RESUMO
Severe alcoholic hepatitis is still associated with high mortality and presence of liver failure manifested by jaundice, coagulopathy and encephalopathy is a poor prognostic indicator. The management of these patients includes at first hand several supportive measures as treatment of alcohol withdrawal, administration of fluid and vitamins and admission to an intensive care unit in the unstable patient. Glucocorticoids have been since decades the most intensively studied therapy in alcoholic hepatitis and are effective in certain subgroups. Indication for such a therapy is usually defined on a Maddrey Discriminant Function > 32. The Lille score at day 7 is used to decide whether corticosteroid therapy should be stopped or continued for a 1 month course. Nutritional supplementation is also likely to be beneficial. The main progress in better understanding its pathophysiology has come from cytokine studies. Various proinflammatory cytokines such as tumor necrosis factor-alpha (TNFα) or interleukin-1 (IL-1) have been proposed to play a role in this disease. This advancement has recently led to pilot studies investigating anti-TNF drugs such as pentoxifylline, infliximab (anti-TNF antibody) or etanercept in the treatment of this disease. These studies revealed besides for pentoxifylline rather negative results. Despite this fact, targeting of certain cytokines such as IL-1 remains an attractive treatment concept for this devastating disorder in the future.
Assuntos
Hepatite Alcoólica/reabilitação , Alcoolismo/fisiopatologia , Alcoolismo/reabilitação , Anticorpos Monoclonais/administração & dosagem , Terapia Combinada , Etanercepte , Fígado Gorduroso Alcoólico/diagnóstico , Fígado Gorduroso Alcoólico/fisiopatologia , Fígado Gorduroso Alcoólico/reabilitação , Hidratação , Glucocorticoides/administração & dosagem , Hepatite Alcoólica/diagnóstico , Hepatite Alcoólica/fisiopatologia , Humanos , Imunoglobulina G/administração & dosagem , Infliximab , Unidades de Terapia Intensiva , Interleucina-1/sangue , Falência Hepática Aguda/diagnóstico , Falência Hepática Aguda/fisiopatologia , Falência Hepática Aguda/reabilitação , Testes de Função Hepática , Transplante de Fígado , Seleção de Pacientes , Pentoxifilina/administração & dosagem , Projetos Piloto , Prognóstico , Receptores do Fator de Necrose Tumoral/administração & dosagem , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/sangue , Vitaminas/administração & dosagemAssuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Fígado Gorduroso Alcoólico/etiologia , Cirrose Hepática Alcoólica/etiologia , Composição Corporal , Relação Dose-Resposta a Droga , Etanol/sangue , Fígado Gorduroso Alcoólico/prevenção & controle , Fígado Gorduroso Alcoólico/reabilitação , Feminino , Humanos , Cirrose Hepática Alcoólica/prevenção & controle , Cirrose Hepática Alcoólica/reabilitação , Masculino , Estado Nutricional , Fatores de Risco , Fatores SexuaisRESUMO
Alcoholic and non-alcoholic steatohepatitis (NASH) are often histopathologically indistinguishable. Apart from the clinical and laboratory findings, the patient's history is of key importance for differentiating between alcoholic steatohepatitis with its poor prognosis, and NASH, with its usually bland course. While the latter rarely requires specific treatment, the former, in particular in its severe form, is a therapeutic challenge. In addition to suitable dietary measures, patients with a Maddrey Score > 32, may need corticosteroids. In patients with mild to moderate steatohepatitis, the daily alcohol consumption appears to be decisive for the prognosis. In severe forms of this condition, in contrast, mortality is high, and patients surviving the acute phase often develop cirrhosis, irrespective of their further drinking habits.
Assuntos
Corticosteroides/uso terapêutico , Alcoolismo/reabilitação , Fígado Gorduroso Alcoólico/reabilitação , Fígado Gorduroso/reabilitação , Alcoolismo/patologia , Fígado Gorduroso/etiologia , Fígado Gorduroso/patologia , Fígado Gorduroso Alcoólico/patologia , Humanos , Fígado/patologia , Obesidade/complicações , Fatores de Risco , Redução de PesoRESUMO
The case report on an acute intrahepatic cholestasis caused by alcoholic intoxication in a 52-year-old medical laboratory assistant is given. In addition to extreme pathologic cholestasis parameters the increase of the tumor marker CA 19-9 was remarkable. By means of laparoscopy and histology, chronic fatty liver hepatitis due to alcoholic intoxication was found. The tumor marker CA 19-9 returned to normal following abstinence from alcohol parallel to the deline of the cholestasis parameters, which means the diagnostic importance of tumor markers in diseases with intrahepatic cholestasis is to be seen in relative terms.