February 2016 Quiz 2

Q2: ANSWER: D

Critique

This is a patient with severe alcoholic hepatitis complicated by sepsis with a Maddrey’s discriminant function greater than 32. Pentoxifylline 400 mg t.i.d. would be the most appropriate choice for treatment. Pentoxifylline is a nonselective phosphodiesterase inhibitor that decreases tumor necrosis factor gene transcription. In one study of severe alcoholic hepatitis, it appeared to reduce both mortality and renal failure. It may have a beneficial effect in preventing HRS. Prednisone would not be optimal in the setting of active infection and sepsis. Anti-TNF treatment has been associated with increased risk of severe infections and this and propylthiouracil have not shown benefit in the treatment of alcoholic hepatitis. For this patient with severe alcoholic hepatitis, treatment will improve survival and observation would not be adequate.

References

1. O’Shea R.S., Dasarathy S., McCullough A.J.. Alcoholic liver disease. Hepatology 2010;51:307-28.
2. Mathurin P., Mendenhall C.L., et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480-7.

Q2: ANSWER: D

Critique

This is a patient with severe alcoholic hepatitis complicated by sepsis with a Maddrey’s discriminant function greater than 32. Pentoxifylline 400 mg t.i.d. would be the most appropriate choice for treatment. Pentoxifylline is a nonselective phosphodiesterase inhibitor that decreases tumor necrosis factor gene transcription. In one study of severe alcoholic hepatitis, it appeared to reduce both mortality and renal failure. It may have a beneficial effect in preventing HRS. Prednisone would not be optimal in the setting of active infection and sepsis. Anti-TNF treatment has been associated with increased risk of severe infections and this and propylthiouracil have not shown benefit in the treatment of alcoholic hepatitis. For this patient with severe alcoholic hepatitis, treatment will improve survival and observation would not be adequate.

References

1. O’Shea R.S., Dasarathy S., McCullough A.J.. Alcoholic liver disease. Hepatology 2010;51:307-28.
2. Mathurin P., Mendenhall C.L., et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480-7.

Q2: ANSWER: D

Critique

This is a patient with severe alcoholic hepatitis complicated by sepsis with a Maddrey’s discriminant function greater than 32. Pentoxifylline 400 mg t.i.d. would be the most appropriate choice for treatment. Pentoxifylline is a nonselective phosphodiesterase inhibitor that decreases tumor necrosis factor gene transcription. In one study of severe alcoholic hepatitis, it appeared to reduce both mortality and renal failure. It may have a beneficial effect in preventing HRS. Prednisone would not be optimal in the setting of active infection and sepsis. Anti-TNF treatment has been associated with increased risk of severe infections and this and propylthiouracil have not shown benefit in the treatment of alcoholic hepatitis. For this patient with severe alcoholic hepatitis, treatment will improve survival and observation would not be adequate.

References

1. O’Shea R.S., Dasarathy S., McCullough A.J.. Alcoholic liver disease. Hepatology 2010;51:307-28.
2. Mathurin P., Mendenhall C.L., et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol. 2002;36:480-7.