Alcoholic hepatitis laboratory findings: Difference between revisions

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{{Alcoholic hepatitis}}
{{Alcoholic hepatitis}}
{{CMG}}; '''Assosciate Editor(s)-In-Chief:''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]]
{{CMG}}; {{AE}} {{ S.M}}
 
==Overview==
The most frequent [[laboratory findings]] of [[Alcoholic hepatitis]] include [[neutrophilic]] [[leukocytosis]] with [[bandemia]],[[anemia ]],[[AST]]/[[ALT]] [[ratio]] greater than 2, mild elevation of [[Alkaline Phosphatase]], [[hypoalbuminemia]], [[hyperbilirubinemia]],prolonged [[prothrombin time]], and elevated [[gamma-glutamyl transpeptidase]] level.


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== Laboratory Findings==
== Laboratory Findings==
* AST:ALT (aspartate aminotransferase:alanine aminotransferase) classically 2:1. The ratio of [[aspartate aminotransferase]] to [[alanine aminotransferase]] is usually > 2.<ref name="pmid10201476">{{cite journal |author=Sorbi D, Boynton J, Lindor KD |title=The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease |journal=Am. J. Gastroenterol. |volume=94 |issue=4 |pages=1018-22 |year=1999 |pmid=10201476 |doi=}}</ref>
* The [[laboratory findings]] include:<ref name="pmid20954276">{{cite journal| author=Amini M, Runyon BA| title=Alcoholic hepatitis 2010: a clinician's guide to diagnosis and therapy. | journal=World J Gastroenterol | year= 2010 | volume= 16 | issue= 39 | pages= 4905-12 | pmid=20954276 | doi=10.3748/wjg.v16.i39.4905 | pmc=2957598 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20954276  }} </ref><ref name="pmid24876748">{{cite journal| author=Chayanupatkul M, Liangpunsakul S| title=Alcoholic hepatitis: a comprehensive review of pathogenesis and treatment. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 20 | pages= 6279-86 | pmid=24876748 | doi=10.3748/wjg.v20.i20.6279 | pmc=4033465 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24876748  }} </ref>
*:* Reason for ratio not clear
** [[Complete blood count]] ([[CBC]]) shows:
*:*:* There may be disproportional damage to [[mitochondria]] releasing AST  
*** [[Neutrophilic]] [[leukocytosis]] with [[bandemia]]
*:*:* Alcoholics may have relative deficiencies of pyridoxal-6-phosphatase
*** [[Anemia ]]
*:* > 300-500 worry about other hepatotoxins
*** Increased [[mean corpuscular volume]] ([[MCV]])
* [[Alkaline phosphatase]], gamma-glutamyltranspeptidase (GGT) and [[bilirubin]] often rise proportionally, and may persist for weeks after transaminases normalize.
*** [[Thrombocytosis]] as part of [[inflammatory]] process or [[thrombocytopenia]] as a result of [[splenic]] sequestration
* A [[leucocytosis]] is commonly seen. If other causes can be excluded, the degree of rise correlates with severity of hepatic injury.
** [[Liver tests]] shows:
*** [[Aspartate aminotransferase]] (AST)level is elevated to 2–6 times the upper limit of [[normal]]
*** [[AST]]/[[ALT]] ([[alanine aminotransferase]]) [[ratio]] greater than 2
*** Mild elevation of [[Alkaline Phosphatase]] ([[ALP]])
*** [[ALP]] level of more than 500 U/L is suggestive of [[infiltrative]] or [[biliary]] [[obstructive]] disease
*** Elevated [[gamma-glutamyl transpeptidase]] ([[GGTP]]) level
*** [[Hypoalbuminemia]]
*** [[Hyperbilirubinemia]]
*** Prolonged [[prothrombin time]] ([[PT]])
****  The severity of [[hyperbilirubinemia]] and [[coagulopathy]] are indicative of severity of [[Alcoholic Hepatitis]]
** [[Blood tests]] in order to exclude other [[diseases]]:
*** [[Hepatitis B surface antigen]] ([[HBsAg]])
*** [[Anti]]–[[hepatitis C]] [[virus]]
*** [[Ferritin]] and [[transferrin]] to exclude [[hemochromatosis]]
*** [[Alpha-fetoprotein]] ([[AFP]]) to exclude [[hepatocellular carcinoma]] ([[HCC]])
*According to National Institute on Alcohol Abuse and Alcoholism (NIAAA), [[Alcoholic Hepatitis]] is diagnosed based on following criteria:<ref> {{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK470217/ |title=Alcoholic Hepatitis - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
** Onset of [[jaundice]] within 60 days of heavy [[alcohol]]consumption >50 g/day for at least of 6 [[months]]
** [[Serum bilirubin]] > 3 mg/dL
** [[AST]]level between 50 U/L to 400 U/L
** [[AST]]:[[ALT]] ratio of more than 1.5
** No other cause of [[acute]] [[hepatitis]]


==References==
==References==

Latest revision as of 16:10, 2 August 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

The most frequent laboratory findings of Alcoholic hepatitis include neutrophilic leukocytosis with bandemia,anemia ,AST/ALT ratio greater than 2, mild elevation of Alkaline Phosphatase, hypoalbuminemia, hyperbilirubinemia,prolonged prothrombin time, and elevated gamma-glutamyl transpeptidase level.

Laboratory Findings

References

  1. ↑ Amini M, Runyon BA (2010). "Alcoholic hepatitis 2010: a clinician's guide to diagnosis and therapy". World J Gastroenterol. 16 (39): 4905–12. doi:10.3748/wjg.v16.i39.4905. PMC 2957598. PMID 20954276.
  2. ↑ Chayanupatkul M, Liangpunsakul S (2014). "Alcoholic hepatitis: a comprehensive review of pathogenesis and treatment". World J Gastroenterol. 20 (20): 6279–86. doi:10.3748/wjg.v20.i20.6279. PMC 4033465. PMID 24876748.
  3. ↑ "Alcoholic Hepatitis - StatPearls - NCBI Bookshelf".

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