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Showing posts with the label Hepatology

Alcoholic liver disease

 INTRODUCTION  Chronic and excessive use of alcohol is one of the major causes of liver disease. 90% of daily heavy drinkers (>60 g alcohol/day) as well as binge drinkers have fatty liver but a smaller percentage (10-35%) of drinkers progress to alcoholic hepatitis which is a precursor for cirrhosis. The long-term risk is 9 times higher in patients with alcoholic hepatitis compared to those with fatty liver alone. Some population-based surveys have documented that men must drink 40 to 80 g of alcohol daily and women must drink 20 to 40 g daily for 10 to 12 years to achieve a significant risk of liver disease. Liver pathology consists of  3 major lesions  that are progressive and rarely exist in a pure form: 1) fatty liver (usually reverses quickly with abstinence), 2) alcoholic hepatitis and 3) cirrhosis. Prognosis of severe alcoholic liver disease (ALD) is bad. Mortality of patients with alcoholic hepatitis concurrent with cirrhosis id nearly 60% at 4 years. Alt

Prognostic scores in alcoholic hepatitis

1. Maddrey (modified) Discriminant Function score of greater or equal to 32 indicates a high risk (30-50%) risk of mortality at 30 days. The risk is even higher is there are signs of hepatic encephalopathy. Scores should be repeated at day 7. 2. MELD stands for Model for End stage Liver Disease. It is used to estimate 90 days mortality. Poor prognosis if score is greater than 18. Score should be repeated at day 7.