Alcoholic Liver Disease

Fatty liver due to alcohol

Usually asymptomatic. The major feature is liver enlargement from accumulation of fat globules within hepatocytes — can occur after a single “binge” of alcohol excess, and usually regresses with abstinence. Other causes of fatty liver include obesity, viral hepatitis, and medications (see Fatty Liver / MASLD).

Suspect alcoholic liver disease in a patient with raised GGT, macrocytosis, and AST > ALT.

Alcoholic hepatitis

A severe form of alcoholic liver disease, occurring in those with known alcoholic liver disease.

History: usually presents with rapid-onset jaundice; confusion and unsteadiness (hepatic encephalopathy); upper abdominal pain; history of a recent alcohol binge.

Examination: fever; hepatic pain and tenderness; jaundice.

Investigations: FBC (neutrophilia); LFTs show reversal of the AST:ALT ratio, with AST concentration 2–3× higher than ALT (though both are usually below 300), disproportionately raised bilirubin, and elevated GGT. Usually diagnosed clinically, but liver biopsy is characteristic and may be required before treatment in severe cases or diagnostic doubt.

Management: refer for inpatient hospital management if the patient meets criteria on the Maddrey discriminant function (MDF) or MELD scoring. Treatment is oral prednisolone 40mg for 28 days (unless no improvement at 7 days, then taper over 3 weeks). Long-term alcohol abstinence is essential. Manage alcohol withdrawal — thiamine, alcohol withdrawal scale monitoring, benzodiazepines.