Alcoholic liver disease screening: Difference between revisions
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==Overview== | ==Overview== | ||
All patients who present with elevated liver enzymes, signs of liver disease or increased frequency of accidental trauma should be screened for alcohol abuse. Most individuals who consume heavy amounts of alcohol tend to deny it, hence there must be a strong suspicion under these circumstances. Physicians must have a low threshold to screen for alcohol abuse. | All patients who present with elevated [[liver enzymes]], signs of [[liver]] disease or increased frequency of accidental trauma should be screened for [[alcohol abuse]]. Most individuals who consume heavy amounts of [[alcohol]] tend to deny it, hence there must be a strong suspicion under these circumstances. Physicians must have a low threshold to screen for [[alcohol abuse]]. | ||
==Screening== | ==Screening== | ||
*Patient should be asked about daily or weekly alcohol consumption.<ref name="pmid19621845">{{cite journal |vauthors=Willenbring ML, Massey SH, Gardner MB |title=Helping patients who drink too much: an evidence-based guide for primary care clinicians |journal=Am Fam Physician |volume=80 |issue=1 |pages=44–50 |year=2009 |pmid=19621845 |doi= |url=}}</ref> | *Patient should be asked about daily or weekly [[alcohol]] consumption.<ref name="pmid19621845">{{cite journal |vauthors=Willenbring ML, Massey SH, Gardner MB |title=Helping patients who drink too much: an evidence-based guide for primary care clinicians |journal=Am Fam Physician |volume=80 |issue=1 |pages=44–50 |year=2009 |pmid=19621845 |doi= |url=}}</ref> | ||
*Patient should be asked about the '''CAGE''' questions (Sensitivity ≥ 70% and Specificity > 90%):<ref name="pmid19621845">{{cite journal |vauthors=Willenbring ML, Massey SH, Gardner MB |title=Helping patients who drink too much: an evidence-based guide for primary care clinicians |journal=Am Fam Physician |volume=80 |issue=1 |pages=44–50 |year=2009 |pmid=19621845 |doi= |url=}}</ref> | *Patient should be asked about the [[CAGE questionnaire|'''CAGE''' questions]] (Sensitivity ≥ 70% and Specificity > 90%):<ref name="pmid19621845">{{cite journal |vauthors=Willenbring ML, Massey SH, Gardner MB |title=Helping patients who drink too much: an evidence-based guide for primary care clinicians |journal=Am Fam Physician |volume=80 |issue=1 |pages=44–50 |year=2009 |pmid=19621845 |doi= |url=}}</ref> | ||
**Have you ever felt the need to cut down on your drinking? | **Have you ever felt the need to cut down on your drinking? | ||
**Are you easily annoyed by criticism of your drinking? | **Are you easily annoyed by criticism of your drinking? | ||
**Have you ever felt guilty about you drinking? | **Have you ever felt guilty about you drinking? | ||
**Have you ever needed an eye opener? | **Have you ever needed an eye opener? | ||
*Two positive '''CAGE''' answers indicate dependence on alcohol. | *Two positive '''[[CAGE questionnaire|CAGE]]''' answers indicate dependence on [[alcohol]]. | ||
*Alcohol use disorders identification test ('''AUDIT-C''') should also be implemented to detect alcohol abuse:<ref name="pmid17451397">{{cite journal |vauthors=Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR |title=AUDIT-C as a brief screen for alcohol misuse in primary care |journal=Alcohol. Clin. Exp. Res. |volume=31 |issue=7 |pages=1208–17 |year=2007 |pmid=17451397 |doi=10.1111/j.1530-0277.2007.00403.x |url=}}</ref> | *[[Alcohol]] use disorders identification test ('''AUDIT-C''') should also be implemented to detect [[alcohol abuse]]:<ref name="pmid17451397">{{cite journal |vauthors=Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR |title=AUDIT-C as a brief screen for alcohol misuse in primary care |journal=Alcohol. Clin. Exp. Res. |volume=31 |issue=7 |pages=1208–17 |year=2007 |pmid=17451397 |doi=10.1111/j.1530-0277.2007.00403.x |url=}}</ref> | ||
**Men should score ≥ four points (Sensitivity = 86% and Specificity = 89%). | **Men should score ≥ four points (Sensitivity = 86% and Specificity = 89%). | ||
**Women should score ≥ three points (Sensitivity = 73% and Specificity = 91%). | **Women should score ≥ three points (Sensitivity = 73% and Specificity = 91%). | ||
Revision as of 19:58, 3 January 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
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Overview
All patients who present with elevated liver enzymes, signs of liver disease or increased frequency of accidental trauma should be screened for alcohol abuse. Most individuals who consume heavy amounts of alcohol tend to deny it, hence there must be a strong suspicion under these circumstances. Physicians must have a low threshold to screen for alcohol abuse.
Screening
- Patient should be asked about daily or weekly alcohol consumption.[1]
- Patient should be asked about the CAGE questions (Sensitivity ≥ 70% and Specificity > 90%):[1]
- Have you ever felt the need to cut down on your drinking?
- Are you easily annoyed by criticism of your drinking?
- Have you ever felt guilty about you drinking?
- Have you ever needed an eye opener?
- Two positive CAGE answers indicate dependence on alcohol.
- Alcohol use disorders identification test (AUDIT-C) should also be implemented to detect alcohol abuse:[2]
- Men should score ≥ four points (Sensitivity = 86% and Specificity = 89%).
- Women should score ≥ three points (Sensitivity = 73% and Specificity = 91%).
References
- ↑ 1.0 1.1 Willenbring ML, Massey SH, Gardner MB (2009). "Helping patients who drink too much: an evidence-based guide for primary care clinicians". Am Fam Physician. 80 (1): 44–50. PMID 19621845.
- ↑ Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR (2007). "AUDIT-C as a brief screen for alcohol misuse in primary care". Alcohol. Clin. Exp. Res. 31 (7): 1208–17. doi:10.1111/j.1530-0277.2007.00403.x. PMID 17451397.