Suspected Alcoholic Liver Disease

 

Introduction

Note alcoholic fatty liver disease can co-exist with over liver disease (e.g. MASLD, Hepatitis etc)

 

Red Flag Features

Synthetic failure – jaundice, low albumin, ascites, prolonged INR, encephalopathy

 

Key Features of Assessment

1. Calculate unit consumption using unit calculator (e.g.Drinkaware)
2. High Risk drinker = Male >50 units or Female >35 units
3. If Low risk drinker assess alcohol dependency using AUDIT questionnaire

 

Investigations

• LFTs (if elevated ALT, bilirubin or ALP follow appropriate pathway to investigate co-existing liver disease depending on clinical judgement)
• Abdominal USS

 

Management

Referral:

Urgent Hepatology referral:

• Synthetic failure (jaundice, low albumin, ascites, prolonged INR) – arrange abdominal USS, raised ALT orderset on ICE, FBC and INR also.

 

Fibroscan referral criteria:

• High risk drinker: >50 units/week male or >35 units/week female
• Previous fibroscan result <10KpA but patient still drinking heavily after 3 years

 

Alcohol Reduction Support:

**With You(Formerly We Are With You or ADDaction)

• 24 Hour helpline – 0333 2000 325
• St Austell/Truro – 01872 263001
• Over 50s alcohol helpline – 0808 801 0750
• YZUP (under 18s)– 01872 300816

 

Advice and Guidance

Please send advice and guidance requests via e-RS to: http://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/gastro/rcht_hepatology_advice_and_guidance

 

Supporting Information

For patients:

British liver trust leaflet: Alcohol-related liver disease (ARLD) - British Liver Trust

 

Page Review Information

Review date	August 2024
Next review date	August 2026
GP Speciality Lead	Dr Madeleine Attridge (Hepatology lead GP)
Contributors	Dr Hyder Hussaini (Consultant Hepatologist RCHT)