So I think I happened across the oldest case of alcoholic hepatitis ever. He was 99 years old and loved his vodka. He even admitted to a "little vodka every night". He came in with a classic 2:1 AST:ALT ratio on his liver enzymes in a non obstructive pattern. But it didn't click with me at the time. He's 99 years old. What kind of 99 year old gets alcoholic hepatitis? It's unheard of.
In the course of his ER evaluation, he was found to have a markedly dilated common bile duct of 25 mm, despite his previous cholecystectomy. With a little conservative management By doing nothing but observing him for a few days all his liver enzymes returned to normal.
That's how you diagnose alcoholic hepatitis in a 99 year old. Patients lie to their doctor, even the 99 year olds. So what. You're my hero, old man. Don't let anyone tell you differently. Just make sure the social worker sends you to a vodka friendly nursing home where you might even meet my patient who was drunk at the nursing home. You guys can be roommates.
You can discover more oddities of medicine by checking out my record clinical findings.
