A 48-year-old man presents to the clinic with progressive jaundice and fatigue over the past 5 days. He reports consuming approximately 12 beers daily for many years and last drank alcohol 2 days ago. His medical history is otherwise unremarkable. He does not take any medications. Temperature is 37.9°C (100.2°F), blood pressure is 118/72 mm Hg, pulse is 98/min, and respiratory rate is 16/min. Physical examination reveals jaundice, hepatomegaly, and mild right upper quadrant tenderness. Laboratory studies show the following:
Which of the following findings most strongly supports the diagnosis of alcohol-associated hepatitis?
The correct answer is:
B: AST greater than ALT.
Alcohol-associated hepatitis typically presents with jaundice, hepatomegaly, and moderate transaminase elevations in which AST exceeds ALT, often by a ratio greater than 2:1. The absolute values are usually below 500 U/L. Chronic excessive alcohol consumption and the characteristic laboratory pattern strongly support the diagnosis.
Answer choice A: ALT greater than AST, is incorrect.
This pattern is more typical of viral hepatitis and many other hepatocellular injuries.
Answer choice C: Lipase greater than three times normal, is incorrect.
Marked lipase elevation suggests acute pancreatitis rather than alcoholic hepatitis.
Answer choice D: Positive antimitochondrial antibodies, is incorrect.
Antimitochondrial antibodies are associated with primary biliary cholangitis.
Answer choice E: Severe alkaline phosphatase elevation without transaminase elevation, is incorrect.
A predominantly cholestatic pattern suggests biliary disease rather than alcoholic hepatitis.
Key Learning Point
Alcohol-associated hepatitis classically demonstrates AST predominance, often with an AST:ALT ratio greater than 2:1.
