Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- dolor abdominal
- hepatomegalia
- hematemesis y melena
- colaterales venosas
- esplenomegalia
- masa hepática
- ictericia
- eritema palmar
- telangiectasia cutánea
- asterixis
Other diagnostic factors
- ascitis
- pérdida de peso
- aumento de peso
- desnutrición y consunción
- anorexia
- fatiga
- confusión
- prurito
- fiebre
- náuseas y vómitos
- acropaquia
- contractura de Dupuytren
- inflamación de las piernas
- agrandamiento de la glándula parótida
- ginecomastia
- hipogonadismo
- demencia
- neuropatía periférica
Risk factors
- consumo prolongado y excesivo de alcohol
- hepatitis C
- sexo femenino
- tabaquismo
- obesidad
- edad >65 años
- etnia hispana
- predisposición genética
Diagnostic investigations
1st investigations to order
- aspartato aminotransferasa (AST) sérica, alanina aminotransferasa (ALT)
- relación aspartato transaminasa (AST)/alanina aminotransferasa (ALT) en suero
- fosfatasa alcalina en suero
- bilirrubina sérica
- albúmina sérica, proteína
- gamma glutamil transferasa sérica (gamma-GT)
- hemograma completo (HC)
- electrolitos, magnesio y fósforo séricos
- urea y creatinina séricas
- tiempo de protrombina en suero (TP), INR
- ecografía hepática
Investigations to consider
- serología de hepatitis viral
- hierro, ferritina y transferrina séricos
- cobre en orina (24 horas)
- ceruloplasmina sérica
- anticuerpos antimitocondriales (AAM) séricos
- anticuerpos antinucleares (ANA) y anticuerpos antimúsculo liso (AML) en suero
- nivel sérico de alfa-1-antitripsina
- amoniaco sérico
- folato sérico
- pruebas no invasivas de la elasticidad del hígado
- tomografía computarizada (TC) o resonancia magnética (IRM) de abdomen
- biopsia hepática
Emerging tests
- prueba sérica de transferrina deficiente en carbohidratos
- aspartato transaminasa (AST) mitocondrial en suero
- Fosfatidil etanol (PETH)
Treatment algorithm
todos los pacientes
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
Disclosures
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
Disclosures
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
Disclosures
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.
References
Key articles
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.Full text Abstract
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.Full text Abstract
Reference articles
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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