Alcohol-related liver disease
Summary
Definition
History and exam
Key diagnostic factors
- abdominal pain
- hepatomegaly
- hematemesis and melena
- venous collaterals
- splenomegaly
- hepatic mass
- jaundice
- palmar erythema
- cutaneous telangiectasia
- asterixis
Other diagnostic factors
- ascites
- weight loss
- weight gain
- malnutrition and wasting
- anorexia
- fatigue
- confusion
- pruritus
- fever
- nausea and vomiting
- finger clubbing
- Dupuytren contracture
- leg swelling
- parotid gland enlargement
- gynecomastia
- hypogonadism
- dementia
- peripheral neuropathy
Risk factors
- prolonged and heavy alcohol consumption
- hepatitis C
- female sex
- cigarette smoking
- obesity
- age >65 years
- Hispanic ethnicity
- genetic predisposition
Diagnostic investigations
1st investigations to order
- 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)
- CBC
- serum electrolytes, magnesium, phosphorus
- serum BUN and creatinine
- serum prothrombin time (PT), INR
- hepatic ultrasound
Investigations to consider
- viral hepatitis serology
- serum iron, ferritin, transferrin
- urine copper (24-hour collection)
- serum ceruloplasmin
- serum antimitochondrial antibody (AMA)
- serum antinuclear antibody (ANA) and antismooth muscle antibody (ASMA)
- serum alpha-1 antitrypsin level
- serum ammonia
- serum folate
- noninvasive tests of liver elasticity
- CT abdomen, MRI abdomen
- liver biopsy
Emerging tests
- serum carbohydrate-deficient transferrin test
- serum mitochondrial AST
- Phosphatidylethanol (PEth)
Treatment algorithm
all patients
Contributors
Authors
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
Disclosures
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
Disclosures
LM declares that he has no competing interests.
Acknowledgements
Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.
Disclosures
MP declares that he has no competing interests.
Peer reviewers
Lorenzo Leggio, MD, MSc
Postdoctoral Research Associate
Center for Alcohol and Addiction Studies
Brown University
Providence
RI
Disclosures
LL declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
გაფრთხილება:
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
გაფრთხილება:
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 traveling 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 traveling 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
გაფრთხილება:
AM declares that he has no competing interests.
რეცენზენტების განცხადებები
BMJ Best Practice-ის თემების განახლება სხვადასხვა პერიოდულობით ხდება მტკიცებულებებისა და რეკომენდაციების განვითარების შესაბამისად. ქვემოთ ჩამოთვლილმა რეცენზენტებმა თემის არსებობის მანძილზე კონტენტს ერთხელ მაინც გადახედეს.
გაფრთხილება
რეცენზენტების აფილიაციები და გაფრთხილებები მოცემულია გადახედვის მომენტისთვის.
წყაროები
ძირითადი სტატიები
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.სრული ტექსტი აბსტრაქტი
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.სრული ტექსტი აბსტრაქტი
გამოყენებული სტატიები
ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.
დიფერენციული დიაგნოზები
- Hepatitis B virus (HBV) infection
- Hepatitis C virus (HCV) infection
- Hepatitis A virus infection
მეტი დიფერენციული დიაგნოზებიგაიდლაინები
- AASLD Practice Guideline on non-invasive liver disease assessments of portal hypertension
- ACG clinical guideline: alcohol-associated liver disease
მეტი გაიდლაინებიპაციენტის ბროშურები
Alcoholic liver disease
Hepatitis B: should I have the vaccine?
მეტი პაციენტის ბროშურებიკალკულატორები
Alcohol Consumption Screening AUDIT Questionnaire
Modified Maddrey's Discriminant Function
მეტი კალკულატორებიVideos
Abdominal paracentesis animated demonstration
მეტი ვიდეოები
შედით სისტემაში ან გამოიწერეთ BMJ Best Practice
ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას