Alcoholic Hepatitis - Management Algorithm Assess Eligibility for Treatment: - Maddrey Discriminant Function ≥ (or possibly MELD >20) - Obtain abdominal to exclude other causes of jaundice - Screen for infection with chest x-ray, blood, urine and ascites cultures Assess for Contraindications to Treatment: - Acute kidney injury with serum creatinine >2.5 mg/dL - Uncontrolled upper gastrointestinal bQiing - Concomitant diseases including HBV. HCV, DILI, HCC, acute pancreatitis. HIV, TB - Multiorgan failure or shock Eligible for Treatment: - Start prednisolone 40 mg daily or equivalent with or without IV N-acetylcysteine - Enteral nutrition goal of >21 kcal/kg Use Lille model after 7 days of treatment: - If Lille < 0.45 continue prednisolone for 28 days - If Lille ≥ 0.45. stop prednisolone #Alcoholic #Hepatitis #Management #Algorithm #hepatology
