clinically cirrhotic, but not on imaging?

[Eyeaboutthat]

If you have a chronic alcoholic with ascites, but imaging shows fatty enlarged liver, would this be alcoholic hepatitis or cirrhosis? Confused because thought ascites is sequelae of fibrotic liver and portal hypertension, so would expect abdominal ultrasound to show atrophied, nodular liver.

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[Eyeaboutthat]

If you have a chronic alcoholic with ascites, but imaging shows fatty enlarged liver, would this be alcoholic hepatitis or cirrhosis? Confused because thought ascites is sequelae of fibrotic liver and portal hypertension, so would expect abdominal ultrasound to show atrophied, nodular liver.

Sorry, found the answer online:
"We conclude that portal hypertension in the course of acute hepatitis is related to the severity of liver damage and is a major factor in the development of ascites. Portal hypertension is mainly determined by intrahepatic vascular space being reduced by the collapse of sinusoids."

 

[funkreatitis]

Alc hep, depending on its severity, can look identical to decompensated cirrhosis, even including sequela and imaging and when the inflammation gets better so do all the sequela, we see this all the time.

 

[Gastrapathy]

But nearly everyone with alc hep is cirrhotic too

 

[IM2GI]

Alc hep, depending on its severity, can look identical to decompensated cirrhosis, even including sequela and imaging and when the inflammation gets better so do all the sequela, we see this all the time.

Because the alc hep decompensated them, as most already have cirrhosis/advanced fibrosis. The ones that recover will often re-compensate with medical management depending on the severity of the event/pre-existing fibrosis.

As for the OP, ultrasound is not a perfect imaging test for cirrhosis. APRI scores, fibroscans, can help if there is ambiguity. In the setting of acute alcoholic hepatitis though not all that useful.

 

[Redpancreas]

Biopsy with bridging fibrosis, etc is the only real way from what I’ve heard.