Alcoholic Fatty Liver Clinical Presentation

  • Author: Mohammad K Ismail, MD, AGAF; Chief Editor: Julian Katz, MD   more...
 
Updated: Aug 19, 2011
 

History

Alcohol-induced steatosis usually is asymptomatic in ambulatory patients.

  • Fatty liver occurs commonly after the ingestion of a moderate or large amount of alcohol, even for a short period of time.
  • A thorough clinical history, especially with regard to the amount of alcohol consumption, is essential to determining the role of alcohol in the etiology of the abnormal liver test results. History obtained from the family members may reveal past alcohol-related problems.
  • No specific test is available to rule out drug-related toxicity, but a good review of all concurrent and recent medications, including over-the-counter medications and alternative treatments, is essential in evaluating the possible causes of abnormal liver test results.
  • Severe fatty infiltration of the liver can result in symptoms of malaise, weakness, anorexia, nausea, and abdominal discomfort.
  • Jaundice is present in 15% of patients admitted to the hospital because of these symptoms of fatty infiltration of the liver.

The American Association for the Study of Liver Diseases 2010 practice guideline for ALD recommends the following for diagnosis:[1]

  • If alcohol abuse or excess is suspected from discussion of alcohol use with the patient, screen the patient for alcohol abuse using a structured questionnaire such as the Alcohol Use Disorders Identification Test (AUDIT).
  • If the patient’s history or a screening test indicates alcohol abuse, use laboratory testing to verify the diagnosis of ALD and rule out other considerations.
  • If ALD is confirmed, test for other alcohol-related organ damage.
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Physical

Fatty liver may be present in the absence of any abnormalities noted on the physical examination.

  • Hepatomegaly is common in patients who are hospitalized, occurring in over 70% of persons with steatosis proven on biopsy.
  • Portal hypertension is rare in alcoholic steatosis.
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Causes

  • Several risk factors may be cofactors required for the development of advanced ALD.
  • Minimum amounts of alcohol intake associated with an increased risk for developing ALD range from 40-80 g/d for 10-12 years.
  • Genetics play a role in alcohol consumption and alcoholism. In addition, early data suggested a genetic predisposition to the development of ALD mostly related to differences in major hepatic enzymes involved in the metabolism of alcohol—alcohol dehydrogenase (ADH), acetaldehyde dehydrogenase (ALDH), and cytochrome P-450 system (CYP4502E1).
  • Several studies demonstrate a high prevalence of hepatitis C virus (HCV) antibody in patients with ALD, as well as iron overload.
  • Obesity and dietary habits have been implicated in individual susceptibility to ALD.
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Contributor Information and Disclosures
Author

Mohammad K Ismail, MD, AGAF  Associate Professor, Department of Internal Medicine and Gastroenterology, Program Director for Gastroenterology Fellowship and Training, University of Tennessee Health Science Center

Mohammad K Ismail, MD, AGAF is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Caroline Riely, MD  Professor, Departments of Medicine and Pediatrics, University of Tennessee Health Science Center College of Medicine

Caroline Riely, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Federation for Medical Research, American Gastroenterological Association, North American Society for Pediatric Gastroenterology and Nutrition, and Society of Obstetric Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Ann Ouyang, MBBS  Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

James L Achord, MD  Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine

James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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