Materiały źródłowe

• #1 Alcoholic Hepatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html

  Alcoholic hepatitis is a clinical syndrome characterized by acute-onset jaundice and liver enzyme abnormalities in the setting of long-term heavy alcohol use. […] Close monitoring for inflammation and organ failure is crucial throughout hospitalization. […] Treatment for moderate disease primarily consists of supportive care, including alcohol cessation and nutritional support. […] Corticosteroids are recommended for severe alcoholic hepatitis. […] Hospital physicians should involve a multidisciplinary team, including substance abuse specialists, gastroenterologists or hepatologists, nephrologists, dietitians, and intensivists, as appropriate. […] Long-term follow-up should focus on abstinence from alcohol, management of underlying cirrhosis, and evaluation for liver transplantation if indicated.

• #2 Alcoholic Hepatitis: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.alcoholic-hepatitis-care-instructions.uh3001

  Alcoholic hepatitis is damage to the liver. It is caused by long-term heavy drinking. The liver gets inflamed and swollen. Then the liver can’t remove waste products from the body. This condition can lead to permanent scarring in the liver. This scarring is called cirrhosis. If drinking is stopped before the liver is severely damaged, your liver may get better. You may have to make changes in your diet and adjust your medicines. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take. […] Do not drink alcohol. Alcohol can damage the liver. Tell your doctor if you need help to quit. Counseling and support groups can help you stay sober. Sometimes medicines can help too. Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes. Do not take any over-the-counter medicines, including ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol), unless your doctor tells you to. Make sure your doctor knows all of the medicines, vitamins, supplements, and herbal remedies you take. Follow your doctor’s instructions about your diet. See a dietitian if you need help choosing the right foods.

• #3 Alcoholic Hepatitis (Alcohol-Associated Hepatitis) Treatment & Management: Approach Considerations, Cessation of Alcohol Intake, Diet and Nutritional Support

  https://emedicine.medscape.com/article/170539-treatment

  In most patients with alcoholic hepatitis, the illness is mild. The short-term prognosis is good, and no specific treatment is required. Hospitalization is not always necessary. Alcohol use must be stopped, and care should be taken to ensure good nutrition; providing supplemental vitamins and minerals, including folate and thiamine, is reasonable. Patients who are coagulopathic should receive vitamin K parenterally. Anticipate symptoms of alcohol withdrawal, and manage them appropriately. […] In contrast, patients with severe acute alcoholic hepatitis are at a high risk for early death, at a rate of 50% or greater within 30 days. […] Patients with severe alcoholic hepatitis may benefit over the short term from specific therapies directed toward reducing liver injury, enhancing hepatic regeneration, and suppressing inflammation.

• #4 Severe alcoholic hepatitis-current concepts, diagnosis and treatment options

  https://www.wjgnet.com/1948-5182/full/v6/i10/688.htm

  Alcoholic hepatitis (AH) is an acute hepatic manifestation occurring from heavy alcohol ingestion. Alcohol abstinence is the cornerstone of therapy for AH and, in the milder forms, is sufficient for clinical recovery. Severe ASH may progress to multi-organ failure including acute kidney injury and infection. Thus, infection and renal failure have a major impact on survival and should be closely monitored in patients with severe ASH. Patients with severe ASH have a reported short-term mortality of up to 40%-50%. Corticosteroids are the mainstay of treatment for severe ASH. When corticosteroids are contraindicated, pentoxifylline may be alternatively used. […] Alcohol abstinence is the linchpin of therapy for AH, since abstinence failure increases mortality rates among those with AH. However, anti-craving drugs such as disulfiram, naltrexone, and acamprosate are not routinely recommended to patients with severe AH due to the risk of potential hepatotoxicity.

• #5 Home – Southern California Liver Centers, Seven Convenient Locations

  https://www.livercenters.com/alcoholic-hepatitis/

  Alcoholic hepatitis occurs when a person develops inflammation of the liver due to alcohol consumption. […] Although most people with alcoholic hepatitis have drunk heavily for many years, the disease can also develop in people who drink only moderately. […] Alcoholic hepatitis is a very serious disease as many as 40 percent of people with the disease die within one month if left untreated. […] At SCLC, we are one of the few centers that manages patients with severe acute alcoholic hepatitis. Our comprehensive diagnostic approach involves supporting the liver during the severe inflammation process until it recovers. This process requires intense care for the patients in a hospital setting. […] If you do receive an alcoholic hepatitis diagnosis, you must stop drinking alcohol immediately. Consult SCLC for an immediate evaluation and management.

• #6 Alcohol Associated Hepatitis (Alcoholic hepatitis) – Cirrhosis Care

  https://cirrhosiscare.ca/treatment-provider/alcoholic-hepatitis-hcp/

  Rule out infection and additional causes of jaundice in all patients with suspected alcohol associated hepatitis. […] Need to consider the management of alcohol withdrawal, nutritional therapy as well as the treatment of alcohol use disorder alongside the treatment of alcohol associated hepatitis. […] Use the Lille model at 7 days to determine if the patient is a non-responder to steroid therapy (Lille 0.45). […] Using very strict criteria, the Alberta transplant program is now evaluating some patients with alcohol associated hepatitis for liver transplantation.

• #7 Alcohol-Associated Liver Disease (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568777/

  List the nursing care management plans for alcoholic liver disease […] Assess nutritional status- many alcoholics have a poor diet that lacks essential nutrients […] Assess the intake of alcohol intake using the CAGE tool […] Assess body weight, weigh patient daily as fluid retention is common […] Measure abdomen girth as some may develop ascites […] Assess liver function enzymes […] Encourage patient to join AA […] Encourage patient to abstain from alcohol […] Avoid all medications that can affect the liver negatively […] Encourage a healthy diet […] Check coagulation profile as liver disease may prolong INR […] Assess mental status as liver disease can cause encephalopathy […] Encourage patient to stop smoking.

• #8 6 Hepatitis Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/hepatitis-nursing-care-plans/

  Use this nursing care plan and management guide to help care for patients with hepatitis. Enhance your understanding of nursing assessment, interventions, goals, and nursing diagnosis, all specifically tailored to address the unique needs of individuals facing hepatitis. This guide equips you with the necessary information to provide effective and specialized care to patients dealing with hepatitis. […] Nursing care planning and management for patients with hepatitis includes: reducing the demands of the liver while promoting physical well-being, preventing complications of hepatitis, enhance self-concept, acceptance of situation, and providing information about the disease process, prognosis, and treatment. […] The following are the nursing priorities for patients with hepatitis: Manage symptoms and provide supportive care. Prevent further liver damage and promote liver health. Monitor liver function and assess disease progression. Administer antiviral medications, if applicable. Educate patients on lifestyle modifications to minimize liver stress. Prevent transmission of hepatitis to others. Address complications or comorbidities associated with hepatitis.

• #8

• #9 Medical management of severe acute alcoholic hepatitis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/medical-management-of-severe-acute-alcoholic-hepatitis/

  6. Severity and prognosis of AH should be evaluated using Maddrey Discriminant Function (MDF), Model for End-Stage Liver Disease (MELD), age, bilirubin, international normalized ratio, and creatinine (ABIC), or Glasgow scoring systems. Current treatments are based on this assessment. […] 7. Presence of systemic inflammatory response syndrome (SIRS) on admission is associated with an increased risk of multi-organ failure (MOF) syndrome. Development of MOF, usually due to infections developing after initial diagnosis of AH, is associated with a very high mortality rate. […] 8. Nephrotoxic drugs, including diuretics, should be avoided or used sparingly in patients with AH, since AKI is an early manifestation of MOF. […] 9. Patients with MDF > 32 or MELD score > 20 without a contraindication to glucocorticoid, such as hepatitis B viral infection, tuberculosis, or other serious infectious diseases, may be treated with methylprednisolone 32 mg daily, but the appropriate duration of treatment remains a subject of controversy. Methylprednisolone does not improve survival beyond 28 days, and the benefits for < 28 days are modest.

• #10

  https://link.springer.com/article/10.1007/s12072-017-9790-5

  Severe alcoholic hepatitis (SAH) is defined by modified Maddrey discriminant function 32 or Model for End-Stage Liver Disease (MELD) 21 and/or hepatic encephalopathy. […] Patients with severe alcoholic hepatitis need combined, i.e., static (MELD score) and dynamic (Lilles score), prognostication. […] Corticosteroids have been the standard-of-care therapy, albeit controversial. […] However, the recent Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) trial revealed that prednisolone was not associated with a significant reduction in 28-day mortality, with no improvement in outcomes at 90 days or 1 year. […] A paradigm shift from antiinflammatory therapy such as corticosteroids to liver regeneration treatment, e.g., granulocyte-colony stimulating factor, molecular targeted treatments, and fecal microbiota transplantation, for severe alcoholic hepatitis is taking place. […] Liver transplantation should be offered to select patients with severe alcoholic hepatitis who are nonresponsive to medical treatment.

• #11 Alcoholic Hepatitis

  https://www.massgeneral.org/condition/alcoholic-hepatitis

  Alcoholic hepatitis is liver damage caused by drinking too much alcohol over time. […] The goal of treatment is to prevent permanent damage to the liver and to begin healing so that the liver can function normally. […] You’ll need to stop drinking alcohol. To do this, you may need to be in an alcohol treatment program. […] You may be admitted to the hospital or treated on an outpatient basis. There is no medicine to cure alcoholic hepatitis. Treatment involves easing symptoms and supportive care. […] Because malnutrition is usually present, you’ll be treated with vitamins and attention to your food intake. […] You must completely stop drinking alcohol and may need an alcohol treatment program. Sometimes diet changes are advised, too.

• #12 Alcohol-associated hepatitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/alcohol-associated-hepatitis/

  Alcohol-associated hepatitis is a clinical syndrome with a broad range of manifestations, from vague malaise to fulminant liver failure. […] Complete alcohol abstinence is the key intervention. Supportive care includes nutritional support, monitoring for alcohol withdrawal, and treatment for alcohol use disorder. […] Patients with severe alcohol-associated hepatitis may benefit from glucocorticoids (with or without N-acetyl cysteine) or early liver transplantation. […] Alcohol cessation is the only management strategy with proven long-term benefits in alcohol-associated hepatitis. […] Ensure adequate calorie and micronutrient intake. […] In patients with severe disease (i.e., MELD 20), consider glucocorticoid therapy, IV n-acetylcysteine (NAC), and referral for early liver transplantation.

• #13 Alcoholic Hepatitis (Alcohol-Associated Hepatitis) Treatment & Management: Approach Considerations, Cessation of Alcohol Intake, Diet and Nutritional Support

  https://emedicine.medscape.com/article/170539-treatment

  Cessation of alcohol use is the mainstay of treatment for alcoholic hepatitis. The 2019 American Association for the Study of Liver Diseases (AASLD) alcoholic-associated liver disease guideline states that abstinence should be enjoined on patients with alcoholic hepatitis to improve long-term prognosis. […] For patients with milder alcoholic hepatitis, a general diet containing 100 g/d of protein is appropriate. Provide supplemental multivitamins and minerals, including folate and thiamine. […] Adequate nutritional support is of paramount importance for the survival and recovery of patients with alcoholic hepatitis. […] Use of medications in alcoholic hepatitis has been considered controversial. […] Orthotopic liver transplantation is widely used in patients with end-stage liver disease.

• #14 Alcoholic hepatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/alcoholic-hepatitis/diagnosis-treatment/drc-20351394

  Treatment for alcoholic hepatitis involves quitting drinking as well as therapies to ease the symptoms of liver damage. […] If you’ve been diagnosed with alcoholic hepatitis, you need to stop drinking alcohol and never drink alcohol again. It’s the only way that might reverse liver damage or keep the disease from getting worse. People who don’t stop drinking are likely to have some life-threatening health problems. […] If you depend on alcohol and want to stop drinking, your healthcare professional can suggest a therapy that meets your needs. It can be harmful to stop drinking all at once. So discuss a plan with your healthcare professional. […] Your healthcare professional might suggest a special diet to fix poor nutrition. You might be referred to an expert in diet to manage disease, called a dietitian. A dietitian can suggest ways to eat better to make up for the vitamins and nutrients you lack.

• #15 Alcoholic hepatitis | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/alcoholic-hepatitis

  If you’re diagnosed with alcoholic hepatitis, you must stop drinking alcohol. People who keep drinking alcohol have a high risk of serious liver damage and death. […] Treatment for alcoholic hepatitis involves quitting drinking as well as therapies to ease the symptoms of liver damage. […] If you’ve been diagnosed with alcoholic hepatitis, you need to stop drinking alcohol and never drink alcohol again. It’s the only way that might reverse liver damage or keep the disease from getting worse. People who don’t stop drinking are likely to have some life-threatening health problems. […] Your healthcare professional might suggest a special diet to fix poor nutrition. You might be referred to an expert in diet to manage disease, called a dietitian. A dietitian can suggest ways to eat better to make up for the vitamins and nutrients you lack. […] For many people with severe alcoholic hepatitis, the risk of dying is high without a liver transplant.

• #16 Alcoholic Hepatitis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/alcoholic-hepatitis

  Even if the damage is too severe to reverse, quitting drinking could prevent further harm to your liver. […] If you have an alcohol addiction and need help to stop drinking, talk with your doctor about the different treatment options for addiction. Hospitals and clinic facilities can offer inpatient and outpatient support for alcohol detoxification and recovery. […] Your doctor may also recommend counseling as part of treatment. Support from a therapist cant address your physical symptoms, but it can go a long way toward improving emotional well-being and helping you learn new coping skills to overcome alcohol cravings and avoid drinking. […] Following these recommendations can improve symptoms and make a difference in your outlook. […] Quitting drinking gradually and getting medical care right away can go a long way toward improving your outlook.

• #17 Alcoholic Hepatitis | Cornerstone Healing Center

  https://cornerstonehealingcenter.com/alcoholic-hepatitis/

  Alcoholic hepatitis is a severe condition resulting from long-term, excessive alcohol consumption that leads to liver inflammation and damage. […] Alcoholic hepatitis is essentially the liver’s plea for help, a critical point where reevaluating one’s drinking habits becomes essential for health. […] Treating alcoholic hepatitis focuses on halting further liver damage, managing symptoms, and addressing the root cause. […] Alcohol Abstinence: The most critical step in treatment. Ceasing alcohol intake can prevent further liver damage and is essential for recovery. […] Nutritional Support: Adequate nutrition is notable for patients with alcoholic hepatitis. Many individuals with this condition suffer from malnutrition, which can exacerbate liver damage and impede recovery. […] The significance of nutritional interventions in managing alcoholic hepatitis is underscored by the study by Haber et al., 2003. […] Addressing alcoholic hepatitis with a multifaceted approach enhances patient care and supports better health outcomes, highlighting the importance of prompt action and comprehensive treatment strategies.

• #18 Alcoholic Hepatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html

  Nutritional support can include low-volume intravenous fluids for dehydration; intravenous or oral thiamine to decrease risk of Wernicke encephalopathy; and supplemental folate, vitamin B6, vitamin B12, and zinc for common vitamin deficiencies. […] Daily energy intake of 35 to 40 kcal per kg of body weight and daily protein intake of 1.2 to 1.5 g per kg of body weight are recommended. […] During inpatient management, using a structured alcohol withdrawal protocol in conjunction with a standard instrument such as the Clinical Institute Withdrawal Assessment for Alcohol Revised to guide benzodiazepine dosing can prevent withdrawal symptoms, including delirium tremens and seizures. […] Given the high rate of concomitant infections in patients with alcoholic hepatitis, it is reasonable to administer broad-spectrum empiric antibiotics while awaiting culture results.

• #18 Alcoholic Hepatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html

  Alcoholic hepatitis is a clinical syndrome characterized by acute-onset jaundice and liver enzyme abnormalities in the setting of long-term heavy alcohol use. […] Close monitoring for inflammation and organ failure is crucial throughout hospitalization. […] Treatment for moderate disease primarily consists of supportive care, including alcohol cessation and nutritional support. […] Corticosteroids are recommended for severe alcoholic hepatitis. […] Hospital physicians should involve a multidisciplinary team, including substance abuse specialists, gastroenterologists or hepatologists, nephrologists, dietitians, and intensivists, as appropriate. […] Long-term follow-up should focus on abstinence from alcohol, management of underlying cirrhosis, and evaluation for liver transplantation if indicated.

• #19 6 Hepatitis Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/hepatitis-nursing-care-plans/

  Goals and expected outcomes may include: The client will maintain adequate hydration, as evidenced by stable vital signs, good skin turgor, capillary refill, strong peripheral pulses, and individually appropriate urinary output. The client will report an improved sense of energy. The client will perform ADLs and participate in desired activities at the level of ability. The client will verbalize understanding of the disease process, prognosis, and potential complications. The client will identify the relationship between signs/symptoms of the disease and correlate symptoms with causative factors. The client will verbalize understanding of therapeutic needs. The client will initiate necessary lifestyle changes and participate in treatment regimen. […] Therapeutic interventions and nursing actions for patients with hepatitis may include: Encourage mouth care before meals. Enhances appetite by eliminating unpleasant tastes. Recommend eating in an upright position. Reduces the sensation of abdominal fullness and may enhance intake. Encourage the intake of fruit juices, carbonated beverages, and hard candy throughout the day. These supply extra calories and may be more easily digested or tolerated than other foods. Consult with the dietitian, and nutritional support team to provide a diet according to the patients needs, with fat and protein intake as tolerated.

• #20 Medical management of severe acute alcoholic hepatitis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/medical-management-of-severe-acute-alcoholic-hepatitis/

  1. Abstinence from drinking alcohol is the cornerstone of treatment for alcohol hepatitis (AH). […] 2. Patients with jaundice and suspected AH should have cultures of blood, urine and ascites, if present, to determine the presence of bacterial infections regardless of whether they have fever. […] 3. Patients with AH who have jaundice should be admitted to the hospital to encourage abstinence, restore adequate nutrition and exclude serious infections. […] 4. Imaging of the liver is warranted as part of the evaluation, but caution should be used in administering iodinated contrast dye, as it increases the risk of acute kidney injury (AKI). […] 5. Patients with AH require a diet with 1-1.5 g protein and 30-40 kcal/kg body weight for adequate recovery. If the patient is unable to eat because of anorexia or altered mental status, a feeding tube should be considered for enteral feeding. Parenteral nutrition alone is inadequate.

• #21 Alcoholic Hepatitis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/p412.html

  After workup and culture findings rule out alternative diagnoses and any infections have been treated successfully, guidelines support initiating oral corticosteroids in patients with severe alcoholic hepatitis. […] Corticosteroid use should be discontinued in patients who do not show an initial response. […] There is growing support for early liver transplantation in some patients with severe alcoholic hepatitis, rather than requiring six months of alcohol abstinence and engagement in alcohol cessation counseling. […] Goals of care should be addressed with the patient and family early in the course of illness.

• #22 Medical management of severe acute alcoholic hepatitis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/medical-management-of-severe-acute-alcoholic-hepatitis/

  10. Patients with a contraindication to glucocorticoids may be treated with pentoxifylline 400 mg three times daily with meals. Data regarding the efficacy are conflicting. […] 11. Patients with severe AH, particularly those with a MELD score > 26 with good insight into their alcohol use disorder and good social support should be referred for evaluation for liver transplantation, as the 90-day mortality rate is very high. […] 12. Patients with mild to moderate AH defined by a MELD score < 20 and MDF < 32 should be referred for abstinence counseling and prescribed a high protein diet supplemented with B vitamins and folic acid.

• #23 Severe alcoholic hepatitis-current concepts, diagnosis and treatment options

  https://www.wjgnet.com/1948-5182/full/v6/i10/688.htm

  Pentoxifylline shows an antioxidant effect and weakly inhibits tumor necrosis factor-alpha (TNF-) synthesis. In patients with severe ASH receiving pentoxifylline, a 6-mo survival rate was higher than in those treated with placebo. However, this beneficial effect was challenged by two recent meta-analyses demonstrating that pentoxifylline decreased the risk of fatal HRS but did not improve survival significantly, although it remains inconclusive. […] There is a pressing need for better definitions to distinguish AH from other clinical syndromes. The definitions need to be related to risk and outcomes, to improve clarity of taxonomy, reduce problems with basic vs clinical classification, and aid in treatment decisions. To standardize the nomenclature of AH, we should compare the clinical, analytical, and molecular characteristics of early ASH that is completely asymptomatic with those of classical AH that appears in patients with jaundice and/or decompensation.

• #24 Pulsenotes | Alcoholic hepatitis notes

  https://app.pulsenotes.com/medicine/hepatology/notes/alcoholic-hepatitis

  Alcoholic hepatitis is characterised by jaundice, anorexia, fever and tender hepatomegaly. […] A combination of clinical features and laboratory findings are used to make a diagnosis of alcoholic hepatitis. […] Patients with alcoholic hepatitis may have mild disease without complications or severe liver injury. […] The key principles for all patients with alcoholic hepatitis include managing alcohol withdrawal, alcohol cessation, hydration, nutrition, aggressive treatment of infections, and pharmacological therapy. […] Patients with severe alcoholic hepatitis should be considered for corticosteroid therapy. […] Severe alcoholic hepatitis is associated with a poor short-term survival. […] During the course of alcoholic hepatitis, particularly severe cases, patients are at increased risk of numerous complications.

• #25 Severe alcoholic hepatitis-current concepts, diagnosis and treatment options

  https://www.wjgnet.com/1948-5182/full/v6/i10/688.htm

  In patients with severe AH, renal impairment is a frequently accompanied symptom during hospitalization and also represents an important predictor of infection and survival. The most common cause of acute renal dysfunction is HRS. To prevent HRS, nephrotoxic drugs such as nonsteroidal anti-inflammatory drugs, aminoglycoside, diuretics, and contrast dye should be avoided and volume expanders including albumin and fresh frozen plasma might be administered. […] Specific therapies are indicated for patients with severe AH (MDF 32) who are at high risk of early death according to clinical prognostic scores. The impact of corticosteroid treatment on survival in those with severe AH has been under debate for the last three decades because of heterogeneity of the study design among different studies and selection bias from ambiguous diagnostic criteria lacking histologic confirmation.

• #26 Alcoholic hepatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/alcoholic-hepatitis/diagnosis-treatment/drc-20351394

  If you have trouble eating, your care professional might suggest a feeding tube. A tube is passed down the throat or through the side and into the stomach. A special nutrient-rich liquid diet is then passed through the tube. […] For many people with severe alcoholic hepatitis, the risk of dying is high without a liver transplant. […] To find a program that works with people who have alcoholic hepatitis. […] To follow the rules of the program. This includes making a promise not to drink alcohol for the rest of your life.

• #27 Alcoholic hepatitis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/alcoholic-hepatitis

  For many people with severe alcoholic hepatitis, the risk of dying is high without a liver transplant. […] For transplant to be an option, you would need: To find a program that works with people who have alcoholic hepatitis. To follow the rules of the program. This includes making a promise not to drink alcohol for the rest of your life.

• #28 11.15 Hepatitis – Health Alterations

  https://wtcs.pressbooks.pub/healthalts/chapter/11-15-hepatitis/

  Nurses monitor vital signs, 24-hour input and output, daily weight trends, and for signs of edema. […] Nursing interventions include the following actions: Optimize nutrition: Anorexia is a common symptom. […] Promote fluid balance: Prescribed intravenous fluids and electrolytes are administered as indicated. […] Prevent bleeding: The client is encouraged to use an electric shaver and a soft-bristled toothbrush or sponge swabs and mouthwash to prevent bleeding. […] Manage fatigue: Bed rest is typically prescribed during acute illness. […] Prevent skin breakdown and maintain skin integrity: Skin is routinely assessed for areas of redness and breakdown. […] Provide emotional support: Nurses perform active listening and encourage the client to verbalize their feelings and concerns. […] Make referrals: Nurses refer clients to community resources, support groups, and drug/alcohol treatment programs as indicated.

• #29 6 Hepatitis Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/hepatitis-nursing-care-plans/

  Monitor IO, and compare with periodic weight. Note enteric losses: vomiting and diarrhea. Provides information about replacement needs and effects of therapy. […] Monitor for recurrence of anorexia and liver tenderness or enlargement. Indicates a lack of resolution and exacerbation of the disease, requiring further rest, and a change in the therapeutic regimen. […] Observe skin for areas of redness, and breakdown. Early detection of problem areas allows for additional intervention to prevent complications/promote healing. […] Assess effect of illness on economic factors of patient and SO. Financial problems may exist because of loss of patients role functioning in the family and prolonged recovery. […] Assess level of understanding of the disease process, expectations and prognosis, possible treatment options. Identifies areas of lack of knowledge or misinformation and provides opportunity to give additional information as necessary. Liver transplantation may be needed in the presence of fulminating disease with liver failure. […] Review necessity of avoidance of alcohol for a minimum of 612 mo or longer based on individual tolerance. Increases hepatic irritation and may interfere with recovery.

• #30

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh3001

  Alcoholic hepatitis is damage to the liver. It is caused by long-term heavy drinking. The liver gets inflamed and swollen and can’t remove waste products from the body. […] Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. […] Do not drink alcohol. Alcohol can damage the liver. Tell your doctor if you need help to quit. Counselling, support groups, and sometimes medicines can help you stay sober. […] Call your doctor or nurse advice line now or seek immediate medical care if: You feel very sleepy or confused. You have a fever. There is a new or increasing yellow tint to your skin or the whites of your eyes. You have new or worse belly pain. You have any abnormal bleeding. […] Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if: You have any problems. Your belly is getting bigger. You are gaining weight.

• #31 Alcoholic Hepatitis: Causes, Symptoms, Treatment, & Prevention | Zinnia Health

  https://zinniahealth.com/substance-use/alcohol/alcoholic-hepatitis

  The most effective prevention measure is to cease alcohol consumption entirely. For those at risk or diagnosed with alcoholic hepatitis, stopping alcohol intake is paramount. This step allows the liver to recover and reduces the risk of further damage. […] Individuals struggling with alcohol dependence should seek professional assistance. Alcohol cessation programs, counseling, and support groups can provide guidance and motivation for sustained abstinence. Healthcare professionals can tailor treatment plans to individual needs. […] Proper nutrition supports liver regeneration and helps combat the effects of malnutrition associated with alcohol abuse. A diet that is rich in vitamins, minerals, and antioxidants will be beneficial to overall liver function. […] Routine medical check-ups are essential for early detection and monitoring of liver health. Regular blood tests and liver function assessments can identify potential issues before they progress to more severe conditions. Timely intervention can significantly improve outcomes.

• #32 Will Alcoholic Hepatitis Go Away?

  https://whitelightbh.com/resources/will-alcoholic-hepatitis-go-away/

  Regular check-ups with your doctor are essential for monitoring your condition and treatment progress. […] If you’re struggling with abstaining from alcohol while managing alcoholic hepatitis, an addiction rehab center can provide a safe and supportive environment to start your recovery journey. […] Residential programs are appropriate for people who have been drinking heavily for several years and who have made multiple attempts to abstain from alcohol. […] This level of care may also be helpful for clients who have underlying medical issues like alcoholic hepatitis. […] Alcoholic hepatitis is a severe condition that can cause long-term damage to the liver. […] Yes, alcoholic hepatitis can be reversible, especially if detected and treated early. […] Ceasing alcohol consumption is crucial for recovery, along with medical interventions such as medication, nutritional support, and possibly liver transplantation in severe cases.

• #33 Will Alcoholic Hepatitis Go Away?

  https://whitelightbh.com/resources/will-alcoholic-hepatitis-go-away/

  The most important part of treatment for alcoholic hepatitis is abstaining from alcohol altogether. […] Other essential elements of alcoholic hepatitis treatment include nutritional support, steroid therapy, and anti-infection medications. […] Regular check-ups are essential to monitor your progress and ensure your liver functions properly. […] During your visits to the doctor, you will get feedback about how your recovery from alcoholic hepatitis is going. […] Taking care of your physical, mental, and emotional health is essential for managing this or any other medical condition. […] Eating a healthy diet is an essential part of managing alcoholic hepatitis. […] Its essential to develop a support network when coping with alcoholic hepatitis. […] Relapse can be a severe risk for people with alcoholic hepatitis because drinking alcohol is detrimental to their healing progress.

• #34 Patients With Alcohol Use Disorder Face Barriers to Lifesaving Hepatitis C Treatment, Study Finds < Yale School of Medicine

  https://medicine.yale.edu/news-article/patients-with-alcohol-use-disorder-face-barriers-to-lifesaving-hepatitis-c-treatment-new-study-finds/

  Patients who have alcohol and other substance use disorders are often marginalized in the medical system and experience barriers to care, largely due to stigma, says Haque. […] It is important for us to ensure that all patients, including those with alcohol and other substance use disorders, receive these lifesaving treatments. […] The team found patients who had an alcohol use disorder whether abstinent or not had a lower chance of receiving DAA treatment. […] Because of the stigma associated with alcohol use disorder as well as assumptions regarding adherence, some clinicians have been reluctant to initiate DAAs for patients with alcohol or other substance use disorders, she says. […] Although it is important for clinicians to provide holistic care for patients with hepatitis C infection, including treatment of alcohol and other substance use disorders when indicated, requiring abstinence or engagement in addiction treatment prior to DAA initiation may lead to delays and unintended harm, Haque says. […] Theres a great need to be able to integrate care for patients with co-occurring addiction and liver diseases so that patients have access to both forms of lifesaving treatment, she says.

• #35 Alcohol and Viral Hepatitis – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hcv/clinical-management/alcohol.asp

  When counseling a patient with hepatitis C, always evaluate the patient’s history of and current use of alcohol. Generally speaking, alcohol is a toxin that causes inflammation of the liver. When both alcohol and viral hepatitis are present, they can have a synergistic effect in causing liver damage. Research has shown that fibrosis scores in hepatitis C patients have correlated with patients’ degree of alcohol use. There is strong evidence that heavy alcohol use (50 grams per day) is associated with higher likelihood of advanced fibrosis in hepatitis C patients. Reducing and minimizing alcohol intake is one thing that patients with hepatitis C can do in their lifestyle to help reduce the progression to serious liver disease. However, controversy exists on the question of what amount of alcohol is safe in patients with hepatitis C.

• #36 Alcohol and Viral Hepatitis – Viral Hepatitis and Liver Disease

  https://www.hepatitis.va.gov/hcv/clinical-management/alcohol.asp

  It is important to note: […] For patients with cirrhosis, due to hepatitis C or any other cause, there is a clear recommendation for zero alcohol consumption. […] The most important message for patients is that alcohol can worsen their liver disease. Recommending minimal alcohol is usually reasonable. […] Providers should recommend minimal alcohol use in patients without cirrhosis and zero alcohol use in patients with cirrhosis. […] There is a high prevalence of drinking among patients with hepatitis C. Collaborate with local substance abuse clinics and mental health providers to address this critical component of viral hepatitis patient care.

• #37 Compassionate Care for Alcohol-Related Hepatitis | Digestive Health Services | University Hospitals | Cleveland, Ohio | University Hospitals

  https://www.uhhospitals.org/services/digestive-health-services/conditions-and-treatments/liver-disease/conditions-and-treatments/alcohol-related-hepatitis

  Hepatitis is inflammation of the liver that can have many causes. When this inflammation is caused by long-term alcohol use, it is called alcohol-related hepatitis. […] Untreated, any type of hepatitis can cause lasting damage to your liver and lead to life-threatening complications, including liver failure. Women are at higher risk of developing alcohol-related hepatitis, perhaps due to differences in how men and women process alcohol. […] Alcoholic hepatitis can be mild, moderate or severe. In cases of advanced disease, symptoms can be severe and appear suddenly. The symptoms may include: Abdominal pain, Ascites (fluid buildup in the belly), Clay-colored stools and diarrhea, Fatigue, Fever or chills, Weight loss, Yellowing of the skin and eyes (jaundice). […] Once a person is confirmed to have alcohol-related hepatitis through a variety of diagnostic tests and a thorough medical and family history, your doctor may recommend the following: Alcohol cessation with mild to moderate disease, it may be possible to reverse the disease process by stopping all alcohol consumption, Steroid medications to help reduce liver inflammation, Nutrition counseling, Improved hydration.

• #38 Fecal Therapy Shows Survival Benefit in Severe Alcoholic Hepatitis | MedPage Today

  https://www.medpagetoday.com/meetingcoverage/aasld/112967

  Adding fecal microbiota therapy to standard care for steroid-ineligible severe alcoholic-associated hepatitis appeared safe and effective in a small randomized trial from India. […] „Fecal microbiota therapy is safe in selected steroid-ineligible patients and leads to improvement in liver function and severity scores along with better liver transplant-free survival than standard medical therapy,” said Sarin, adding that the approach should be further evaluated in a larger trial. […] Severe alcoholic-associated hepatitis is linked with very poor survival rates. While corticosteroids remain the first choice of treatment, they are only effective in a subset of patients. „In our experience, about 80% of patients with [severe alcoholic-associated hepatitis] are steroid-ineligible when they are hospitalized,” Sarin explained. „So for them, there are very few options.”

• #39 Mitchell Shiffman, MD: Current Alcohol-Associated Hepatitis Care, Larsucosterol’s Potential

  https://www.hcplive.com/view/mitchell-schiffman-md-current-alcohol-associated-hepatitis-care-larsucosterol-potential

  In the absence of an FDA-approved therapeutic for the treatment of alcohol-associated hepatitis, abstinence and adequate nutritional support serve as the cornerstone of treatment for affected patients. […] Patients with severe alcohol-associated hepatitis are also candidates for treatment with corticosteroids, although their use is controversial due to a potential lack of long-term benefits. […] Currently, the only accepted therapy, although the data for this becomes weaker and weaker over time, is the use of corticosteroids. […] If I have people with severe alcoholic hepatitis that are stable or look like they’re getting better, then I usually don’t give them any treatment. […] However, a new treatment option may be on the horizon for patients with severe alcohol-associated hepatitis: larsucosterol. […] Larsucosterol is a very interesting drug in that it interacts with a protein called DNA methyltransferase, explaining how DNA methyltransferase activity prevents downstream genes from being produced to assist alcohol-associated hepatitis recovery, also called gene silencing.

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