Synopsis
Detect alcohol-related liver disease without stigma, manage withdrawal and decompensation safely, and recognise severe acute alcohol-related hepatitis requiring specialist treatment.
- Alcohol-related liver disease spans steatosis, steatohepatitis, fibrosis and cirrhosis; normal aminotransferases do not exclude advanced fibrosis.
- Ask about alcohol neutrally using beverage type, volume, strength, frequency, alcohol-free days and recent change, then convert to UK units and screen for dependence.
- A dependent patient can develop seizures or delirium tremens if alcohol stops abruptly; plan monitored withdrawal rather than simply advising immediate unsupported cessation.
Key red flags
New jaundice over days to weeks with anorexia, fever, tender hepatomegaly, leukocytosis and AST typically exceeding ALT after sustained drinking supports the syndrome once infection and obstruction are excluded.
Investigation priorities
Quantify exposure, dependence, harms and withdrawal risk without judgement.
Management branches
Ascites, encephalopathy, gastrointestinal bleeding, jaundice with organ dysfunction or suspected infection.
- Use ABCDE and the current BSG–BASL admission bundle: obtain bloods and cultures, review medicines, assess bleeding and encephalopathy, monitor urine and identify the precipitant.
- Perform diagnostic ascitic tap without avoidable delay when ascites is present, start indicated infection or bleeding treatment and involve hepatology early.
Key medicines
Parenteral thiamineUse the local prophylaxis or treatment regimen matched to Wernicke risk.
Symptom-triggered benzodiazepineTitrate through the authorised withdrawal scale and local liver-impairment protocol.