hepatic and biliary disorders
Alcohol Related Liver Disease
Key Points
Risk of alcohol-related liver disease increases markedly in men if they ingest>40 g, particularly>80 g, of alcohol per day (eg, about 2 to 8 cans of beer, about 3 to 6 glasses of wine, or 3 to 6 shots of hard liquor) for>10 years; risk increases markedly in women if they ingest about half that amount. Screen patients using the AUDIT or CAGE questionnaire, and when in doubt about the patient's alcohol consumption, consider use of alcohol biomarkers. To estimate prognosis, consider unfavorable histologic findings (eg, neutrophils, perivenular fibrosis) and use of a formula (eg, Maddrey discriminant function, Model for End-Stage Liver Disease [MELD] score). Emphasize abstinence, provide supportive care, and hospitalize and give corticosteroids to patients with severe acute alcoholic hepatitis. Consider liver transplantation for patients with decompensated liver disease (ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy) despite abstinence. 