Alcohol-related liver disease
小结
定义
病史和体格检查
关键诊断因素
- presence of risk factors
- abdominal pain
- hepatomegaly
- haematemesis and melaena
- venous collaterals
- splenomegaly
- hepatic mass
- jaundice
- palmar erythema
- cutaneous telangiectasia
- asterixis
其他诊断因素
- ascites
- weight loss
- weight gain
- malnutrition and wasting
- anorexia
- fatigue
- confusion
- pruritus
- fever
- nausea and vomiting
- finger clubbing
- Dupuytren's contracture
- leg swelling
- parotid gland enlargement
- gynaecomastia
- hypogonadism
- dementia
- peripheral neuropathy
危险因素
- prolonged and heavy alcohol consumption
- hepatitis C
- female sex
- cigarette smoking
- obesity
- age >65 years
- Hispanic ethnicity
- genetic predisposition
诊断性检查
首要检查
- serum aspartate aminotransferase (AST), alanine aminotransferase (ALT)
- serum AST/ALT ratio
- serum alkaline phosphatase
- serum bilirubin
- serum albumin, protein
- serum gamma glutamyl transferase (gamma-GT)
- FBC
- serum electrolytes, magnesium, phosphorus
- serum urea and creatinine
- serum prothrombin time (PT), INR
- hepatic ultrasound
需考虑的检查
- viral hepatitis serology
- serum iron, ferritin, transferrin
- urine copper (24-hour collection)
- serum ceruloplasmin
- serum anti-mitochondrial antibody (AMA)
- serum anti-nuclear antibody (ANA) and anti-smooth muscle antibody (ASMA)
- serum alpha-1 antitrypsin level
- serum ammonia
- serum folate
- non-invasive tests of liver elasticity
- CT abdomen, MRI abdomen
- liver biopsy
新兴检查
- serum carbohydrate-deficient transferrin test
- serum mitochondrial AST
- Phosphatidylethanol (PEth)
治疗流程
all patients
撰稿人
作者
Craig McClain, MD
Professor
Chief of Research Affairs
Associate Vice President for Health Affairs/Research
Division of Gastroenterology, Hepatology and Nutrition
Department of Medicine
University of Louisville School of Medicine
Louisville
KY
利益声明
CM receives contract research support from the National Institutes of Health, the Veterans Administration, and Target Pharma Solutions.
Luis Marsano, MD
Professor and Director of Hepatology
Division of Gastroenterology, Hepatology and Nutrition
Department of Medicine
University of Louisville School of Medicine
Louisville
KY
利益声明
LM declares that he has no competing interests.
鸣谢
Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.
利益声明
MP declares that he has no competing interests.
同行评议者
Lorenzo Leggio, MD, MSc
Postdoctoral Research Associate
Center for Alcohol and Addiction Studies
Brown University
Providence
RI
利益声明
LL declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
利益声明
NR declares that she has no competing interests.
Nick Sheron, MD, FRCP
Head of Clinical Hepatology and Senior Lecturer
Division of Infection, Inflammation and Immunity
University of Southampton Medical School
Southampton General Hospital NHS Trust
Southampton
UK
利益声明
NS has received research grants from the Medical Research Council (MRC), Wellcome Trust, British Liver Trust, Alcohol Education Research Council, and various other funding bodies. He has undertaken paid consultancy work and received travelling expenses from pharmaceutical companies developing drugs for the treatment of inflammatory bowel disease and liver disease. He has been paid for medico-legal work in the areas of hepatitis C and alcohol-related liver disease. The following memberships and advisory work are unpaid apart from travelling expenses: EU Alcohol Forum, EU Alcohol Marketing Taskforce, Royal College of Physicians Alcohol Committee, Alcohol Health Alliance UK. NS has undertaken advisory and media work for the UK Department of Health, Home Office, Department of Transport, Cross Cabinet Strategy Committee, National Institute for Health and Care Excellence, Southampton City Council, UK Police, and British Liver Trust, and various other NGOs, local government, and other bodies. NS is an unpaid trustee of the Drinkaware Trust, an independent body set up by the UK Government to use industry resources to reduce alcohol-related harm. The Trust is funded entirely by the alcohol industry, with a board of trustees comprising 5 industry members, 5 members with alcohol-related health expertise, and 3 lay members.
Alastair MacGilchrist, MD, FRCP
Consultant Hepatologist
Royal Infirmary of Edinburgh
Edinburgh
UK
利益声明
AM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Jophlin LL, Singal AK, Bataller R, et al. ACG clinical guideline: alcohol-associated liver disease. Am J Gastroenterol. 2024 Jan 1;119(1):30-54.全文 摘要
Crabb DW, Im GY, Szabo G, et al. Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2020 Jan;71(1):306-33.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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