Internal Medicine

P1: SBT

0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18

90 Alcoholic Liver Disease (ALD)

■History of trauma, DUI, withdrawal seizure, pancreatitis

■Family history of alcoholism

■Spectrum of ALD: fatty liver (usually asymptomatic); alcoholic hep-

atitis (usually symptomatic as described below); alcoholic cirrhosis

(compensated or decompensated)

Signs & Symptoms

■Fatigue, malaise, anorexia, fever, RUQ pain & tenderness, encepha-

lopathy, GI bleeding, ascites, jaundice

■Telangiectasia, palmar erythema, Dupuytren contracture, gyneco-

mastia & testicular atrophy (in men), hepatomegaly, splenomegaly,

asterixis, fetor hepaticus

tests

Basic Blood Studies

■AST>ALT (both usually <300 IU/L; AST/ALT > 2)

■Elevated alkaline phosphatase, elevated GGT, elevated uric acid

■Elevated WBC, increased MCV

■Chemistry panel (elevated glucose, elevated triglyceride, decreased

K+, decreased phosphorus, decreased Mg++)

Specific Diagnostic Tests

■Blood alcohol level

■Rule out other liver diseases, eg, anti-HCV antibody, iron studies

Imaging

■Abdominal US or CT: not diagnostic:

➣Rule out other hepatic lesions

➣Cirrhosis & collaterals w/ advanced disease

Liver Biopsy

■Confirm diagnosis if atypical features

■Determine prognosis by staging

■Determine relative contribution of concomitant hepatitis (eg,

HCV)

■Differentiate hepatic siderosis from hemochromatosis

differential diagnosis

■Nonalcoholic steatohepatitis (NASH)

■Chronic hepatitis C alone or coexisting w/ ALD (25–65%)