Alcohol Associated Hepatitis (Alcoholic hepatitis)

Top tips:

  1. Rule out infection and additional causes of jaundice in all patients with suspected alcohol associated hepatitis
  2. Severe alcohol associated hepatitis is most easily diagnosed by a MELD >20 (this is the original MELD calculation, not the MELD-Na)
  3. Need to consider the management of alcohol withdrawal, nutritional therapy as well as the treatment of alcohol use disorder alongside the treatment of alcohol associated hepatitis
  4. Use the Lille model at 7 days to determine if the patient is a non-responder to steroid therapy (Lille ≥ 0.45)
  5. Using very strict criteria, the Alberta transplant program is now evaluating some patients with alcohol associated hepatitis for liver transplantation.

Order panel for Alcohol associated hepatitis:

For adults admitted with Alcohol associated hepatitis.
Alcohol Associated Hepatitis Order Panel

General Cirrhosis Admission and Discharge Order Sets

*Add specific panels to general admission orders as appropriate*

For adults with cirrhosis requiring hospital admission
Cirrhosis Adult Admission Orders

For adults with cirrhosis requiring hospital discharge
Cirrhosis Adult Discharge Orders

Check out the bottom of the page for short videos from Dr. Borman!

Diagnosis

General Management

Specific Management

Introducing Dr. Borman

Video 1 - Top things you need to know in hospital

Coming soon!

Video 2 - What to be aware of as a family physician 

Coming soon!

Patient materials:

You can direct patients to the following:
Alcohol

211.ca

AHS Help in Tough Times

Calculators:

Use these calculators to help with the diagnosis:

lillescoreINR

www.alchepscores.com

original MELD score

Downloadable content:

You can download these to print or view offline:
AASLD guidance statement 2019

References:

This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.

Authors: Dr. Meredith Borman, Dr. Monty Ghosh, Dr. Puneeta Tandon

References:

  1. Crabb DW et al. Diagnosis and Treatment of Alcohol-Related Liver Diseases: 2019 Practice Guidance from the American Association for the Study of Liver Diseases. Hepatology 2019 July 17 epub ahead of print, PMID 31314133
  2. Singal AK et al. ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol 2018 Feb;113(2):175-194 PMID 29336434
  3. Nguyen-Khac N et al. Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. N Engl J Med 2011 Nov; 365(19):1781-9 PMID 22070475
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