Alcoholic liver disease laboratory findings: Difference between revisions
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*Low potassium levels (hypokalemia) | *Low potassium levels (hypokalemia) | ||
*Low magnesium levels (hypomagnesemia) | *Low magnesium levels (hypomagnesemia) | ||
*Elevated index of red blood cell size; increased mean corpuscular erythrocyte volume (MCV) | *Elevated index of red blood cell size; increased mean corpuscular erythrocyte volume (MCV).<ref name="pmid18239988">{{cite journal |vauthors=Kazemi-Shirazi L, Veloso MP, Frommlet F, Steindl-Munda P, Wrba F, Zehetmayer S, Marsik C, Ferenci P |title=Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful? |journal=Wien. Klin. Wochenschr. |volume=120 |issue=1-2 |pages=25–30 |year=2008 |pmid=18239988 |doi=10.1007/s00508-007-0921-1 |url=}}</ref><ref name="pmid21451926">{{cite journal |vauthors=Das SK, Mukherjee S, Vasudevan DM, Balakrishnan V |title=Comparison of haematological parameters in patients with non-alcoholic fatty liver disease and alcoholic liver disease |journal=Singapore Med J |volume=52 |issue=3 |pages=175–81 |year=2011 |pmid=21451926 |doi= |url=}}</ref> | ||
*Increased number of white blood cells (leukocytosis) | *Increased number of white blood cells (leukocytosis). | ||
*Decreased number of platelets (thrombocytopenia) | *Decreased number of platelets (thrombocytopenia).<ref name="pmid18239988">{{cite journal |vauthors=Kazemi-Shirazi L, Veloso MP, Frommlet F, Steindl-Munda P, Wrba F, Zehetmayer S, Marsik C, Ferenci P |title=Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful? |journal=Wien. Klin. Wochenschr. |volume=120 |issue=1-2 |pages=25–30 |year=2008 |pmid=18239988 |doi=10.1007/s00508-007-0921-1 |url=}}</ref><ref name="pmid21451926">{{cite journal |vauthors=Das SK, Mukherjee S, Vasudevan DM, Balakrishnan V |title=Comparison of haematological parameters in patients with non-alcoholic fatty liver disease and alcoholic liver disease |journal=Singapore Med J |volume=52 |issue=3 |pages=175–81 |year=2011 |pmid=21451926 |doi= |url=}}</ref> | ||
*Increased bilirubin levels, prolonged prothrombin time (PT) and decreased circulating albumin (hypoalbuminemia) are seen in alcoholic hepatitis and cirrhosis. | *Increased International Normalized Ratio (INR).<ref name="pmid18239988">{{cite journal |vauthors=Kazemi-Shirazi L, Veloso MP, Frommlet F, Steindl-Munda P, Wrba F, Zehetmayer S, Marsik C, Ferenci P |title=Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful? |journal=Wien. Klin. Wochenschr. |volume=120 |issue=1-2 |pages=25–30 |year=2008 |pmid=18239988 |doi=10.1007/s00508-007-0921-1 |url=}}</ref><ref name="pmid21451926">{{cite journal |vauthors=Das SK, Mukherjee S, Vasudevan DM, Balakrishnan V |title=Comparison of haematological parameters in patients with non-alcoholic fatty liver disease and alcoholic liver disease |journal=Singapore Med J |volume=52 |issue=3 |pages=175–81 |year=2011 |pmid=21451926 |doi= |url=}}</ref> | ||
*Increased bilirubin levels, prolonged prothrombin time (PT) and decreased circulating albumin (hypoalbuminemia) are seen in alcoholic hepatitis and cirrhosis.<ref name="pmid21451926">{{cite journal |vauthors=Das SK, Mukherjee S, Vasudevan DM, Balakrishnan V |title=Comparison of haematological parameters in patients with non-alcoholic fatty liver disease and alcoholic liver disease |journal=Singapore Med J |volume=52 |issue=3 |pages=175–81 |year=2011 |pmid=21451926 |doi= |url=}}</ref> | |||
==2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>== | ==2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>== | ||
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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
It is important to take a complete history and find out about the patient's alcohol use and current signs and symptoms for alcoholic liver disease. As laboratory tests do not give the definitive diagnosis of alcoholic liver disease. It is also important to rule out other causes of liver disease such as, chronic viral hepatitis which could co-exist, autoimmune hepatitis, hemochromatosis and drug related hepatotoxicity. Initial assessment must include a complete blood count, hepatic panel (ALT, AST, bilirubin, GGT, alkaline phosphatase), INR and PT.
Laboratory Findings
Laboratory findings consistent with the diagnosis of alcoholic liver disease include:[1]
- Elevated liver enzymes:[2]
- Aspartate aminotransferase (AST) level will be greater than that of Alanine aminotransferase (ALT).
- AST and ALT levels both will be below 300 IU/ml.
- The key to diagnosis of alcoholic liver disease is that the AST to ALT ratio will be greater than 2.
- Elevated levels of gamma glutamyltransferase (GGT) will indicate heavy alcohol use and may also indicate liver injury. This test is sensitive but not specific.[3]
- Elevated triglyceride levels (hypertriglyceridemia).
- Elevated uric acid levels (hyperuricemia)
- Low potassium levels (hypokalemia)
- Low magnesium levels (hypomagnesemia)
- Elevated index of red blood cell size; increased mean corpuscular erythrocyte volume (MCV).[4][5]
- Increased number of white blood cells (leukocytosis).
- Decreased number of platelets (thrombocytopenia).[4][5]
- Increased International Normalized Ratio (INR).[4][5]
- Increased bilirubin levels, prolonged prothrombin time (PT) and decreased circulating albumin (hypoalbuminemia) are seen in alcoholic hepatitis and cirrhosis.[5]
2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[6]
Laboratory Tests : Guidelines (DO NOT EDIT)[6]
| Class I |
| 1. " For patients with a history of alcohol abuse or excess and evidence of liver disease, further laboratory tests should be done to exclude other etiologies and to confirm the diagnosis. (Level of evidence: C) " |
References
- ↑ Marsano LS, Mendez C, Hill D, Barve S, McClain CJ (2003). "Diagnosis and treatment of alcoholic liver disease and its complications". Alcohol Res Health. 27 (3): 247–56. PMID 15535453.
- ↑ Diehl AM (2002). "Liver disease in alcohol abusers: clinical perspective". Alcohol. 27 (1): 7–11. PMID 12062630.
- ↑ Moussavian SN, Becker RC, Piepmeyer JL, Mezey E, Bozian RC (1985). "Serum gamma-glutamyl transpeptidase and chronic alcoholism. Influence of alcohol ingestion and liver disease". Dig. Dis. Sci. 30 (3): 211–4. PMID 2857631.
- ↑ 4.0 4.1 4.2 Kazemi-Shirazi L, Veloso MP, Frommlet F, Steindl-Munda P, Wrba F, Zehetmayer S, Marsik C, Ferenci P (2008). "Differentiation of nonalcoholic from alcoholic steatohepatitis: are routine laboratory markers useful?". Wien. Klin. Wochenschr. 120 (1–2): 25–30. doi:10.1007/s00508-007-0921-1. PMID 18239988.
- ↑ 5.0 5.1 5.2 5.3 Das SK, Mukherjee S, Vasudevan DM, Balakrishnan V (2011). "Comparison of haematological parameters in patients with non-alcoholic fatty liver disease and alcoholic liver disease". Singapore Med J. 52 (3): 175–81. PMID 21451926.
- ↑ 6.0 6.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.