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Severe alcohol-related hepatitis — SCE Acute Medicine MCQ

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HardAcute Gastrointestinal PresentationsSevere alcohol-related hepatitisSCE Acute Medicine

A patient with jaundice, tender hepatomegaly, AST 160 IU/L, ALT 62 IU/L, bilirubin 180 micromol/L and prolonged prothrombin time reports heavy alcohol use. What is the next management principle?

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Correct answer: D — Assess severity and exclude infection before corticosteroids

The best answer is “Assess severity and exclude infection before corticosteroids”. This is correct because the clinical syndrome and a validated severity score guide prognosis and treatment selection. Infection, gastrointestinal bleeding and other contraindications must be assessed before steroids. An AST:ALT pattern alone is not diagnostic, biopsy is selective, and pentoxifylline is not routine effective therapy.

Reference: British Society of Gastroenterology alcohol-related-liver-disease guideline: https://www.bsg.org.uk/clinical-resource/quality-standards-alcohol-related-liver-disease