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Enfermedad hepática relacionada con el alcohol

Última revisão: 13 Sep 2025
Last updated: 10 Dec 2024

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
Full details

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
Full details

Risk factors

  • consumo prolongado y excesivo de alcohol
  • hepatitis C
  • sexo femenino
  • tabaquismo
  • obesidad
  • edad >65 años
  • etnia hispana
  • predisposición genética
Full details

Diagnostic tests

1st tests 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
Full details

Tests 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
Full details

Emerging tests

  • prueba sérica de transferrina deficiente en carbohidratos
  • aspartato transaminasa (AST) mitocondrial en suero
  • Fosfatidil etanol (PETH)

Treatment algorithm

ONGOING

todos los pacientes

Contributors

Authors

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

Divulgaciones

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

Divulgaciones

LM declares that he has no competing interests.

Agradecimientos

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

Divulgaciones

MP declares that he has no competing interests.

Revisores por pares

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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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