Alcoholic liver disease history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
History should focus on the history of alcohol use by the patient, and the history of symptoms that may have developed.
History
- Patient should have a significant history of alcohol use.[1]
- CAGE questionnaire should be implemented.[1]
- AUDIT-C questions should be asked.[2]
- Guidelines for identifying persons at risk for developing alcoholic liver disease:[3][4]
- Low risk for developing alcohol use disorder:
- Female: no more than 3 drinks on any single day and no more than 7 drinks per week.
- Male: no more than 4 drinks on any single day and no more than fourteen drinks per week.
- Moderate alcohol consumption:
- Female: up to 1 drink per day.
- Male: up to 2 drinks per day.
- Binge drinking:
- Blood alcohol concentration (BAC) levels of 0.08 g/dl. Typically after 4 drinks for females and 5 drinks for males at a time.
- Heavy alcohol use:
- Binge drinking on 5 or more days in the past month.
- Low risk for developing alcohol use disorder:
Symptoms
The symptoms of alcoholic liver disease are as follows:[5][6][7][8][9]
| Alcoholic steatosis | Alcoholic hepatitis | Compensated cirrhosis | Decompensated cirrhosis | |||
|---|---|---|---|---|---|---|
| Common symptoms | Less common symptoms | Common symptoms | Less common symptoms | Common symptoms | Less common symptoms | |
| Asymptomatic | Yellow discoloration of skin | Abdominal distention | Asymptomatic | Muscle cramps | Yellow discoloration of skin | Sleep disturbances / Confusion |
| Loss of appetite | Proximal muscle weakness | Loss of appetite | Irregular menstruation | Itchy skin | Easy bruisability | |
| Fever | Confusion (hepatic encephalopathy) | Loss of weight | Impotence / infertility / loss of sexual drive | Blood in vomitus / stool | ||
| Abdominal pain | Weakness / fatigue | Abdominal distention / Weight gain | ||||
| Leg swelling | ||||||
- Adopted from World Journal of Gastroenterology[10]
2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[11]
Abstinence : Guidelines (DO NOT EDIT)[11]
| Class I |
| 1. " Clinicians should discuss alcohol use with patients, and any suspicion of possible abuse or excess should prompt use of a structured questionnaire and further evaluation. (Level of evidence: C) " |
| 2. " Patients with alcoholic liver disease (ALD) and suggestive symptoms should be screened for evidence of other end-organ damage, as appropriate. (Level of evidence: C) " |
References
- ↑ 1.0 1.1 Willenbring ML, Massey SH, Gardner MB (2009). "Helping patients who drink too much: an evidence-based guide for primary care clinicians". Am Fam Physician. 80 (1): 44–50. PMID 19621845.
- ↑ Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR (2007). "AUDIT-C as a brief screen for alcohol misuse in primary care". Alcohol. Clin. Exp. Res. 31 (7): 1208–17. doi:10.1111/j.1530-0277.2007.00403.x. PMID 17451397.
- ↑ "Drinking Levels Defined | National Institute on Alcohol Abuse and Alcoholism (NIAAA)".
- ↑ "NIAAA Publications".
- ↑ Stickel F, Seitz HK (2013). "Update on the management of alcoholic steatohepatitis". J Gastrointestin Liver Dis. 22 (2): 189–97. PMID 23799218.
- ↑ Mathurin P, Lucey MR (2012). "Management of alcoholic hepatitis". J. Hepatol. 56 Suppl 1: S39–45. doi:10.1016/S0168-8278(12)60005-1. PMID 22300464.
- ↑ Hamberg KJ, Carstensen B, Sørensen TI, Eghøje K (1996). "Accuracy of clinical diagnosis of cirrhosis among alcohol-abusing men". J Clin Epidemiol. 49 (11): 1295–301. PMID 8892498.
- ↑ Angeli P, Albino G, Carraro P, Dalla Pria M, Merkel C, Caregaro L, De Bei E, Bortoluzzi A, Plebani M, Gatta A (1996). "Cirrhosis and muscle cramps: evidence of a causal relationship". Hepatology. 23 (2): 264–73. doi:10.1002/hep.510230211. PMID 8591851.
- ↑ Burra P, Germani G, Masier A, De Martin E, Gambato M, Salonia A, Bo P, Vitale A, Cillo U, Russo FP, Senzolo M (2010). "Sexual dysfunction in chronic liver disease: is liver transplantation an effective cure?". Transplantation. 89 (12): 1425–9. doi:10.1097/TP.0b013e3181e1f1f6. PMID 20463637.
- ↑ Torruellas C, French SW, Medici V (2014). "Diagnosis of alcoholic liver disease". World J. Gastroenterol. 20 (33): 11684–99. doi:10.3748/wjg.v20.i33.11684. PMC 4155359. PMID 25206273.
- ↑ 11.0 11.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.