Alcoholic liver disease laboratory findings: Difference between revisions
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==Overview== | ==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. | 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 ([[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]], [[bilirubin]], [[Gamma-glutamyl transpeptidase|GGT]], [[Alkaline phosphatase|alkaline]] [[Alkaline phosphatase|phosphatase]]), [[INR]] and [[Prothrombin time|PT]]. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory findings consistent with the diagnosis of alcoholic liver disease include:<ref name="pmid15535453">{{cite journal |vauthors=Marsano LS, Mendez C, Hill D, Barve S, McClain CJ |title=Diagnosis and treatment of alcoholic liver disease and its complications |journal=Alcohol Res Health |volume=27 |issue=3 |pages=247–56 |year=2003 |pmid=15535453 |doi= |url=}}</ref> | Laboratory findings consistent with the diagnosis of [[alcoholic liver disease]] include:<ref name="pmid15535453">{{cite journal |vauthors=Marsano LS, Mendez C, Hill D, Barve S, McClain CJ |title=Diagnosis and treatment of alcoholic liver disease and its complications |journal=Alcohol Res Health |volume=27 |issue=3 |pages=247–56 |year=2003 |pmid=15535453 |doi= |url=}}</ref> | ||
*Elevated liver enzymes:<ref name="pmid12062630">{{cite journal |vauthors=Diehl AM |title=Liver disease in alcohol abusers: clinical perspective |journal=Alcohol |volume=27 |issue=1 |pages=7–11 |year=2002 |pmid=12062630 |doi= |url=}}</ref> | *Elevated [[liver]] [[enzymes]]:<ref name="pmid12062630">{{cite journal |vauthors=Diehl AM |title=Liver disease in alcohol abusers: clinical perspective |journal=Alcohol |volume=27 |issue=1 |pages=7–11 |year=2002 |pmid=12062630 |doi= |url=}}</ref> | ||
**Aspartate aminotransferase (AST) level will be greater than that of Alanine aminotransferase (ALT) | **[[Aspartate transaminase|Aspartate aminotransferase (AST]]) level will be greater than that of [[Alanine transaminase|Alanine aminotransferase (ALT)]] | ||
** | **[[Aspartate transaminase|AST]] and [[Alanine transaminase|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 | **The key to diagnosis of [[alcoholic liver disease]] is that the [[Aspartate transaminase|AST]] to [[Alanine transaminase|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 | *Elevated levels of [[Gamma-glutamyl transpeptidase|gamma glutamyltransferase (GGT)]] will indicate heavy [[alcohol]] use and may also indicate [[liver]] injury. This test is sensitive but not specific<ref name="pmid2857631">{{cite journal |vauthors=Moussavian SN, Becker RC, Piepmeyer JL, Mezey E, Bozian RC |title=Serum gamma-glutamyl transpeptidase and chronic alcoholism. Influence of alcohol ingestion and liver disease |journal=Dig. Dis. Sci. |volume=30 |issue=3 |pages=211–4 |year=1985 |pmid=2857631 |doi= |url=}}</ref> | ||
*Elevated triglyceride levels ( | *Elevated [[triglyceride]] levels ([[Hypertriglyceridemia (patient information)|hypertriglyceridemia]]) | ||
*Elevated uric acid levels (hyperuricemia) | *Elevated [[uric acid]] levels ([[hyperuricemia]]) | ||
*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 volume|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 | *Decreased number of [[Platelet|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 International Normalized Ratio (INR) | *Increased [[International normalized ratio|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 | *Increased [[bilirubin]] levels, prolonged [[Prothrombin time|prothrombin time (PT)]] and decreased circulating [[albumin]] ([[hypoalbuminemia]]) are seen in [[Alcoholism|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> | ||
*Iron overload:<ref name="pmid11505030">{{cite journal |vauthors=Whitfield JB, Zhu G, Heath AC, Powell LW, Martin NG |title=Effects of alcohol consumption on indices of iron stores and of iron stores on alcohol intake markers |journal=Alcohol. Clin. Exp. Res. |volume=25 |issue=7 |pages=1037–45 |year=2001 |pmid=11505030 |doi= |url=}}</ref><ref name="pmid18702344">{{cite journal |vauthors=Cylwik B, Chrostek L, Szmitkowski M |title=[The effect of alcohol on iron metabolism] |language=Polish |journal=Pol. Merkur. Lekarski |volume=24 |issue=144 |pages=561–4 |year=2008 |pmid=18702344 |doi= |url=}}</ref><ref name="pmid7117074">{{cite journal |vauthors=Chapman RW, Morgan MY, Laulicht M, Hoffbrand AV, Sherlock S |title=Hepatic iron stores and markers of iron overload in alcoholics and patients with idiopathic hemochromatosis |journal=Dig. Dis. Sci. |volume=27 |issue=10 |pages=909–16 |year=1982 |pmid=7117074 |doi= |url=}}</ref><ref name="pmid10197487">{{cite journal |vauthors=Fletcher LM, Halliday JW, Powell LW |title=Interrelationships of alcohol and iron in liver disease with particular reference to the iron-binding proteins, ferritin and transferrin |journal=J. Gastroenterol. Hepatol. |volume=14 |issue=3 |pages=202–14 |year=1999 |pmid=10197487 |doi= |url=}}</ref> | *[[Iron overload disorder|Iron overload]]:<ref name="pmid11505030">{{cite journal |vauthors=Whitfield JB, Zhu G, Heath AC, Powell LW, Martin NG |title=Effects of alcohol consumption on indices of iron stores and of iron stores on alcohol intake markers |journal=Alcohol. Clin. Exp. Res. |volume=25 |issue=7 |pages=1037–45 |year=2001 |pmid=11505030 |doi= |url=}}</ref><ref name="pmid18702344">{{cite journal |vauthors=Cylwik B, Chrostek L, Szmitkowski M |title=[The effect of alcohol on iron metabolism] |language=Polish |journal=Pol. Merkur. Lekarski |volume=24 |issue=144 |pages=561–4 |year=2008 |pmid=18702344 |doi= |url=}}</ref><ref name="pmid7117074">{{cite journal |vauthors=Chapman RW, Morgan MY, Laulicht M, Hoffbrand AV, Sherlock S |title=Hepatic iron stores and markers of iron overload in alcoholics and patients with idiopathic hemochromatosis |journal=Dig. Dis. Sci. |volume=27 |issue=10 |pages=909–16 |year=1982 |pmid=7117074 |doi= |url=}}</ref><ref name="pmid10197487">{{cite journal |vauthors=Fletcher LM, Halliday JW, Powell LW |title=Interrelationships of alcohol and iron in liver disease with particular reference to the iron-binding proteins, ferritin and transferrin |journal=J. Gastroenterol. Hepatol. |volume=14 |issue=3 |pages=202–14 |year=1999 |pmid=10197487 |doi= |url=}}</ref> | ||
**Elevated serum ferritin | **Elevated serum [[ferritin]] | ||
**Increased transferrin saturation | **Increased [[transferrin]] saturation | ||
**Elevated hepatic iron concentration | **Elevated hepatic [[iron]] concentration | ||
==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>== | ||
===Laboratory Tests : 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>=== | ===Laboratory Tests : 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>=== | ||
{|class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[AASLD guidelines classification scheme#Class of recommendation|Class I]] | | colspan="1" style="text-align:center; background:LightGreen" |[[AASLD guidelines classification scheme#Class of recommendation|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"| '''1.''' <nowiki>"</nowiki> 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. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C)]] <nowiki>"</nowiki> | | bgcolor="LightGreen" | '''1.''' <nowiki>"</nowiki> 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. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: C)]] <nowiki>"</nowiki> | ||
|} | |} | ||
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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]
- Iron overload:[6][7][8][9]
- Elevated serum ferritin
- Increased transferrin saturation
- Elevated hepatic iron concentration
2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[10]
Laboratory Tests : Guidelines (DO NOT EDIT)[10]
| 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.
- ↑ Whitfield JB, Zhu G, Heath AC, Powell LW, Martin NG (2001). "Effects of alcohol consumption on indices of iron stores and of iron stores on alcohol intake markers". Alcohol. Clin. Exp. Res. 25 (7): 1037–45. PMID 11505030.
- ↑ Cylwik B, Chrostek L, Szmitkowski M (2008). "[The effect of alcohol on iron metabolism]". Pol. Merkur. Lekarski (in Polish). 24 (144): 561–4. PMID 18702344.
- ↑ Chapman RW, Morgan MY, Laulicht M, Hoffbrand AV, Sherlock S (1982). "Hepatic iron stores and markers of iron overload in alcoholics and patients with idiopathic hemochromatosis". Dig. Dis. Sci. 27 (10): 909–16. PMID 7117074.
- ↑ Fletcher LM, Halliday JW, Powell LW (1999). "Interrelationships of alcohol and iron in liver disease with particular reference to the iron-binding proteins, ferritin and transferrin". J. Gastroenterol. Hepatol. 14 (3): 202–14. PMID 10197487.
- ↑ 10.0 10.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.