In a patient with ascites and a history of heavy alcohol use, combination of the following is indicative of alcholic hepatitis until proven otherwise, except:
A. aspartate aminotransferase (AST) level that is elevated (but <300 IU per milliliter), and a ratio of the aspartate aminotransferase level to the alanine aminotransferase (ALT) level that is more than 2
B. a total serum bilirubin level of more than 5 mg per deciliter (86 μmol per liter)
C. Elevated CPK
D. an elevated INR
E. neutrophilia
Answer: C
The combination of an aspartate aminotransferase level that is elevated (but <300 IU per milliliter) and a ratio of the aspartate aminotransferase level
to the alanine aminotransferase level that is more than 2, a total serum bilirubin level of more than 5 mg per deciliter (86 μmol per liter), an elevated
INR, and neutrophilia in a patient with ascites and a history of heavy alcohol use is indicative of alcoholic hepatitis until proven otherwise. Elevated is not a characteristic feature. Elevated creatinine is also possible, but it is already an ominous sign which portends the onset of hepatorenal syndrome.
Reference
Michael R. Lucey, M.D., Philippe Mathurin, M.D., Ph.D., and Timothy R. Morgan, M.D.Review. Alcoholic Hepatitis. NEJM, Volume 360:2758-2769 June 25, 2009 Number 26