월요점심집담회. EndoTODAY 이준행

[일원내시경교실 월요점심집담회 2016-5-16. 신동현 교수님 특강 (alcoholic hepatitis)]

신동현 교수님의 멋진 특강이 있었습니다. 제목은 alcoholic hepatitis입니다. 정확히 진단하여 적절히 steroid를 쓰자는 것이 요지라고 생각됩니다. 인상적인 슬라이드 몇 장 골라보았습니다.

Patients must first be accurately diagnosed with AH, based on history, physical examination, and analyses of blood samples and, in some cases, biopsies collected via the transjugular route. Alcohol dependence should be determined and treated initiated at this point. Patients should then be assessed for complications such as infections, upper gastrointestinal bleeding, and renal failure. Patients’ nutritional needs should then be addressed; patients should be given 35 - 40 cal/kg/day orally or enterally, as well as 1.2 - 1.5 g protein/kg/day. The severity of AH should then be assessed. Patients with a MDF≥32 and MELD>20 should receive prednisolone (40 mg/day) with or without NAC for 7 days, and then bilirubin should be measured. Patients with Lille scores below 0.45 should continue treatment for 28 days. Patients with Lille scores above 0.45 should stop treatment. There are no specific treatments for patients with DF<32 and MELD≤20.