47 Questions
What is the formula for calculating the Maddrey discriminant function (MDF) score?
MDF score = 4.6 (prothrombin time [s] – control prothrombin time [s]) + total bilirubin (mg/dL)
What score is considered to suggest moderate to severe disease when using the Model for End-Stage Liver Disease (MELD) score?
MELD score greater than 20
What are the contraindications to prednisolone in the treatment of alcoholic hepatitis?
Active infection, upper gastrointestinal bleeding, acute kidney injury, concomitant liver disease (especially HCV and HBV), and multiorgan failure
What trial showed a trend toward improvement in 28-day mortality with prednisolone, although the results were not statistically significant?
The STOPAH trial
What is the recommended treatment for severe cases of alcoholic hepatitis (MDF score ≥32, MELD score >20, or hepatic encephalopathy)?
Prednisolone
Why is pentoxifylline no longer recommended for the treatment of alcoholic hepatitis?
It is not effective in patients whose symptoms do not respond to prednisolone
How can response to glucocorticoids be assessed on day 7 in patients with alcoholic hepatitis?
Using the Lille score
When should prednisolone be discontinued in patients with no response to glucocorticoids (Lille score ≥0.45)?
Because of the risk for infection
What does a Lille score below 0.45 support in the treatment of alcoholic hepatitis?
Prednisolone continuation for 28 days
What score is used to assess nonsevere alcoholic hepatitis?
MDF score
What are the four forms alcohol injury to the liver may take?
steatosis, steatohepatitis, fibrosis, or cirrhosis
What is the most important component in making a diagnosis of alcoholic liver disease?
history of alcohol use
What is the daily alcohol consumption threshold for most patients with alcoholic liver disease?
more than 100 g of alcohol daily for 20 years
What are the common clinical manifestations of alcoholic hepatitis?
fever, jaundice, tender hepatomegaly, and leukocytosis
Approximately what percentage of heavy drinkers develop cirrhosis?
25%
What may be difficult to differentiate from decompensated cirrhosis in patients with underlying cirrhosis?
alcoholic hepatitis
What physical examination findings may be present in patients with steatosis or steatohepatitis?
hepatomegaly
What are some of the findings of advanced liver disease that may be present in patients with alcoholic hepatitis or cirrhosis?
muscle wasting, scleral icterus, jaundice, spider angiomata, gynecomastia, testicular atrophy, or palmar erythema
What laboratory evaluation findings may indicate alcohol-induced liver disease?
elevated mean corpuscular volume, AST-to-ALT ratio greater than 2, elevated γ-glutamyl transferase level, elevated phosphatidyl ethanol level, elevated INR, and thrombocytopenia
What specific immunoglobulin level may be elevated in alcohol-induced liver disease?
IgA level
What is the ANI scoring system used for?
Distinguishing alcoholic liver disease (ALD) from nonalcoholic fatty liver disease (NAFLD)
What is the Lille score used for in the treatment of alcoholic hepatitis?
Assessing response to glucocorticoids
Why is pentoxifylline no longer recommended for the treatment of alcoholic hepatitis?
It has been associated with increased mortality
What percentage of heavy drinkers develop cirrhosis approximately?
50-60%
What is the characteristic feature of acute-on-chronic liver failure?
Gradual deterioration of liver function
In acute-on-chronic liver failure, what are the precipitating factors for organ failure?
Alcohol use, viral hepatitis, drug-induced liver injury
What management is often required for patients with acute-on-chronic liver failure?
Vigilance to identify and promptly treat infection
What determines whether a patient with acute-on-chronic liver failure will be a candidate for liver transplantation?
Clinical course
In cases of non-acetaminophen acute liver failure, what should be considered?
Intravenous N-acetylcysteine
What is the interventional radiologic procedure used to eradicate gastric varices via the systemic circulation?
Balloon-occluded retrograde transvenous obliteration
What is the characteristic finding in portal hypertensive gastropathy?
Presence of dilated mucosal gastric veins and venules
What is the primary treatment approach for isolated gastric varices associated with splenic vein thrombosis?
Splenectomy
What is the main difference in the presentation of gastric antral vascular ectasias in patients with and without portal hypertension?
Diffuse mucosal lesions in patients without cirrhosis
Which intervention is not effective for treating gastric antral vascular ectasias?
TIPS
Which interventional radiologic procedure is used to eradicate gastric varices via the systemic circulation?
Balloon-occluded retrograde transvenous obliteration
What is the primary treatment approach for isolated gastric varices associated with splenic vein thrombosis?
Splenectomy
What is the characteristic finding in portal hypertensive gastropathy?
Presence of dilated mucosal gastric veins and venules
What is the common endoscopic finding in patients with cirrhosis?
Ectatic vessels lining the mucosa of the distal stomach
What is the treatment for gastric antral vascular ectasias?
Argon plasma coagulation
What is the first-line therapy for acute gout, and what percentage of patients does it effectively treat?
Non-steroidal anti-inflammatory drugs (NSAIDs); >90%
In what circumstances is oral colchicine an alternate therapy for acute gout, and what is the recommended dosing regimen for colchicine?
Oral colchicine is an alternate therapy in patients with contraindications to NSAIDs, and the recommended dosing regimen is an initial 1.2-mg dose followed by 0.6 mg an hour later, then continued at 0.6 mg once or twice daily until 2-3 days after symptoms resolve.
Why should hypouricemic therapy with allopurinol be avoided initially in acute gout?
It can worsen the acute gouty attack.
In which patient populations is colchicine usually avoided, and what is the recommended dosing adjustment for the elderly?
Colchicine is usually avoided in severe liver or renal disease and in patients taking another cytochrome P450 inhibitor. In the elderly, the drug should be given at a reduced dose.
What are the factors considered in the treatment of acute gout, besides the patient's comorbidities and previous treatments?
Patient preferences
What are the characteristic abnormalities seen in achalasia?
Aperistalsis in the lower esophagus and constriction of the LES
What histologic examination findings are associated with achalasia?
Sparse ganglion cells
What is the characteristic radiographic finding in achalasia?
Bird-beak appearance
Test your knowledge of diagnosing alcoholic liver disease, including steatosis, steatohepatitis, fibrosis, and cirrhosis. Understand the clinical syndrome of severe steatohepatitis and its presentation in patients with chronic alcoholic liver disease.
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