PDC Test - Alcoholic Hepatitis

You can earn 0.25 PDC by passing the exam following this article, which has been approved for publication by NCRA's Council of the Academy of Professional Reporters.

The questions are based on the material in the article but some may require additional research. Send your answer sheet to NCRA's Continuing Education Office, 8224 Old Courthouse Road, Vienna, VA 22182, and enclose a check for $40 (member) or $50 (non-member) to cover the processing fee. 

Alcoholic Hepatitis

By B. J. Johnson

Excessive alcohol consumption is the third-leading preventable cause of death in the United States. Alcohol-associated mortality is disproportionately high among young people, and approximately 30 years of life are lost per alcohol-associated death – or in the aggregate, 2.3 million years of potential life lost in 2001 in the United States.

Excess consumption of alcohol is associated with both short-term and long-term liver damage several types of cancer, unintentional injuries both in the workplace and on the road, domestic and social violence, broken marriages, and damaged social and family relationships.

The association between alcohol intake and alcoholic liver disease has been well documented, although cirrhosis of the liver develops in only a small proportion of heavy drinkers. The risk of cirrhosis increases proportionally with consumption of more than 30 g of alcohol per day; the highest risk is associated with consumption of more than 120 g per day. It is presumed that other factors, such as sex, genetic characteristics, and environmental influences (including chronic viral infection) play a role in the genesis of alcoholic liver disease.

Chronic alcohol use may cause several types of liver injury. Regular alcohol use, even for just a few days, can result in a fatty liver (also called steatosis), a disorder in which hepatocytes contain macrovesicular droplets of triglycerides. Although alcoholic fatty liver resolves with abtinence, steatosis predisposes people who continue to drink to hepatic fibrosis and cirrhosis. This review focuses on alcoholic hepatitis, a treatable form of alcoholic liver disease. Since up to 40% of patients with severe alcoholic hepatitis die within 6 months after the onset of the clinical syndrome, appropriate diagnosis and treatment are essential.

Alcoholic hepatitis is a clinical syndrome of jaundice and liver failure that generally occurs after decades of heavy alcohol use (mean intake, approximately 100 g per day. Not uncommonly, the patient will have ceased alcohol consumption several weeks before the onset of symptoms. The typical age at presentation is 40 to 60 years. Although female sex is an independent risk factor for alcoholic hepatitis,.more men drink to excess, and there are more men than women with alcoholic liver disease. The type of alcohol consumed does not appear to affect the risk of alcoholic hepatitis.

The cardinal sign of alcoholic hepatitis is the rapid onset of jaundice. Other common signs and symptoms include fever, ascites, and proximal muscle loss. Patients with severe alcoholic hepatitis may have encephalopathy. Typically, the liver is enlarged and tender.

Recovery from alcoholic hepatitis is dictated largely by abstinence from alcohol, the presence of a mild clinical syndrome, and the implementation of appropriate treatment. Within several weeks after discontinuation of alcohol intake, jaundice and fever may resolve,m but ascites and hepatic encephalopathy may persist for months to years. Either continued jaundice or the onset of renal failure signifies a poor prognosis. Unfortunately, even when patients adhere to all aspects of medical management, recovery is not guaranteed.

The differential diagnosis of alcoholic hepatitis inclues nonalcoholic steatohepatitis, acute or chronic viral hepatitis, drug-induced liver injury, fulminant Wilson’s disease, autoimmune liver disease, alpha-1 antitrypsin deficiency, pyogenic hepatic abscess, ascending cholangitis and decompensation associated with hepatocellular carcinoma.

The findings on liver biopsy may confirm the features described above and may help rule out other causes of liver disease, but a biopsy is not required to make the diagnosis. The risk of bleeding during or after the biopsy can be reduced with the use fo the transjugular route. A liver biopsy is not recommended to confirm or refute abstinence,m since it is difficult to asses the timeline of the resolution of the histologic features.

Some patients with alcoholic hepatitis will become candidates for liver transplantation. The MELD score, which is based on a numberical scale, predicts a patient’s risk of death while waiting for a liver transplant; the score is based on serum levels of bilirubin and creatanine and the INR.

B.J. Johnson, RPR, CPE, is a reporter in Reno, NV.

Questions for article on Alcoholic Hepatitis (Ahep)

1.Excessive alcohol consumption is the second leading preventable cause of death in the United States.
A.True.
B.False                      

2.Alcoholic Hepatitis is a clinical symptom of
A.Heart failure
B.Lung failure
C.Liver Failure
D. Parkinson’s Disease                     

3. What is the main sign of alcoholic hepatitis?
A.Inability to breathe
B.Brittle and breaking nails
C.Loss of skin tone
D.Rapid onset of Jaundice               

4. Common signs of  Ahep include
A.Fever
B.Ascites
C.Proximal muscle loss
D.All of the above                             

5.Cirrhosis of the liver develops in only a small portion of heavy drinkers
A.False
B.True                                   

6. Being female is an independent risk factor for Ahep
A.True
B.False                                  

7. Alcoholic-associated mortality is disproportionately high among
A.Farm workers
B.Factory workers
C.Young people
D.Those past 50                                

8. A sign of Ahep is
A.Frequent urination
B,.Liver tenderness
C.Pancreatic pain
D.Skin rash
E.All of the above                 

9. In Ahep the liver is usually enlarged
A.True
B.False                                  

10. Consumption of more than 30g of alcohol daily increases the risk of liver cirrhosis
A.True
B.False                                  

11. A poor prognosis for recovery from Ahep is signified by
A.Onset of renal failure
B.Continued jaundice
C. Both of the above                        

12. The MELD score is based on
A.Probability of patient’s death
B.A numerical scale
C.Serum levels of glucosamides      

13. A differential diagnosis of Ahep includes
A.Nonalcoholic steatohepatitis
B.Acute viral hepatitis
C.Drug-induced liver injury
D.All of the above                            

14. Even when patients follow medical protocols, recovery from Ahep is not guaranteed
 A.False
B.True                                   

15An important aspect of Ahep recover is
A.Abstinence from alcohol
B.Abstinence. from anti-inflammatory drugs
C.Abstinence from fatty foods          
D.All of the above                                        

16. A liver biopsy is required to make a diagnosis of Alcoholic Hepatitis
A.True
B.False                                  

17. After several weeks of not ingesting alcohol, jaundice and fever may subside
A.True
B.False                                              

18. The MELD score predicts a patient’s risk of death while awaiting
A.Treatment for cirrhosis
B.Liver transplant
C.Liver cleansing