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Alcohol-related liver disease

Última revisión: 22 Sep 2025
Última actualización: 10 Dec 2024

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • abdominal pain
  • hepatomegaly
  • hematemesis and melena
  • venous collaterals
  • splenomegaly
  • hepatic mass
  • jaundice
  • palmar erythema
  • cutaneous telangiectasia
  • asterixis
Todos los datos

Otros factores de diagnóstico

  • 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
Todos los datos

Factores de riesgo

  • prolonged and heavy alcohol consumption
  • hepatitis C
  • female sex
  • cigarette smoking
  • obesity
  • age >65 years
  • Hispanic ethnicity
  • genetic predisposition
Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

  • 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
Todos los datos

Pruebas diagnósticas que deben considerarse

  • 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
Todos los datos

Pruebas emergentes

  • serum carbohydrate-deficient transferrin test
  • serum mitochondrial AST
  • Phosphatidylethanol (PEth)

Algoritmo de tratamiento

En curso

all patients

Colaboradores

Autores

Craig McClain, MD
Craig McClain

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
Luis Marsano

Professor and Director of Hepatology

Division of Gastroenterology, Hepatology and Nutrition

Department of Medicine

University of Louisville School of Medicine

Louisville

KY

Declarações

LM declares that he has no competing interests.

Agradecimentos

Dr Craig McClain and Dr Luis Marsano would like to gratefully acknowledge Dr Mihir Patel, a previous contributor to this topic.

Declarações

MP declares that he has no competing interests.

Revisores

Lorenzo Leggio, MD, MSc

Postdoctoral Research Associate

Center for Alcohol and Addiction Studies

Brown University

Providence

RI

Declarações

LL declares that he has no competing interests.

Nancy Reau, MD

Assistant Professor of Medicine

University of Chicago

Center for Liver Disease

Chicago

IL

Declarações

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

Declarações

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

Declarações

AM declares that he has no competing interests.

Créditos aos pareceristas

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Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

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Principais artigos

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.Texto completo  Resumo

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.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Alcohol-related liver disease images
  • Diagnósticos diferenciais

    • Hepatitis B virus (HBV) infection
    • Hepatitis C virus (HCV) infection
    • Hepatitis A virus infection
    Mais Diagnósticos diferenciais
  • Diretrizes

    • AASLD Practice Guideline on non-invasive liver disease assessments of portal hypertension​
    • ACG clinical guideline: alcohol-associated liver disease
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Alcoholic liver disease

    Hepatitis B: should I have the vaccine?

    Mais Folhetos informativos para os pacientes
  • Calculadoras

    Alcohol Consumption Screening AUDIT Questionnaire

    Modified Maddrey's Discriminant Function

    Mais Calculadoras
  • Videos

    Abdominal paracentesis animated demonstration

    Mais vídeos
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