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: M. Khurram Afzal, MD [2]


History should focus on the history of alcohol use by the patient, and the history of symptoms that may have developed.


  • 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.


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) "


  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 "" (PDF). Retrieved 2012-10-27.

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