Alcoholic liver disease differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Alcoholic liver disease should be differentiated from other diseases that produce similar symptoms, and other types of liver diseases. It should also be differentiated from diseases of the gallbladder. Conditions that may present in a similar manner to alcoholic liver disease are; [[cholecystitis]], [[cholelithiasis]], drug toxicity, non-alcoholic fatty liver disease, and other forms of hepatitis (eg. viral, autoimmune).
[[Alcoholic liver disease]] should be differentiated from other diseases that produce similar symptoms, and other types of [[liver]] diseases. It should also be differentiated from diseases of the [[gallbladder]]. Conditions that may present in a similar manner to [[alcoholic liver disease]] are; [[cholecystitis]], [[cholelithiasis]], [[drug toxicity]], [[non-alcoholic fatty liver disease]], and other forms of [[hepatitis]] (eg. [[viral]], [[autoimmune]]).


==Differentiating Alcoholic liver disease from other Diseases==
==Differentiating Alcoholic liver disease from other Diseases==


Alcoholic liver disease can be differentiated from other diseases on the basis of clinical manifestations including fever, abdominal pain and jaundice. The diseases are:<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><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><ref name="pmid1198096">{{cite journal |vauthors=Baraona E, Leo MA, Borowsky SA, Lieber CS |title=Alcoholic hepatomegaly: accumulation of protein in the liver |journal=Science |volume=190 |issue=4216 |pages=794–5 |year=1975 |pmid=1198096 |doi= |url=}}</ref><ref name="pmid11113085">{{cite journal |vauthors=Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O |title=Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial |journal=Gastroenterology |volume=119 |issue=6 |pages=1637–48 |year=2000 |pmid=11113085 |doi= |url=}}</ref><ref name="pmid6421159">{{cite journal |vauthors=Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA |title=Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis |journal=Am. J. Med. |volume=76 |issue=2 |pages=211–22 |year=1984 |pmid=6421159 |doi= |url=}}</ref><ref name="pmid3131572">{{cite journal |vauthors=Pirovino M, Linder R, Boss C, Köchli HP, Mahler F |title=Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations |journal=Klin. Wochenschr. |volume=66 |issue=7 |pages=298–302 |year=1988 |pmid=3131572 |doi= |url=}}</ref><ref name="pmid2910764">{{cite journal |vauthors=Dutta SK, Dukehart M, Narang A, Latham PS |title=Functional and structural changes in parotid glands of alcoholic cirrhotic patients |journal=Gastroenterology |volume=96 |issue=2 Pt 1 |pages=510–8 |year=1989 |pmid=2910764 |doi= |url=}}</ref><ref name="pmid3983651">{{cite journal |vauthors=Van Thiel DH, Gavaler JS, Schade RR |title=Liver disease and the hypothalamic pituitary gonadal axis |journal=Semin. Liver Dis. |volume=5 |issue=1 |pages=35–45 |year=1985 |pmid=3983651 |doi=10.1055/s-2008-1041756 |url=}}</ref><ref name="pmid7227854">{{cite journal |vauthors=Epstein O, Dick R, Sherlock S |title=Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease |journal=Gut |volume=22 |issue=3 |pages=203–6 |year=1981 |pmid=7227854 |pmc=1419499 |doi= |url=}}</ref><ref name="pmid3592873">{{cite journal |vauthors=Attali P, Ink O, Pelletier G, Vernier C, Jean F, Moulton L, Etienne JP |title=Dupuytren's contracture, alcohol consumption, and chronic liver disease |journal=Arch. Intern. Med. |volume=147 |issue=6 |pages=1065–7 |year=1987 |pmid=3592873 |doi= |url=}}</ref><ref>Erlinger S, Benhamou J. Cirrhosis: clinical aspects. In: Mcintyre N, Benhamou J, Rizzetto M, editors. Oxford textbook of clinical hepatology. Oxford: University Press; 1991. p. 380.</ref><ref> Groszman R, Franchis R. Portal hypertension. In: Schiff E, Sorrell M, Maddrey W, editors. Diseases of the liver. Philadelphia: Lippincot Williams & Wilkens; 1999. p. 415.</ref>
[[Alcoholic liver disease]] can be differentiated from other diseases on the basis of clinical manifestations including [[fever]], [[abdominal pain]] and [[jaundice]]. The diseases are:<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><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><ref name="pmid1198096">{{cite journal |vauthors=Baraona E, Leo MA, Borowsky SA, Lieber CS |title=Alcoholic hepatomegaly: accumulation of protein in the liver |journal=Science |volume=190 |issue=4216 |pages=794–5 |year=1975 |pmid=1198096 |doi= |url=}}</ref><ref name="pmid11113085">{{cite journal |vauthors=Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O |title=Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial |journal=Gastroenterology |volume=119 |issue=6 |pages=1637–48 |year=2000 |pmid=11113085 |doi= |url=}}</ref><ref name="pmid6421159">{{cite journal |vauthors=Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA |title=Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis |journal=Am. J. Med. |volume=76 |issue=2 |pages=211–22 |year=1984 |pmid=6421159 |doi= |url=}}</ref><ref name="pmid3131572">{{cite journal |vauthors=Pirovino M, Linder R, Boss C, Köchli HP, Mahler F |title=Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations |journal=Klin. Wochenschr. |volume=66 |issue=7 |pages=298–302 |year=1988 |pmid=3131572 |doi= |url=}}</ref><ref name="pmid2910764">{{cite journal |vauthors=Dutta SK, Dukehart M, Narang A, Latham PS |title=Functional and structural changes in parotid glands of alcoholic cirrhotic patients |journal=Gastroenterology |volume=96 |issue=2 Pt 1 |pages=510–8 |year=1989 |pmid=2910764 |doi= |url=}}</ref><ref name="pmid3983651">{{cite journal |vauthors=Van Thiel DH, Gavaler JS, Schade RR |title=Liver disease and the hypothalamic pituitary gonadal axis |journal=Semin. Liver Dis. |volume=5 |issue=1 |pages=35–45 |year=1985 |pmid=3983651 |doi=10.1055/s-2008-1041756 |url=}}</ref><ref name="pmid7227854">{{cite journal |vauthors=Epstein O, Dick R, Sherlock S |title=Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease |journal=Gut |volume=22 |issue=3 |pages=203–6 |year=1981 |pmid=7227854 |pmc=1419499 |doi= |url=}}</ref><ref name="pmid3592873">{{cite journal |vauthors=Attali P, Ink O, Pelletier G, Vernier C, Jean F, Moulton L, Etienne JP |title=Dupuytren's contracture, alcohol consumption, and chronic liver disease |journal=Arch. Intern. Med. |volume=147 |issue=6 |pages=1065–7 |year=1987 |pmid=3592873 |doi= |url=}}</ref><ref>Erlinger S, Benhamou J. Cirrhosis: clinical aspects. In: Mcintyre N, Benhamou J, Rizzetto M, editors. Oxford textbook of clinical hepatology. Oxford: University Press; 1991. p. 380.</ref><ref>Groszman R, Franchis R. Portal hypertension. In: Schiff E, Sorrell M, Maddrey W, editors. Diseases of the liver. Philadelphia: Lippincot Williams & Wilkens; 1999. p. 415.</ref>
*Hemochromatosis
*[[Hemochromatosis]]
*Wilson's disease
*[[Wilson's disease]]
*Viral hepatitis
*[[Viral hepatitis]]
*Alcoholic hepatitis
*[[Alcoholic hepatitis]]
*Drug induced hepatitis
*Drug induced [[hepatitis]]
*Autoimmune hepatitis
*[[Autoimmune hepatitis]]
*Cirrhosis
*[[Cirrhosis]]
*Cholestatic jaundice
*[[Cholestatic jaundice]]


<span style="font-size:85%">'''Abbreviations:'''
<span style="font-size:85%">'''Abbreviations:'''
Line 47: Line 47:
! rowspan="25" align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! rowspan="25" align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hepatocellular Jaundice
! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hepatocellular Jaundice
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemochromatosis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hemochromatosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 58: Line 58:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ferritin ↑  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Ferritin]] ↑  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Wilson's disease
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Wilson's disease]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 73: Line 73:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Serum cerulloplasmin ↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Serum cerulloplasmin ↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Viral hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Viral hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 86: Line 86:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Specific viral antibody for each type
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Specific [[viral]] [[antibody]] for each type
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Alcoholic hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Alcoholic hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 103: Line 103:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Drug induced hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Drug induced [[hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 117: Line 117:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Autoimmune hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Autoimmune hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 128: Line 128:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti-LKM antibody
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anti-LKM [[antibody]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Cirrhosis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 142: Line 142:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑/N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Low platate
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Thrombocytopenia|Low platelet]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small liver on ultrasond
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small [[liver]] on [[ultrasound]]
|-
|-
! rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice
! rowspan="6" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Common bile duct]] stone
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 157: Line 157:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated ducts on sono
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Dilated [[ducts]] on [[ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT/ERCP
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[CT]]/[[Endoscopic retrograde cholangiopancreatography|ERCP]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hepatitis A cholestatic type
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatitis A]] [[cholestatic]] type
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 171: Line 171:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |HAV- AB
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Hepatitis A|HAV]]- AB
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal ultrasound
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Abdominal [[ultrasound]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |EBV / CMV hepatitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Epstein Barr virus|EBV]] / [[Cytomegalovirus infection|CMV]] [[hepatitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
Line 185: Line 185:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive serology
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Positive [[serology]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary biliary cirrhosis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary biliary cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 199: Line 199:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |AMA positive
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Anti-mitochondrial antibody|AMA]] positive
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Primary sclerosing cholangitis
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Primary sclerosing cholangitis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 213: Line 213:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on MRCP  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Beading on [[Magnetic resonance cholangiopancreatography|MRCP]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Liver biopsy]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pancreatic carcinoma
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
Line 227: Line 227:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mass on ultrasond
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mass on [[ultrasound]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT scan for diagnosis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[CT scan]] for diagnosis
|}
|}
|}
|}


==References==
==References==

Revision as of 21:08, 5 January 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

Alcoholic liver disease should be differentiated from other diseases that produce similar symptoms, and other types of liver diseases. It should also be differentiated from diseases of the gallbladder. Conditions that may present in a similar manner to alcoholic liver disease are; cholecystitis, cholelithiasis, drug toxicity, non-alcoholic fatty liver disease, and other forms of hepatitis (eg. viral, autoimmune).

Differentiating Alcoholic liver disease from other Diseases

Alcoholic liver disease can be differentiated from other diseases on the basis of clinical manifestations including fever, abdominal pain and jaundice. The diseases are:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography

Classification of jaundice based on etiology Disease History and clinical manifestations Diagnosis
Lab Findings Other blood tests Other diagnostic
Family history Fever RUQ Pain Pruritis AST ALT ALK BLR Indirect BLR Direct Viral serology
Jaundice Hepatocellular Jaundice Hemochromatosis + - -/+ - ↑ ↑ ↑/N ↑/N N - Ferritin ↑ Liver biopsy
Wilson's disease + - -/+ - ↑ ↑ N ↑/N N - Serum cerulloplasmin ↑ Liver biopsy
Viral hepatitis - -/+ - - ↑ ↑ N ↑/N N + Specific viral antibody for each type -
Alcoholic hepatitis - -/+ -/+ - ↑↑ ↑ N ↑/N N - - -
Drug induced hepatitis - -/+ - - ↑ ↑ N ↑/N N - - -
Autoimmune hepatitis -/+ - - -/+ ↑ ↑ N ↑/N N - Anti-LKM antibody Liver biopsy
Cirrhosis -/+ -/+ -/+ - ↑ ↑ ↑/N ↑/N ↑/N -/+ Low platelet Small liver on ultrasound
Cholestatic Jaundice Common bile duct stone -/+ - + + N N ↑ N ↑ - Dilated ducts on ultrasound CT/ERCP
Hepatitis A cholestatic type - -/+ + + N N ↑ N ↑ + HAV- AB Abdominal ultrasound
EBV / CMV hepatitis - -/+ + + N N ↑ N ↑ + Positive serology -
Primary biliary cirrhosis -/+ - -/+ + N/↑ N/↑ ↑ N ↑ - AMA positive Liver biopsy
Primary sclerosing cholangitis -/+ - -/+ + N/↑ N/↑ ↑ N ↑ - Beading on MRCP Liver biopsy
Pancreatic carcinoma + - -/+ - N/↑ N/↑ ↑ N ↑ - Mass on ultrasound CT scan for diagnosis

References

  1. ↑ Stickel F, Seitz HK (2013). "Update on the management of alcoholic steatohepatitis". J Gastrointestin Liver Dis. 22 (2): 189–97. PMID 23799218.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ Baraona E, Leo MA, Borowsky SA, Lieber CS (1975). "Alcoholic hepatomegaly: accumulation of protein in the liver". Science. 190 (4216): 794–5. PMID 1198096.
  8. ↑ Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial". Gastroenterology. 119 (6): 1637–48. PMID 11113085.
  9. ↑ Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA (1984). "Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis". Am. J. Med. 76 (2): 211–22. PMID 6421159.
  10. ↑ Pirovino M, Linder R, Boss C, Köchli HP, Mahler F (1988). "Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations". Klin. Wochenschr. 66 (7): 298–302. PMID 3131572.
  11. ↑ Dutta SK, Dukehart M, Narang A, Latham PS (1989). "Functional and structural changes in parotid glands of alcoholic cirrhotic patients". Gastroenterology. 96 (2 Pt 1): 510–8. PMID 2910764.
  12. ↑ Van Thiel DH, Gavaler JS, Schade RR (1985). "Liver disease and the hypothalamic pituitary gonadal axis". Semin. Liver Dis. 5 (1): 35–45. doi:10.1055/s-2008-1041756. PMID 3983651.
  13. ↑ Epstein O, Dick R, Sherlock S (1981). "Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease". Gut. 22 (3): 203–6. PMC 1419499. PMID 7227854.
  14. ↑ Attali P, Ink O, Pelletier G, Vernier C, Jean F, Moulton L, Etienne JP (1987). "Dupuytren's contracture, alcohol consumption, and chronic liver disease". Arch. Intern. Med. 147 (6): 1065–7. PMID 3592873.
  15. ↑ Erlinger S, Benhamou J. Cirrhosis: clinical aspects. In: Mcintyre N, Benhamou J, Rizzetto M, editors. Oxford textbook of clinical hepatology. Oxford: University Press; 1991. p. 380.
  16. ↑ Groszman R, Franchis R. Portal hypertension. In: Schiff E, Sorrell M, Maddrey W, editors. Diseases of the liver. Philadelphia: Lippincot Williams & Wilkens; 1999. p. 415.

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