Yes—Severe Alcoholic Hepatitis is the best ALD case for an interactive case discussion. Here's a presentation outline similar to your Crohn disease PPT. --- Slide 1 Severe Alcoholic Hepatitis Case Discussion --- Slide 2 – Clinical Case Clinical Question A 46-year-old man presents to the emergency department with: Progressive jaundice for 10 days Fever Right upper quadrant abdominal pain Loss of appetite Increasing abdominal distension He has consumed 8–10 drinks daily for the past 18 years. His last drink was 3 days ago. On examination: Temperature: 38.3°C BP: 100/60 mmHg Pulse: 108/min Scleral icterus Tender enlarged liver Mild ascites Spider angiomas What is the most likely diagnosis? A. Acute viral hepatitis B. Severe alcoholic hepatitis C. Acute cholecystitis D. Autoimmune hepatitis E. Drug-induced liver injury --- Slide 3 – Patient Summary Patient Profile 46-year-old man Heavy alcohol use (18 years) Symptoms Jaundice Fever RUQ pain Anorexia Fatigue Abdominal distension Examination Hepatomegaly Ascites Spider angiomas Tachycardia --- Slide 4 – Laboratory Results Test Result Interpretation AST 210 U/L Elevated ALT 90 U/L AST:ALT >2 Bilirubin 15 mg/dL Severe jaundice INR 2.0 Poor liver function Albumin 2.7 g/dL Reduced synthesis WBC 18,000/mm³ Inflammation MCV 108 fL Chronic alcohol use --- Slide 5 – Diagnosis Severe Alcoholic Hepatitis Definition Acute inflammatory liver injury caused by excessive alcohol intake, occurring on a background of chronic alcohol use. --- Slide 6 – Pathophysiology Alcohol ⬇ Acetaldehyde formation ⬇ Oxidative stress ⬇ Inflammation ⬇ Neutrophil infiltration ⬇ Hepatocyte injury ⬇ Fibrosis ⬇ Liver failure --- Slide 7 – Pathology Gross Enlarged yellow liver Fatty change Histology Ballooned hepatocytes Mallory-Denk bodies Neutrophilic infiltration Pericellular fibrosis Steatosis --- Slide 8 – Clinical Features Jaundice Fever RUQ pain Tender hepatomegaly Ascites Peripheral edema Hepatic encephalopathy Muscle wasting --- Slide 9 – Severity Assessment Maddrey Discriminant Function ≥32 = Severe disease Consider corticosteroids MELD Score Predicts mortality Lille Score Assessed after 7 days Determines response to steroids --- Slide 10 – Investigations CBC Liver function tests PT/INR Renal function Ultrasound abdomen Viral hepatitis serology Blood cultures if fever Liver biopsy (if diagnosis is uncertain) --- Slide 11 – Management Supportive Complete alcohol abstinence High-calorie nutrition Protein supplementation Thiamine Folic acid Correct electrolytes Medical Prednisolone for severe disease (if no contraindications) Treat infections before steroids Manage ascites and encephalopathy Liver Transplant Selected patients with severe disease not responding to treatment. --- Slide 12 – Complications Acute liver failure Hepatic encephalopathy Ascites Spontaneous bacterial peritonitis Hepatorenal syndrome Variceal bleeding Death --- Slide 13 – Final Diagnosis ✅ B. Severe Alcoholic Hepatitis Why not the others? Acute viral hepatitis: Viral serology positive; AST:ALT ratio usually not >2. Acute cholecystitis: RUQ pain and fever, but jaundice is usually less prominent and ultrasound shows gallbladder disease. Autoimmune hepatitis: Positive ANA/ASMA and typically affects younger women. Drug-induced liver injury: Requires a history of hepatotoxic medication exposure. --- Slide 14 – High-Yield Points Must Know AST:ALT >2:1 AST usually <300 U/L Elevated GGT and MCV Mallory-Denk bodies Neutrophilic infiltration Maddrey DF ≥32 → consider prednisolone Lille score after 7 days Alcohol abstinence is the most important long-term treatment. This case follows the same style as your Crohn disease presentation, with an interactive diagnosis, stepwise workup, severity scoring, management, and exam-focused revision points.