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:

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

  • Patient should have a significant history of alcohol use.[1]
  • CAGE questionnaire should be implemented.[1]
  • AUDIT-C questions should be asked.[2]
  • Chronic alcohol intake i.e. > 80 g/d in men and 40 g/d in women with alcoholic hepatitis or cirrhosis.

Symptoms

The symptoms of alcoholic liver disease are as follows:[3][4][5][6][7]

Alcoholic steatosis Alcoholic hepatitis Compensated cirrhosis Decompensated cirrhosis
Asymptomatic Yellow discoloration of skin Asymptomatic Yellow discoloration of skin
Loss of appetite Loss of appetite Itchy skin
Fever Loss of weight Blood in vomitus / stool
Abdominal pain Weakness / fatigue Abdominal distention / Weight gain
Abdominal distention Muscle cramps Sleep disturbances / Confusion
Proximal muscle weakness Irregular menstruation Leg swelling
Confusion (hepatic encephalopathy) Impotence / infertility/ loss of sexual drive Easy bruisability

2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[8]

Abstinence : Guidelines (DO NOT EDIT)[8]

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. Stickel F, Seitz HK (2013). "Update on the management of alcoholic steatohepatitis". J Gastrointestin Liver Dis. 22 (2): 189–97. PMID 23799218.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 8.0 8.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.



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