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Continuing Medical Education Questions: February 2018: ACG Clinical Guideline: Alcoholic Liver Disease

Umashanker, Renuka, MD, FACG1

American Journal of Gastroenterology: February 2018 - Volume 113 - Issue 2 - p 195
doi: 10.1038/ajg.2018.4
CLINICAL GUIDELINES
Free
CME

1Gastroenterology of CT, Hamden, CT

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LEARNING OBJECTIVES

After this activity, the participant will discuss the clinical implications of alcoholic liver disease and its treatment.

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QUESTIONS:

1. Which of the following environmental risk factors is most important when determining the risk of cirrhosis in heavy drinkers?

A. Caffeine

B. Obesity

C. Binge drinking

D. Type of alcoholic beverage consumed

2. A 54-year-old man presents with complaints of fatigue and malaise. He reports a decrease in appetite and a weight loss of 20 pounds over the last year. He reports occasional looser bowel movements but denies nausea, vomiting, or rectal bleeding. He also reports drinking 6 beers per day for longer than 5 years. On physical examination he appears malnourished but otherwise alert and oriented. His vital signs are normal, lungs are clear to auscultation, and heart sounds are normal. Scleral icterus and spider angiomas along his neck and chest wall are observed, as well as pitting edema and palmar erythema. Bowel sounds are normal with mild hepatosplenomegaly. Laboratory values show white blood cells 4.1, hemoglobin 11.9, platelets 75K, prothrombin time 18 seconds, bilirubin 9 mg/dl, AST 250 U/L, ALT 160 U/L, alkaline phosphatase 160 IU/L, and discriminant function 36. You decide to start the patient on prednisolone 40 mg per day.

What next step do you take with this patient?

A. Monitor for response to prednisolone therapy at 4 weeks using the Lille score.

B. Monitor for response to prednisolone therapy at 4 weeks using the model for end-stage liver disease (MELD) score.

C. Monitor for response to prednisolone therapy at 1 week using the Lille score.

D. Monitor for response to prednisolone therapy at 1 week using the discriminant function.

3. What percentage of patients with steatosis will have histological evidence of hepatic infl ammation with continued excessive alcohol ingestion?

A. 10%

B. 25%

C. 33%

D. 50%

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