hepatic and biliary disorders
Alcohol Related Liver Disease
Diagnosis of Alcohol Related Liver Disease
Confirmed history of alcohol use Alcohol biomarkers Liver tests and complete blood count (CBC) Sometimes liver biopsy 80 g per day. Patients can be screened for Alcohol Use Disorder and Rehabilitation using the CAGE questionnaire (need to 100 fL reflects the direct effect of alcohol on bone marrow as well as macrocytic anemia resulting from Folate Deficiency , which is common among people with alcohol use disorder who are undernourished. Indexes of the severity of liver disease are Serum bilirubin, which represents secretory function Prothrombin time or international normalized ratio, which reflects synthetic ability Thrombocytopenia can result from the direct toxic effects of alcohol on bone marrow or from splenomegaly, which accompanies Portal Hypertension . Neutrophilic leukocytosis may result from alcoholic hepatitis, although coexisting infection (particularly pneumonia and spontaneous bacterial peritonitis) should also be suspected. Imaging Tests of the Liver and Gallbladder are not routinely needed for diagnosis. If done for other reasons, abdominal ultrasonography or CT may suggest hepatic steatosis or show splenomegaly, evidence of If abnormalities suggest alcohol-related liver disease, screening tests for other treatable forms of liver disease, especially viral hepatitis, should be done. Because features of hepatic steatosis, alcoholic hepatitis, and cirrhosis overlap, describing the precise findings is more useful than assigning patients to a specific category, which can only be determined by Liver Biopsy . Not all experts agree on the indications for liver biopsy. Proposed indications include the following: Unclear clinical diagnosis (eg, equivocal clinical and laboratory findings, unexplained persistent elevations of aminotransferase levels) Clinical suspicion of>1 cause of liver disease (eg, alcohol plus viral hepatitis) Desire for a precise prediction of prognosis Liver biopsy confirms liver disease, helps identify excessive alcohol use as the likely cause, and establishes the stage of liver injury. If iron accumulation is observed, measurement of the iron content and genetic testing can eliminate Hereditary Hemochromatosis as the cause. For stable patients with cirrhosis, the American Association for the Study of Liver Diseases (AASLD) recommends that liver ultrasonography, with or without alpha-fetoprotein (AFP) measurement, should be done every 6 months to Screening . They also suggest that surveillance not be done for patients with Child’s class C cirrhosis unless they are on the transplant waiting list because of their low anticipated survival ( 1.Heimbach JK, Kulik LM, Finn RA, et al:AASLD guidelines for the treatment of hepatocellular carcinoma.Hepatology67(1):358-380, 2018. doi: 10.1002/hep.29086 