Torruellas C, French SW, Medici V. Diagnosis of alcoholic liver disease. World J Gastroenterol 2014; 20(33): 11684-11699 [PMID: PMC4155359 DOI: 10.3748/wjg.v20.i33.11684]
Corresponding Author of This Article
Valentina Medici, MD, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, 4150 V Street, Suite 3500, Sacramento, CA 95817, United States. valentina.medici@ucdmc.ucdavis.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Topic Highlight
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 7, 2014; 20(33): 11684-11699 Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11684
Table 1 Typical clinical features of alcoholic liver disease[36-40]
Spectrum of ALD
Clinical presentation
Alcoholic fatty liver
Asymptomatic
Alcoholic hepatitis
Jaundice
Anorexia
Fever
+/- RUQ/epigastric pain
+/- Abdominal distention due to ascites
+/- Proximal muscle weakness
+/- Confusion due to HE
Compensated cirrhosis
Asymptomatic
Anorexia
Weight loss
Weakness
Fatigue
Muscle cramps
Amenorrhea or irregular menses
Impotence, infertility, loss of sexual drive
Decompensated cirrhosis
Jaundice
Pruritus
GI bleeding
Weight gain
Abdominal distention due to ascites
Lower extremity edema
Easy bruising
Sleep disturbances
Confusion
Table 2 Alcohol use disorders identification test[46]
1 How often do you have on a drink containing alcohol?
(0) Never (skip to questions 9-10)
(1) Monthly or less
(2) 2 to 4 times a month
(3) 2 to 3 times a week
(4) 4 or more times a week
2 How many drinks containing alcohol do you have on a typical day when you are drinking?
(0) 1 or 2
(1) 3 or 4
(2) 5 or 6
(3) 7, 8, or 9
(4) 10 or more
3 How often do you have six or more drinks on one occasion?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
4 How often during the last year have you found that you were not able to stop drinking once you had started?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
5 How often during the last year have you failed to do what was normally expected from you because of drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
6 How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
7 How often during the last year have you had a feeling of guilt or remorse after drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
8 How often during the last year have you been unable to remember what happened the night before because you had been drinking?
(0) Never
(1) Less than monthly
(2) Monthly
(3) Weekly
(4) Daily or almost daily
9 Have you or someone else been injured as a result of your drinking?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year
10 Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?
(0) No
(2) Yes, but not in the last year
(4) Yes, during the last year
Table 3 Brief screening tests for alcohol use disorders[44,48]
Test
Questions
Scoring
Positive result
AUDIT-C
Q1: How often did you have a drink containing alcohol in the past year?
For women ≥ 3 points; for men ≥ 4 points
Never
0 points
Monthly or less
1 point
Two to four times a month
2 points
Two to three times per week
3 points
Four or more times a week
4 points
Q2: How many drinks did you have on a typical day when you were drinking in the past year?
One or two
0 points
Three or four
1 point
Five or six
2 points
Seven to nine
3 points
Ten or more
4 points
Q3: How often did you have six or more drinks on one occasion in the past year?
Never
0 points
Less than monthly
1 point
Monthly
2 points
Weekly
3 points
Daily or almost daily
4 points
Single question screening test from NIAAA
How many times in the past year have you had five (four for women) or more drinks in a day?
One point per time
≥ 1 time
Three question screening test from NIAA
Q1: On average, how many days per week do you drink alcohol? Q2: On a typical day when you drink, how many drinks do you have? Q3: What is the maximum number of drinks you had on any given occasion during the past month
For men, > 14 drinks per week or > 4 drinks per occasion; for women or person older than 65 years, > 7 drinks per week or > 3 drinks per occasion
Table 4 Physical findings in alcoholic liver disease[58-67]