31-Year-Old Woman With Jaundice and Abdominal Pain

The diagnosis of acute liver failure requires severe acute liver injury and impaired synthetic function (INR >1.5) along with which one of the following additional features? a. Portal hypertension b. Hepatic encephalopathy c. Less than 7 days of symptoms d. An identifiable etiology e. Jaundice Identification of acute liver failure is crucial as mortality in patients not receiving liver transplant approaches 30%.3 Whereas portal hypertension is frequently observed in patients with subacute liver failure, this is not required for diagnosis of liver failure. [...]after gastric bypass, there is decreased first pass metabolism in the stomach via alcohol dehydrogenase and gastric emptying is greatly accelerated secondary to a decreased stomach size, which leads to increased absorption of alcohol in the jejunum.7 Weight loss does not increase risk of alcoholic hepatitis. [...]1 year prior, she completed a 2-month inpatient rehabilitation program for her alcohol abuse. 4.Which of the following laboratory values is most helpful in determining prognosis and utility of steroids in patients with alcoholic hepatitis? a. PT b. Leukocytes c. Albumin d. Sodium e. Creatinine The Maddrey discriminant function (MDF) can be used to predict prognosis and indicate utility of steroids in patients with severe alcoholic hepatitis. The National Institute on Alcohol Abuse and Alcoholism defines a standard drink as either 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.21 Individuals are considered low-risk for developing alcohol use disorder when alcohol consumption is as follows: no more than 3 drinks on a single day and no more than 7 drinks per week for women and no more than 4 drinks on a single day and no more than 14 drinks per week for men.22 As alcohol consumption in the United States continues to increase, so too will the incidence of alcoholic hepatitis.