Difference between revisions of "Alcoholic liver disease history and symptoms"

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__NOTOC__
 
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{{Alcoholic liver disease}}
 
{{Alcoholic liver disease}}
{{CMG}}
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{{CMG}}; {{AE}} {{MKA}}
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==Overview==
 
==Overview==
History should focus on the history of alcohol use by the patient, and the history of symptoms that may have developed. Pertinent symptoms that may be reported are an increase in abdominal girth (due to [[ascites]], loss of appetite, [[gynocomastia]], skin changes, excessive thirst, [[fatigue]], [[nausea]], [[hematemesis]], mental [[confusion]], and [[jaundice]].
+
History should focus on the history of [[alcohol]] use by the patient, and the history of symptoms that may have developed.
 +
 
 
==History==
 
==History==
* Recent history of heavy drinking
+
 
* Chronic alcohol intake i.e. > 80 g/d in men and 40 g/d in women with alcoholic hepatitis or cirrhosis.
+
*Patient should have a significant history of [[alcohol]] use.<ref name="pmid19621845">{{cite journal |vauthors=Willenbring ML, Massey SH, Gardner MB |title=Helping patients who drink too much: an evidence-based guide for primary care clinicians |journal=Am Fam Physician |volume=80 |issue=1 |pages=44–50 |year=2009 |pmid=19621845 |doi= |url=}}</ref>
 +
*[[CAGE questionnaire]] should be implemented.<ref name="pmid19621845">{{cite journal |vauthors=Willenbring ML, Massey SH, Gardner MB |title=Helping patients who drink too much: an evidence-based guide for primary care clinicians |journal=Am Fam Physician |volume=80 |issue=1 |pages=44–50 |year=2009 |pmid=19621845 |doi= |url=}}</ref>
 +
*AUDIT-C questions should be asked.<ref name="pmid17451397">{{cite journal |vauthors=Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR |title=AUDIT-C as a brief screen for alcohol misuse in primary care |journal=Alcohol. Clin. Exp. Res. |volume=31 |issue=7 |pages=1208–17 |year=2007 |pmid=17451397 |doi=10.1111/j.1530-0277.2007.00403.x |url=}}</ref>
 +
*Guidelines for identifying persons at risk for developing alcoholic liver disease:<ref name="urlDrinking Levels Defined | National Institute on Alcohol Abuse and Alcoholism (NIAAA)">{{cite web |url=https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking |title=Drinking Levels Defined &#124; National Institute on Alcohol Abuse and Alcoholism (NIAAA) |format= |work= |accessdate=}}</ref><ref name="urlNIAAA Publications">{{cite web |url=https://pubs.niaaa.nih.gov/publications/aa65/aa65.htm |title=NIAAA Publications |format= |work= |accessdate=}}</ref>
 +
**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.
 +
 
 
==Symptoms==
 
==Symptoms==
  
* [[Abdominal pain]] and tenderness
+
The symptoms of alcoholic liver disease are as follows:<ref name="pmid23799218">{{cite journal |vauthors=Stickel F, Seitz HK |title=Update on the management of alcoholic steatohepatitis |journal=J Gastrointestin Liver Dis |volume=22 |issue=2 |pages=189–97 |year=2013 |pmid=23799218 |doi= |url=}}</ref><ref name="pmid22300464">{{cite journal |vauthors=Mathurin P, Lucey MR |title=Management of alcoholic hepatitis |journal=J. Hepatol. |volume=56 Suppl 1 |issue= |pages=S39–45 |year=2012 |pmid=22300464 |doi=10.1016/S0168-8278(12)60005-1 |url=}}</ref><ref name="pmid8892498">{{cite journal |vauthors=Hamberg KJ, Carstensen B, Sørensen TI, Eghøje K |title=Accuracy of clinical diagnosis of cirrhosis among alcohol-abusing men |journal=J Clin Epidemiol |volume=49 |issue=11 |pages=1295–301 |year=1996 |pmid=8892498 |doi= |url=}}</ref><ref name="pmid8591851">{{cite journal |vauthors=Angeli P, Albino G, Carraro P, Dalla Pria M, Merkel C, Caregaro L, De Bei E, Bortoluzzi A, Plebani M, Gatta A |title=Cirrhosis and muscle cramps: evidence of a causal relationship |journal=Hepatology |volume=23 |issue=2 |pages=264–73 |year=1996 |pmid=8591851 |doi=10.1002/hep.510230211 |url=}}</ref><ref name="pmid20463637">{{cite journal |vauthors=Burra P, Germani G, Masier A, De Martin E, Gambato M, Salonia A, Bo P, Vitale A, Cillo U, Russo FP, Senzolo M |title=Sexual dysfunction in chronic liver disease: is liver transplantation an effective cure? |journal=Transplantation |volume=89 |issue=12 |pages=1425–9 |year=2010 |pmid=20463637 |doi=10.1097/TP.0b013e3181e1f1f6 |url=}}</ref>
* Dry mouth
+
 
* Excessive thirst
+
{| class="wikitable"
* [[Fatigue]]
+
! rowspan="2" |Alcoholic steatosis
* [[Fever]]
+
! colspan="2" |Alcoholic hepatitis
* Fluid collection in the abdomen ([[ascites]])
+
! colspan="2" |Compensated cirrhosis
* [[Jaundice]]
+
! colspan="2" |Decompensated cirrhosis
* Loss of appetite
+
|-
* Mental confusion
+
!Common symptoms
* [[Nausea]]
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!Less common symptoms
* Unintentional weight gain (because of fluid collection)
+
!Common symptoms
 +
!Less common symptoms
 +
!Common symptoms
 +
!Less common symptoms
 +
|-
 +
| rowspan="5" |[[Asymptomatic]]
 +
|[[Jaundice|Yellow discoloration of skin]]
 +
|[[Abdominal distension|Abdominal distention]]
 +
|[[Asymptomatic]]
 +
|[[Muscle cramps]]
 +
|[[Jaundice|Yellow discoloration of skin]]
 +
|[[Sleep disturbances]] / [[Confusion]]
 +
|-
 +
|[[Anorexia|Loss of appetite]]
 +
|Proximal [[muscle weakness]]
 +
|[[Anorexia|Loss of appetite]]
 +
|[[Menstruation|Irregular menstruation]]
 +
|[[Pruritis|Itchy skin]]
 +
|[[Bruising|Easy bruisability]]
 +
|-
 +
|[[Fever]]
 +
|[[Confusion]] ([[hepatic encephalopathy]])
 +
|[[Weight loss|Loss of weight]]
 +
|[[Impotence]] / [[infertility]] / loss of sexual drive
 +
|[[Hematemesis|Blood in vomitus]] / [[Hematochezia|stool]]
 +
|
 +
|-
 +
|[[Abdominal pain]]
 +
|
 +
|[[Weakness]] / [[fatigue]]
 +
|
 +
|[[Abdominal distension|Abdominal distention]] / [[Weight gain]]
 +
|
 +
|-
 +
|
 +
|
 +
|
 +
|
 +
|[[Leg swelling]]
 +
|
 +
|}
 +
 
 +
<small>
 +
*Adopted from World Journal of Gastroenterology<ref name="pmid25206273">{{cite journal |vauthors=Torruellas C, French SW, Medici V |title=Diagnosis of alcoholic liver disease |journal=World J. Gastroenterol. |volume=20 |issue=33 |pages=11684–99 |year=2014 |pmid=25206273 |pmc=4155359 |doi=10.3748/wjg.v20.i33.11684 |url=}}</ref></small>
  
Other symptoms that can occur with this disease:
+
==2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>==
* Abnormally dark or light skin
+
===Abstinence : Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>===
* Agitation
+
{| class="wikitable"
* Bloody, dark black, or tarry bowel movements ([[melena]])
 
* Breast development in males ([[gynocomastia]])
 
* Changing mood
 
* Confusion ([[encephalopathy]])
 
:* Changed level of consciousness
 
:* [[Hallucinations]]
 
:* Impaired short- or long-term memory
 
* Difficulty paying attention ([[attention deficit]])
 
* Impaired ability to concentrate
 
* Impaired judgment
 
* [[Light-headedness]] or [[fainting]], especially when standing
 
* Paleness
 
* [[Tachycardia]] when rising to standing position
 
* Redness on feet or hands
 
* Slow, sluggish, lethargic movement
 
* Hematemesis or coffee-ground emesis
 
Symptoms vary based on the severity of the disease. They are usually worse after a recent period of heavy drinking.
 
===2010 AASLD/ACG Alcoholic Liver Disease Guidelines : Abstinence (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>===
 
{|class="wikitable"
 
 
|-
 
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[AASLD guidelines classification scheme#Class of recommendation|Class I]]
+
| colspan="1" style="text-align:center; background:LightGreen" |[[AASLD guidelines classification scheme#Class of recommendation|Class I]]
 
|-
 
|-
| bgcolor="LightGreen"| '''1.''' <nowiki>"</nowiki> 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. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C)]] <nowiki>"</nowiki>
+
| bgcolor="LightGreen" | '''1.''' <nowiki>"</nowiki> 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. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C)]] <nowiki>"</nowiki>
  
 
|-
 
|-
| bgcolor="LightGreen"| '''2.''' <nowiki>"</nowiki> Patients with alcoholic liver disease (ALD) and suggestive symptoms should be screened for evidence of other end-organ damage, as appropriate. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C)]] <nowiki>"</nowiki>
+
| bgcolor="LightGreen" | '''2.''' <nowiki>"</nowiki> Patients with alcoholic liver disease (ALD) and suggestive symptoms should be screened for evidence of other end-organ damage, as appropriate. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C)]] <nowiki>"</nowiki>
 
|}
 
|}
  
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{{reflist|2}}
 
{{reflist|2}}
  
{{WH}}
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[[Category:Surgery]]
{{WS}}
 
[[Category:Pathology]]
 
 
[[Category:Gastroenterology]]
 
[[Category:Gastroenterology]]
[[Category:Alcohol abuse]]
+
[[Category:Up-To-Date]]
 
[[Category:Hepatology]]
 
[[Category:Hepatology]]
 +
[[Category:Primary care]]
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[[Category:Medicine]]
 +
 +
{{WS}}
 +
{{WH}}

Latest revision as of 19:56, 9 February 2018

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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:
    • Heavy alcohol use:
      • Binge drinking on 5 or more days in the past month.

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. 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.
  2. 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.
  3. "Drinking Levels Defined | National Institute on Alcohol Abuse and Alcoholism (NIAAA)".
  4. "NIAAA Publications".
  5. Stickel F, Seitz HK (2013). "Update on the management of alcoholic steatohepatitis". J Gastrointestin Liver Dis. 22 (2): 189–97. PMID 23799218.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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. 11.0 11.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.



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