00:00 Let's begin our next case. 00:03 A 67-year-old woman is seen in clinic for a routine visit. 00:07 She feels well, her only past medical history is hypertension. 00:11 She drinks 6 cans of beer per night. 00:15 She recently traveled to Mexico but has not had any diarrhea. 00:19 Her vitals are normal. 00:20 She has mild hepatomegaly on physical exam. 00:24 Lab studies are shown here: So her ALT is 85 (U/L), AST is 180 (U/L) and her bilirubin is 0.8 (mg/dL). 00:32 What is the most likely diagnosis? So let's point out that she has an alcohol use disorder. 00:40 She has recent travel to Mexico which does raise some suspicion for hepatitis A or E but notably, she has no symptoms of either of these diseases. 00:51 And she has this AST to ALT ratio of greater than 2 to 1. 00:57 We'll discuss what that means in a bit. 01:01 So, let's talk now about alcohol-induced liver disease. 01:05 In general, this is just inflammation of the liver caused by alcohol. 01:10 Patients often have a serum AST and ALT elevation of 2 to 6 times the upper limit of normal. 01:19 The typical ratio is an AST to ALT ratio of 2 to 1 or greater. 01:26 Patients may be either asymptomatic with just fatty liver or they may be symptomatic and develop alcoholic hepatitis. 01:34 So here on the right you can see the natural progression of this disease. 01:38 You begin with a normal liver. 01:40 With recurrent alcohol use, you develop fatty liver or steatosis With ongoing use, you can develop inflammation, so steatohepatitis. 01:49 This can then progress to fibrosis, cirrhosis and lastly, the dreaded hepatocellular carcinoma. 01:58 So, patients with this disease may present with jaundice, a loss of appetite or anorexia and they may also have tender hepatomegaly. 02:08 The treatment depends on the severity of their disease. 02:12 So if it is mild, you just do supportive care and counsel them to remain abstinent from alcohol. 02:19 If their disease is moderate to severe with inflammation, you could consider prednisone. 02:27 So, let's return to our case. 02:30 We have a 67-year-old woman with an alcohol use disorder, a recent travel to Mexico but no symptoms of hepatitis A or E and she has an AST to ALT ratio of greater than 2 to 1 and both of these tests are somewhat abnormal within the 2 to 6 times the upper limit of normal. 02:49 So this ratio with our clinical picture should prompt you to think of alcoholic liver disease. 02:55 She is asymptomatic so she likely just has alcoholic steatohepatitis and she should be counseled for her alcohol use disorder.
The lecture Alcohol-induced Liver Disease with Case by Kelley Chuang, MD is from the course Disorders of the Hepatobiliary Tract.
Which of the following is the treatment of moderate to severe alcohol-induced liver disease with inflammation?
Which of the following is the AST:ALT ratio in alcohol-induced liver disease?
5 Stars |
|
1 |
4 Stars |
|
0 |
3 Stars |
|
0 |
2 Stars |
|
0 |
1 Star |
|
0 |
top lecture very usefyl. why is it so diffiucult to leave reviews. trying to study here