GPAtlas🧭 When to suspect
Suspect alcohol-related liver disease (ARLD) in anyone drinking above the UK low-risk guideline of 14 units per week, and particularly in 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), proceeding to the full AUDIT where positive. Presentation may be insidious with non-specific symptoms such as fatigue or malaise, or 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. |
Source: NICE NG50 · BSG
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