Alcoholism
Last updated: Wednesday, 27, October, 2010
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Diagnosis is based on clinical assessment. Laboratory tests include: FBC, blood film; PT; GGT, urate, triglycerides, as appropriate; ethanol is helpful in detecting recent alcohol ingestion. In chronic alcoholism, macrocytosis, thrombocytopenia, prolonged PT, elevated GGT, hyperuricaemia or hypertriglyceridaemia may be found. The most specific indicator of chronic excessive alcohol ingestion is carbohydrate-deficient transferrin but it has a low sensitivity. |
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Alcoholic liver disease |
AST, ALT, ALP, bilirubin, albumin, protein (total), PT. An AST/ALT ratio of >1 suggests liver disease is due to alcohol. Protein electrophoresis or immunoglobulin quantitation may assist in establishing chronicity. Liver biopsy, if indicated. |
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Fatty liver |
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Alcoholic Hepatitis |
See Hepatitis |
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Hepatocellular carcinoma |
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Acute metabolic disorders |
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Glucose. |
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Electrolytes, hydroxybutyrate. |
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Electrolytes, lactate. |
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Wernicke-Korsakoff syndrome |
If confirmation is required, blood must be collected for vitamin B1 assay prior to therapy. |
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Central pontine myelinolysis |
A demyelinating syndrome associated with rapid sodium fluxes. Electrolytes. |
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Peripheral Neuropathy |
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Infection |
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Aspiration of upper respiratory tract bacteria esp Streptococcus pneumoniae and Klebsiella pneumoniae. Alcoholism also predisposes to infection with Legionella pneumophila. |
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Bacteraemia/Septicaemia |
Inability of the liver to deal with bacteria coming from the gastrointestinal tract in the portal system predisposes to septicaemia caused by Gram-negative bacilli, eg Escherichia coli, Klebsiella pneumoniae. |
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Primary infection with Streptococcus pneumoniae or Gram-negative bacilli, eg Escherichia coli. Diagnosis established by aspiration of peritoneal fluid for microscopy and culture (peritoneal fluid examination). |
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Multifactorial; likely cause(s) indicated by blood film findings and red cell indices. Bone marrow aspiration occasionally indicated, particularly if severe, unexplained anaemia, pancytopenia. |
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Alcohol marrow toxicity |
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FBC, PT, APTT, thrombin time, fibrin degradation products, fibrinogen. |
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Failure of coagulation factor synthesis |
See coagulation disorders |
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Hepatocellular failure |
See hepatic failure |
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Bone marrow aspiration may be appropriate. |
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Primary fibrinolysis may occur and is usually low grade. |
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Dysfibrinogenaemia |
In severe liver disease, especially with hepatocellular carcinoma. Thrombin time, reptilase time. |