Topic Highlight
Copyright copy;2010 Baishideng Publishing Group Co.
World J Gastroenterol. Oct 21, 2010; 16(39): 4905-4912
Published online Oct 21, 2010. doi: 10.3748/wjg.v16.i39.4905
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]
Nausea and vomiting34-55
Abdominal pain27-46
Weight loss29-43
Physical Examination Findings
Encephalopathy (from asterixis to coma)18-23
Gastrointestinal bleeding requiring transfusion23
Hepatic bruit59
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
DoseOxandrolone 40 mg orally daily
Duration of therapy30 d maximum
Circumstances for useMaddrey score ≥ 80 on admission
No improvement in Maddrey score or MELD after 10-14 d of pentoxifylline