{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 21, Ep 2 of 2: Alcohol-Associated Liver Disease and Early Transplant","html":"","width":"100%","height":180,"duration":714,"description":"Episode two moves along the alcohol continuum to alcohol-associated liver disease, one biology read across steatosis, steatohepatitis, and cirrhosis, then zeroes in on the acute superimposed syndrome of severe alcoholic hepatitis. The organizing idea: severe disease is defined by a Maddrey above thirty-two or a MELD over twenty, treated with prednisolone only after infection is excluded, with the day-seven Lille score as the binary decision to continue or stop. It works through the AST-greater-than-ALT lab signature, the ethanol-metabolism mechanism that drives it, and the drug interactions that follow. The close is early transplant for selected steroid nonresponders, which retired the old six-month sobriety rule in favor of a structured psychosocial assessment.\n \nTopics covered\n\nThree-stage spectrum: steatosis, steatohepatitis, cirrhosis\nEthanol metabolism, the NADH shift, and drug interactions\nRisk modifiers: sex, genetics, and the acetaldehyde variant\nThe AST-greater-than-ALT lab pattern\nSevere alcoholic hepatitis and the consensus diagnostic criteria\nMaddrey and MELD severity thresholds\nPrednisolone therapy and mandatory infection screening\nThe day-seven Lille response decision\nEarly transplant selection criteria\n \n \nKey decisions\n\nDiagnose probable alcoholic hepatitis from jaundice within two months, heavy use for at least six months, an AST between fifty and four hundred with a ratio over one and a half, and a bilirubin over three, letting you skip biopsy in the typical patient.\nDefine severe disease by a Maddrey discriminant function above thirty-two or a MELD over twenty; MELD-Na is not used here.\nExpect an AST-to-ALT ratio above one and a half, often above two, with both under four hundred; transaminases over four hundred in a drinker signal something on top of alcohol, classically acetaminophen or ischemic hepatitis.\nGive prednisolone forty milligrams daily for up to twenty-eight days, but only after culturing blood, urine, and ascites and imaging the...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}