The Spectrum of Alcoholic Liver Disease

Patients may present with various clinical signs or symptoms.


The majority of cases of early liver damage can be diagnosed incidentally on routine blood tests in the ED or primary care. Many patients with fatty liver will be asymptomatic, hepatomegaly on examination may be the only finding.

Early symptoms of alcoholic liver disease

The majority of early symptoms of sustained alcohol abuse are generally non-specific symptoms, such as abdominal discomfort, vomiting or anxiety.

Injuries associated with intoxication

Often the first attendance to the ED of patient with potential ALD is due to a consequence of alcohol, such as falls, rib fractures, head injury or domestic violence.


This is the end point of liver damage and is when the liver tissue is replaced by scar tissue due to the sustained damage caused by alcohol.

The synthetic function of the liver is compromised leading to bleeding and metabolic complications together with complications of portal hypertension mentioned previously.

Portal hypertension

Clinical findings in portal hypertension are caused by blood being forced down different channels as the portal system pressure rises due to liver damage. Signs include ascites, varices (rectal and oesophageal), dilated abdominal veins, caput medusa with the risk of developing encephalopathy.

Alcoholic hepatitis

These patients will often look more unwell with pyrexia and anorexia. Their liver function tests will be deranged and they may have clinical signs of chronic liver damage.