GPAtlas🧭 When to suspect
Suspect alcohol-related liver disease (ARLD) in anyone drinking above the UK low-risk guideline of 14 units per week.
• Particularly those with a history of higher-risk drinking or dependence.
• Risk rises steeply at higher intake – > 50 units/week (men) or > 35 units/week (women).
• Many patients remain entirely asymptomatic with normal liver function tests, even with advanced fibrosis.
Screen for risk using AUDIT-C initially:
• A score of ≥ 5 indicates increasing or higher-risk drinking.
• Proceed to the full Alcohol Use Disorders Identification Test (AUDIT) where positive.
Presentation may be:
• Insidious, with non-specific symptoms such as fatigue or malaise.
• Acute, with overt decompensation – jaundice, ascites, variceal bleeding, or encephalopathy.
| Stage | Features |
|---|---|
| Alcoholic fatty liver (steatosis) | • Reversible fat accumulation • Usually asymptomatic • Reverses with abstinence |
| Alcoholic hepatitis | • Inflammation ranging from mild to severe • The severe form (jaundice, fever, tender hepatomegaly) is a medical emergency |
| Fibrosis | • Progressive scarring • Typically silent |
| Cirrhosis (compensated) | • Established scarring • May still be entirely asymptomatic with normal LFTs |
| Decompensated cirrhosis | • Jaundice, ascites, variceal bleeding, or encephalopathy – poor prognosis • Needs urgent care |
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