over time, cirrhosis will develop. Health Home Conditions and Diseases Hepatitis. Hepatitis is inflammation of the liver that leads to liver cell damage and cell death.
What causes alcoholic hepatitis? Alcoholic hepatitis is caused by drinking too much alcohol. The liver breaks down alcohol. Over time, if you drink more alcohol than the liver can process, it can become seriously damaged.
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