12/12/2016

Alcoholic Hepatitis Clinical Presentation: History and Physical Examination, Complications

AlcoholicHepatitisClinicalPresentation
Updated:Dec27,2015
Author:DouglasMHeuman,MD,FACP,FACG,AGAFChiefEditor:BSAnand,MDmore...

PRESENTATION

HistoryandPhysicalExamination
Heavyalcoholuseisaprerequisiteforthedevelopmentofalcoholichepatitis.Thehistoryisusually
apparenthowever,insomepatients,alcoholusemaybecovert.
Cluestothepresenceofalcoholismincludeahistoryofmultiplemotorvehicleaccidents,convictions
fordrivingwhileintoxicated,andpoorinterpersonalrelationships.Alcoholismexhibitsagenetic
predisposition,andahistoryofalcoholisminacloserelativemayalsoindicatethatapatientisatrisk.

Presentation
Patientswithclinicallysymptomaticalcoholichepatitistypicallypresentwithnonspecificsymptomsof
nausea,malaise,andlowgradefever.Theclinicalpresentationmaybeprecipitatedbycomplications
ofimpairedliverfunctionorportalhypertension,suchasuppergastrointestinalhemorrhagefrom
esophagealvarices,confusionandlethargyfromhepaticencephalopathy,orincreasedabdominal
girthfromascites.
Apersonwhousesalcoholheavilymaycometomedicalattentionbecauseofanintercurrentmedical
illnessthatproducesalteredmentalstatusorpersistentvomiting,which,inturn,triggersalcohol
withdrawalsymptoms.Insuchinstances,theclinicianmustbealerttothepresenceofaprecipitating
illness(eg,subduralhematoma,acutepancreatitis,gastrointestinalhemorrhage)andtothelikelihood
ofalcoholwithdrawalsymptoms(eg,seizures,deliriumtremens)inadditiontotheproblems
associatedwithalcoholichepatitis.

2010AASLDscreeninganddiagnosticrecommendationsforALD
The2010AmericanAssociationfortheStudyofLiverDiseases(AASLD)alcoholicliverdisease(ALD)
practiceguidelineincludesthefollowingrecommendationsforscreeninganddiagnosis[3]:
Afterdiscussionofalcoholusewiththepatient,ifabuseorexcessuseissuspected,screenthe
patientforalcoholabuseusingastructuredquestionnairesuchastheAlcoholUseDisorders
IdentificationTest(AUDIT)
Ifthepatient'shistoryorascreeningtestispositiveforalcoholabuse,uselaboratorytestingto
verifythediagnosisofALDandruleoutotherconsiderations
IfALDispresent,examinethepatientforevidenceofotheralcoholrelatedorgandamage

Physicalexamination
Patientswithalcoholichepatitisarecommonlyfebrilewithtachycardia.Mildtachypneawithprimary
respiratoryalkalosismaybeobserved.Theliverisusuallyenlarged,oftenwithmildhepatic
tenderness.Hepatomegalyresultsfrombothsteatosisandswellingofinjuredhepatocytes.
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12/12/2016

Alcoholic Hepatitis Clinical Presentation: History and Physical Examination, Complications

Manifestationsofhepaticfailureorportalhypertensionmayincludescleralicteruswithdarkeningof
theurine,splenomegaly,asterixis(aflappingtremorcharacteristicofmetabolicencephalopathies),
peripheraledema,andbulgingflankswithshiftingabdominaldullness(indicatingthepresenceof
ascites).
Spiderangiomata,proximalmusclewasting,alteredhairdistribution,andgynecomastiamaybe
observed,althoughthesefindingsmostcommonlyreflectcoexistentcirrhosis.

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Alcoholic Hepatitis Clinical Presentation: History and Physical Examination, Complications

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