ALCOHOLIC LIVER DISEASE: Diagnostics: – ROUTINE SCREENING TEST LABORATORY DIAGNOSIS OF ALCOHOLIC FATTY LIVER AND ALCOHOLIC HEPATITIS TESTCOMMENT ASTIncreased two- to sevenfold, <400 U/L, greater than ALT ALTIncreased two- to sevenfold, <400 U/L AST/ALTUsually >1 GGTPNot specific to alcohol, easily inducible, elevated in all forms of fatty liver BilirubinMarkedly increased in alcoholic hepatitis despite modest elevation in alkaline phosphatase PMNIf >5500/μL, predicts severe alcoholic hepatitis when discrimination function >32 Harrison’s principle of internal medicine, 17 th Edition, Volume II, pg 1970

ALCOHOLIC LIVER DISEASE: Diagnostics: – OTHER FINDINGS: – Hypoalbuminemia Advance liver disease – Coagulopathy ULTRASONOGRAPHY – ULTRASONOGRAPHY – Fatty infiltration of liver – Determining liver size – Portal vein flow reversal Serious liver disease with less – Ascites potential for complete reversal – Intraabdominal collaterals

CIRRHOSIS Diagnostics: – ACCURATE KNOWLEDGE OF HISTORY – ACCURATE KNOWLEDGE OF HISTORY: know if the patient continues to use and abuse alcohol – LIVER BIOPSY – standard for diagnosis – done through percutaneous, transjugular, laparoscopic, or fine-needle approach – Histological classification – Withheld, until abstinence is maintained for 6 months (to determine residual, nonreversible disease)

Diagnostics: – LABORATORY FINDINGS: LABORATORY DIAGNOSIS OF CIRRHOSIS TESTCOMMENT ASTModerately elevated, greater than ALT ALTModerately elevated AST/ALTUsually >1 GGTPNot specific to alcohol, easily inducible, elevated in all forms of fatty liver BilirubinElevated as cirrhosis progresses, along with slight elevation of alkaline phosphatase GlobulinsIncreased, due to shunting of bacterial antigens away from liver to lymphoid tissue

Diagnostics: – OTHER FINDINGS: – Hypoalbuminemia – Coagulopathy – Hyponatremia ↑ ADH and Aldosterone, inability to excrete H20 – Thrombocytopenia Splenomegaly, ↓ Liver thrombopoietin – Neutropenia and Leukopenia Due to Splenomegaly

– ULTRASONOGRAPHY – small and nodular liver in advanced cirrhosis along with increased echogenicity with irregular appearing areas – ENDOSCOPY – In patients with established cirrhosis, to exclude esophageal varices and primary sclerosing cholangitis