Approach

A detailed history of the quantity and duration of alcohol ingestion, together with a physical exam and appropriate laboratory tests, is essential in the diagnosis of ALD. Key risk factors include prolonged heavy alcohol consumption, presence of hepatitis C, and female sex.

Asymptomatic elevation of aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) in a person consuming alcohol in excess is a common mode of presentation. It is important to emphasise that the signs, symptoms, histological stages, and severity of liver disease are variable among individuals with ALD. In addition, relatively asymptomatic patients may have histologically advanced liver disease. Clinical decompensation carries a poor prognosis regardless of the histological stage of ALD. Patients with ALD may have more than one pattern of alcoholic liver damage simultaneously. For example, they may have alcoholic hepatitis on a background of cirrhosis.

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