Alcohol is a hepatotoxin, commonly consumed globally. Alcoholic liver disease (ALD) is a general term that defines the spectrum of alcohol-related liver injuries. 

Excessive or harmful alcohol use remains one among the top five risk factors for death and disability globally. All patients with clinical features of hepatitis or chronic liver disease or having elevated serum elevated transaminase levels should be screened for an alcohol use disorder. 

History, clinical and laboratory findings are crucial for ALD diagnosis. But diagnosing ALD clinically can be challenging as there is a lack of diagnostic test that confirms the diagnosis and patients may not give information about their degree of alcohol consumption. Furthermore, no or minimal clinical findings may be present in early ALD characterized by hepatic steatosis. 

Characteristic laboratory findings in ALD include transaminase levels with aspartate aminotransferase > alanine aminotransferase and increased mean corpuscular volume, gamma-glutamyltranspeptidase, and IgA:IgG. 

Indistinct cases may need imaging and liver biopsy for assisting the diagnosis. A typical presence and distribution of hepatic steatosis, inflammation and Mallory-Denk bodies are seen as the histological features of ALD. Since ALD is potentially reversible in essence, soberness, routine screening of the general population and early diagnosis are crucial.

SOURCE- Torruellas C, French SW, Medici V. Diagnosis of alcoholic liver disease. World J Gastroenterol. 2014;20(33):11684-11699. doi:10.3748/wjg.v20.i33.11684