Alcohol-related liver disease
Summary
Definição
Анамнез и осмотр
Ключевые диагностические факторы
- abdominal pain
- hepatomegaly
- hematemesis and melena
- venous collaterals
- splenomegaly
- hepatic mass
- jaundice
- palmar erythema
- cutaneous telangiectasia
- asterixis
Другие диагностические факторы
- 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
Факторы риска
- prolonged and heavy alcohol consumption
- hepatitis C
- female sex
- cigarette smoking
- obesity
- age >65 years
- Hispanic ethnicity
- genetic predisposition
Диагностические исследования
Исследования, которые показаны в первую очередь
- 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
Исследования, проведение которых нужно рассмотреть
- 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
Неотложные исследования
- serum carbohydrate-deficient transferrin test
- serum mitochondrial AST
- Phosphatidylethanol (PEth)
Алгоритм лечения
all patients
Составители
Авторы
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
Раскрытие информации
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
Раскрытие информации
LM declares that he has no competing interests.
Выражение благодарностей
Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.
Раскрытие информации
MP declares that he has no competing interests.
Рецензенты
Lorenzo Leggio, MD, MSc
Postdoctoral Research Associate
Center for Alcohol and Addiction Studies
Brown University
Providence
RI
Раскрытие информации
LL declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
Раскрытие информации
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
Раскрытие информации
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
Раскрытие информации
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.
Список литературы
Основные статьи
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.Полный текст Аннотация
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.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Hepatitis B virus (HBV) infection
- Hepatitis C virus (HCV) infection
- Hepatitis A virus infection
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- ACG clinical guideline: alcohol-associated liver disease
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