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Alcohol-associated hepatitis — ESEGH MCQ

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HardHepatologyAlcohol-associated hepatitisESEGH

A 45-year-old man with alcohol-related liver disease is admitted with jaundice and fever. He drinks 80 units weekly. Blood tests show bilirubin 240 micromol/L, AST 168 IU/L, ALT 74 IU/L, INR 2.0, neutrophils 15 x 10^9/L and creatinine 90 micromol/L. Ultrasound shows no obstruction and blood cultures are pending. What is the most important next step?

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Correct answer: A — Screen and treat infection before considering corticosteroids

Severe alcohol-associated hepatitis may respond to corticosteroids, but infection must be actively excluded and treated because steroids increase sepsis risk. The AST:ALT pattern and jaundice fit alcohol-associated hepatitis, while absent duct dilatation argues against obstructive cholangitis. Azathioprine and venesection are inappropriate. The pearl is that prognostic scores guide steroid decisions, but infection assessment comes first.

Reference: BSG Alcohol-related Liver Disease Guideline; EASL Alcohol-related Liver Disease Guideline