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It is essential to take an accurate history of alcohol intake.

  • FBC: may reveal macrocytosis
  • LFTs:
    • a raised gamma GT indicates possible alcohol abuse
    • abnormal ALT reflects hepatocellular damage
    • an AST:ALT ratio that is greater than 2 suggests alcoholic damage
  • there may be an elevated serum IgA; anti-smooth muscle antibodies may be found
  • liver biopsy: reveals extent of liver damage and suggests prognosis

Investigations not specific for liver disease:

  • serum carbohydrate-deficient transferrin: this is a sensitive test for alcoholism, but does not reveal the presence or absence of liver disease
  • blood alcohol

Last reviewed 01/2018