Single Best Answer (SBA) · Alcohol-Related Liver Disease
A 27-year-old man with heavy alcohol use since adolescence presents with 7 days of worsening jaundice, right upper quadrant pain, fever, nausea and fatigue. He has marked tender hepatomegaly (5 cm below the costal margin) and no other stigmata of chronic liver disease. What is the most likely diagnosis?
Show answer and explanation
Answer: E. Alcoholic hepatitis
Alcoholic hepatitis
A young heavy drinker with a short history of worsening jaundice, RUQ pain, fever, nausea and tender hepatomegaly has alcoholic hepatitis - an acute inflammatory phase within the spectrum of alcohol-related liver disease.
The spectrum of alcohol-related liver disease
| Stage | Note |
|---|---|
| Macrovesicular steatosis (fatty liver) | 90-95% of heavy drinkers; reversible |
| Alcoholic hepatitis | 10-35%; hepatocyte ballooning, Mallory bodies, inflammation |
| Cirrhosis | 8-20% |
Why alcoholic hepatitis
- Tender hepatomegaly with fever and a rapid rise in jaundice in a heavy drinker is the classic picture.
- Deep jaundice disproportionate to the transaminase rise is characteristic.
Histology
- Macrovesicular steatosis with hepatocyte ballooning and Mallory bodies (Mallory-Denk bodies), with neutrophilic inflammation.
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