We are seeing an increased volume of alcoholic liver disease due to the COVID pandemic. Previously admissions to ICU for alcoholic hepatitis were rare, but these are now occurring with regularity.
IBCC – Alcoholic hepatitis — https://emcrit.org/pulmcrit/alcoholic-hepatitis/
Duh.
Compression of the central arteriole caused the entire lesion to blanch, and it quickly refilled once the compression was released This pattern of blanching and refilling characterizes spider angiomas, which are suggestive of liver disease.
For the underwriter who always wondered what one of these things looks like. For the geekiest underwriters, click on and take a look at the video. And for the underwriter who thinks she should have a Medical Doctor, the following is from the NEJM Resident E-Bulletin of 02.23.12.
The differential diagnosis includes five major syndromes: hepatic encephalopathy, Wernicke’s encephalopathy, alcohol withdrawal, occult seizures, and infection. Hepatic encephalopathy refers to an alternation in cognitive function that is secondary to a metabolic process caused by liver failure. Wernicke’s encephalopathy refers to the triad of gait ataxia, ophthalmoplegia and confusion caused by thiamine deficiency, commonly seen in chronic alcoholics. Alcohol withdrawal, occult seizures, and underlying infection may also cause a subacute confusional state in a patient with chronic liver disease.
Alcoholic Hepatitis
Original Article
Glucocorticoids plus N-Acetylcysteine in Severe Alcoholic Hepatitis
E. Nguyen-Khac and Others
Severe acute alcoholic hepatitis is a life-threatening liver disease. Although glucocorticoid treatment is recommended and improves survival, the mortality remains high, with 35% of patients dying within 6 months.
How does chronic alcohol consumption lead to hepatitis?
Chronic alcohol consumption increases intestinal permeability, worsens endotoxemia, stimulates Kupffer cells, and thus increases production of proinflammatory cytokines. High levels of tumor necrosis factor α (TNF-α) activate cell-death pathways and induce the production of reactive oxygen species, notably superoxide anions, by the hepatocyte mitochondria, leading to cell death.
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