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Clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis

Scott L Friedman, MD
Section Editor
Bruce A Runyon, MD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Excessive alcohol consumption is associated with a range of hepatic manifestations, including alcoholic fatty liver disease (with or without steatohepatitis), alcoholic hepatitis, and cirrhosis. Patients with an alcohol intake of 30 or more grams per day (one standard drink contains 14 grams of alcohol (figure 1)) are at increased risk of cirrhosis, although the majority of patients will not develop cirrhosis despite heavy alcohol intake (point prevalence of 1 percent for those who drink 30 to 60 g/day and 6 percent for those who drink 120 g/day) [1-3]. Unfortunately, among those who do develop liver disease, symptoms often develop only after severe, life-threatening liver disease has already developed.

This topic will review the clinical manifestations and diagnosis of alcoholic fatty liver disease and alcoholic cirrhosis. The management of alcoholic liver disease, the pathogenesis of alcoholic liver disease, and the approach to patients with alcoholic hepatitis are discussed separately. (See "Prognosis and management of alcoholic fatty liver disease and alcoholic cirrhosis" and "Cirrhosis in adults: Overview of complications, general management, and prognosis" and "Pathogenesis of alcoholic liver disease" and "Alcoholic hepatitis: Clinical manifestations and diagnosis" and "Management and prognosis of alcoholic hepatitis" and "Liver transplantation for alcoholic liver disease".)

In 2010, the American Association for the Study of Liver Diseases and the American College of Gastroenterology issued a joint guideline for the evaluation and management of patients with alcoholic liver disease [4]. Another guideline was published in 2012 by the European Association for the Study of the Liver [5]. The discussion that follows is generally consistent with these guidelines.


Alcohol abuse is common worldwide, with an estimated lifetime prevalence of 18 percent among adults in the United States. It was estimated that in 2010, alcohol-attributable cirrhosis was responsible for 493,300 deaths (1 percent of all deaths) [6]. In the United States, the National Institutes of Health estimated that in 2009, there were more than 31,000 deaths from cirrhosis and that alcohol played a role in 48 percent of those deaths (age-adjusted death rate of 4.5 deaths per 100,000 population) [7]. (See "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis".)

Rates of alcoholic liver disease are higher in areas with greater per capita alcohol consumption compared with areas with low levels of consumption. Areas with high rates of alcohol consumption and alcoholic liver disease include Eastern Europe, Southern Europe, and the United Kingdom [8]. Alarm over the rising impact of alcoholic liver disease has provoked national response in the United Kingdom to address this crisis [9]. On the other hand, countries with large Muslim populations have the lowest rates of alcohol consumption and alcoholic liver disease. The United States is intermediate in its level of consumption (9.4 L per adult per year, compared with 13.4 L per year in the United Kingdom and 0.6 L per year in Indonesia).

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Literature review current through: Nov 2017. | This topic last updated: Dec 15, 2016.
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