ABSTRACT
Alcoholic liver disease is a spectrum of lesions, of which the most severe is alcoholic steatohepatitis (ASH). Recent European guidelines define alcoholic hepatitis as a clinical syndrome: the recent onset of jaundice and/or ascites in a patient with ongoing alcohol misuse. Next to infection, the most frequent aetiology is ASH, a histological diagnosis. In case of severe ASH, as defined by prognostic scores, a biopsy is needed to confirm the diagnosis. Non-severe forms of ASH may improve with interruption of alcohol abuse only; however survival of severe forms of ASH is improved by the association of corticosteroids and N-acetylcysteine. In case of uncontrolled infection, pentoxifylline may be administered. The Lille score, measured at the 7th day of corticosteroid therapy, measures response to therapy and guides the total duration of treatment.
Subject(s)
Fatty Liver, Alcoholic/diagnosis , Fatty Liver, Alcoholic/drug therapy , Algorithms , Fatty Liver, Alcoholic/physiopathology , Free Radical Scavengers/therapeutic use , Glucocorticoids/therapeutic use , Humans , Prednisone/therapeutic use , Severity of Illness IndexABSTRACT
The liver plays a key role in coagulation as all clotting factors except for factor VIII are synthetized by hepatocytes. In cirrhotic patients, there is a decrease of clotting factors and a thrombocytopenia. Those parameters usually modify routine coagulation tests and may suggest that cirrhotic patients are at a higher risk of bleeding. However, studies have shown that these patients are rather at risk for thrombosis. The reason is a concomitant decrease of coagulation inhibitors factors that is not detected in routine laboratory coagulation tests. The coagulation system in cirrhotic patient is a balance of pro and anti-coagulants. This balance may be affected by co-factors such as renal failure or infection. Artificial correction of laboratory values by transfusion of blood products may be rather deleterious (e.g. volume overload, TRALI).
