Table 1. Clinical, biochemical and Imaging in alcoholic liver disease.
| Spectrum | Clinical features | Imaging | Laboratory findings |
|---|---|---|---|
| Alcoholic fatty liver | Asymptomatic or RUQ discomfort | USG: abdomen shows hyperechoic texture if fat content >30% | Normal liver function test or slightly elevated liver enzymes (AST, ALT and GGT) and imaging shows fatty liver |
| Hepatomegaly on examination | CT abdomen: LAI can be used for assessment of liver fat | ||
| MRI abdomen: in and out of phase for fat for detecting hepatic steatosis | |||
| Transient elastography with CAP is emerging imaging | |||
| Alcoholic hepatitis | Combination of these symptoms and signs: Jaundice, loss of appetite, RUQ pain or discomfort, ascites, muscle weakness, confusion, pedal edema, petechial spots and sometimes fever, hepatomegaly which may be tender | More of clinical diagnosis | Raised serum bilirubin >3 mg% |
| Ultrasound abdomen/CT abdomen/MRI shows features of alcoholic fatty liver and/or cirrhosis with or without ascites | Raised AST/ALT >3–5 times ULN with raised GGT | ||
| Elevated INR | |||
| Cirrhosis without alcoholic hepatitis | May be totally asymptomatic in compensated cirrhosis or anorexia, weight loss, fatigue, muscle cramps, ascites, impotence, infertility, loss of pubic hairs, palmer erythema and pedal edema. Jaundice and ascites may be present in decompensated disease. Firm liver which may feel nodular | USG: coarsened echo pattern and nodularity of liver | Normal to borderline elevated liver enzymes with low albumin |
| CT and MRI abdomen: are highly predictable for cirrhosis and any associated liver lesion | Normal to high INR | ||
| Transient elastography to assess liver stiffness and response to treatment | Low platelet count | ||
| Elevated bilirubin level | |||
| Cirrhosis with alcoholic hepatitis | Severe anorexia, weight loss, fatigue, muscle cramps, ascites, palmer erythema and pedal edema. Jaundice and moderate to tense ascites are present in majority of the patients. Firm liver which is non tender | USG/CT: triple phase/MRI: triple phase for assessment of liver cirrhosis and liver SOL | Elevated bilirubin (>3–5 mg%) raised AST/ALT and ratio is <2. High INR with low hemoglobulin, albumin and platelet count |
RUQ, right upper quadrant; USG, ultrasonography; CT, computed tomography; LAI, liver attenuation index; MRI, magnetic resonance imaging; CAP, controlled attenuation parameter; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyltranspeptidase; ULN, upper limit of normal; INR, international normalised ration; SOL, space occupying lesions.