Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Alcoholic liver disease should be differentiated from other diseases that produce similar symptoms, and other types of liver diseases. It should also be differentiated from diseases of the gallbladder. Conditions that may present in a similar manner to alcoholic liver disease are; cholecystitis, cholelithiasis, drug toxicity, non-alcoholic fatty liver disease, and other forms of hepatitis (eg. viral, autoimmune).
Differentiating Alcoholic liver disease from other Diseases
table for diff
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography
Classification of jaundice based on etiology
|
Disease
|
History and clinical manifestations
|
Diagnosis
|
Lab Findings
|
Other blood tests
|
Other diagnostic
|
Family history
|
Fever
|
RUQ Pain
|
Pruritis
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
Jaundice
|
Hepatocellular Jaundice
|
Hemochromatosis
|
+
|
-
|
-/+
|
-
|
↑
|
↑
|
↑/N
|
↑/N
|
N
|
-
|
Ferritin ↑
|
Liver biopsy
|
Wilson's disease
|
+
|
-
|
-/+
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
Serum cerulloplasmin ↑
|
Liver biopsy
|
Viral hepatitis
|
-
|
-/+
|
-
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
+
|
Specific viral antibody for each type
|
-
|
Alcoholic hepatitis
|
-
|
-/+
|
-/+
|
-
|
↑↑
|
↑
|
N
|
↑/N
|
N
|
-
|
-
|
-
|
Drug induced hepatitis
|
-
|
-/+
|
-
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
-
|
-
|
Autoimmune hepatitis
|
-/+
|
-
|
-
|
-/+
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
Anti-LKM antibody
|
Liver biopsy
|
Cirrhosis
|
-/+
|
-/+
|
-/+
|
-
|
↑
|
↑
|
↑/N
|
↑/N
|
↑/N
|
-/+
|
Low platate
|
Small liver on ultrasond
|
Cholestatic Jaundice
|
Common bile duct stone
|
-/+
|
-
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
-
|
Dilated ducts on sono
|
CT/ERCP
|
Hepatitis A cholestatic type
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
HAV- AB
|
Abdominal ultrasound
|
EBV / CMV hepatitis
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
Positive serology
|
|
Primary biliary cirrhosis
|
-/+
|
-
|
-/+
|
+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
AMA positive
|
Liver biopsy
|
Primary sclerosing cholangitis
|
-/+
|
-
|
-/+
|
+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
Pancreatic carcinoma
|
+
|
-
|
-/+
|
-
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Mass on ultrasond
|
CT scan for diagnosis
|
Isolated Jaundice
|
Crigler-Najjar type 2
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
↑
|
-
|
Genetic testing
|
Gilbert
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
↑
|
-
|
Genetic testing
|
Rotor syndrome
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
N
|
↑
|
-
|
Genetic testing
|
Liver biopsy
|
Dubin-Johnson syndrome
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
N
|
↑
|
-
|
Genetic testing
|
Liver biopsy
|
Hereditory spherocytosis
|
+
|
-
|
-/+
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
Osmotic fragility
|
G6PD deficiency
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
Thalassemia
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
Sickle cell disease
|
+
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Genetic testing
|
Paroxismal nocturnal hemoglobinoria
|
-
|
-
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Flocytometery
|
Immune hemolysis
|
-
|
-/+
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Autoantibodies
|
Hematoma
|
-
|
-/+
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Anemia
|
Truma or surgery in history
|
|
The differential diagnosis for jaundice and pruritis are:
Disease
|
History and clinical manifestations
|
Diagnosis
|
Lab Findings
|
Other blood tests
|
Other diagnostic
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
Type of jaundice
|
Pruritis
|
Family history
|
Common bile duct stone
|
Cholestatic Jaundice
|
+
|
-/+
|
N
|
N
|
↑
|
N
|
↑
|
-
|
Dilated ducts on sono
|
CT/ERCP
|
Hepatitis A cholestatic type
|
+
|
-
|
N
|
N
|
↑
|
N
|
↑
|
+
|
HAV- AB
|
Abdominal ultrasound
|
EBV / CMV hepatitis
|
+
|
-
|
N
|
N
|
↑
|
N
|
↑
|
+
|
Positive serology
|
PCR or ELISA
|
Primary biliary cirrhosis
|
+
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
AMA positive
|
Liver biopsy
|
Primary sclerosing cholangitis
|
+
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
Autoimmune hepatitis
|
Hepatocellular Jaundice
|
-/+
|
-/+
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
Anti-LKM antibody
|
Liver biopsy
|
|
The differential diagnosis for jaundice, pruritis and RUQ pain are:
Disease
|
History and clinical manifestations
|
Diagnosis
|
Lab Findings
|
Other blood tests
|
Other diagnostic
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
Type of jaundice
|
Pruritis
|
RUQ pain
|
Fever
|
Family history
|
Common bile duct stone
|
Cholestatic Jaundice
|
+
|
+
|
-
|
-/+
|
N
|
N
|
↑
|
N
|
↑
|
-
|
Dilated ducts on sono
|
CT/ERCP
|
Hepatitis A cholestatic type
|
+
|
+
|
-/+
|
-
|
N
|
N
|
↑
|
N
|
↑
|
+
|
HAV- AB
|
Abdominal ultrasound
|
EBV / CMV hepatitis
|
+
|
+
|
-/+
|
-
|
N
|
N
|
↑
|
N
|
↑
|
+
|
Positive serology
|
PCR or ELISA
|
Primary biliary cirrhosis
|
+
|
-/+
|
-
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
AMA positive
|
Liver biopsy
|
Primary sclerosing cholangitis
|
+
|
-/+
|
-
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
|
The differential diagnosis for jaundice, pruritis and RUQ pain are:
Classification of jaundice based on etiology
|
Disease
|
History and clinical manifestations
|
Diagnosis
|
Lab Findings
|
Other blood tests
|
Other diagnostic
|
Family history
|
Fever
|
RUQ Pain
|
Pruritis
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
Jaundice
|
Cholestatic Jaundice
|
Common bile duct stone
|
-/+
|
-
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
-
|
Dilated ducts on ultrasond
|
CT/ERCP
|
Hepatitis A cholestatic type
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
HAV- AB
|
Abdominal ultrasound
|
EBV / CMV hepatitis
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
Positive serology
|
|
Primary biliary cirrhosis
|
-/+
|
-
|
-/+
|
+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
AMA positive
|
Liver biopsy
|
Primary sclerosing cholangitis
|
-/+
|
-
|
-/+
|
+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
|
The differential diagnosis for jaundice, fever and RUQ pain are:
Classification of jaundice based on etiology
|
Disease
|
History and clinical manifestations
|
Diagnosis
|
Lab Findings
|
Other blood tests
|
Other diagnostic
|
Family history
|
Fever
|
RUQ Pain
|
Pruritis
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
Jaundice
|
Hepatocellular Jaundice
|
Alcoholic hepatitis
|
-
|
-/+
|
-/+
|
-
|
↑↑
|
↑
|
N
|
↑/N
|
N
|
-
|
-
|
-
|
Cirrhosis
|
-/+
|
-/+
|
-/+
|
-
|
↑
|
↑
|
↑/N
|
↑/N
|
↑/N
|
-/+
|
Low platate
|
Small liver on ultrasond
|
Cholestatic Jaundice
|
Hepatitis A cholestatic type
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
HAV- AB
|
Abdominal ultrasound
|
EBV / CMV hepatitis
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
Positive serology
|
PCR or ELISA
|
|
The differential diagnosis for jaundice and fever are:
Classification of jaundice based on etiology
|
Disease
|
History and clinical manifestations
|
Diagnosis
|
Lab Findings
|
Other blood tests
|
Other diagnostic
|
Family history
|
Fever
|
RUQ Pain
|
Pruritis
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
Jaundice
|
Hepatocellular Jaundice
|
Viral hepatitis
|
-
|
-/+
|
-
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
+
|
Specific viral antibody for each type
|
-
|
Alcoholic hepatitis
|
-
|
-/+
|
-/+
|
-
|
↑↑
|
↑
|
N
|
↑/N
|
N
|
-
|
-
|
-
|
Drug induced hepatitis
|
-
|
-/+
|
-
|
-
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
-
|
-
|
Cirrhosis
|
-/+
|
-/+
|
-/+
|
-
|
↑
|
↑
|
↑/N
|
↑/N
|
↑/N
|
-/+
|
Low platate
|
Small liver on ultrasond
|
Cholestatic Jaundice
|
Hepatitis A cholestatic type
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
HAV- AB
|
Abdominal ultrasound
|
EBV / CMV hepatitis
|
-
|
-/+
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
+
|
Positive serology
|
PCR or ELISA
|
Isolated Jaundice
|
Immune hemolysis
|
-
|
-/+
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Autoantibodies
|
Hematoma
|
-
|
-/+
|
-
|
-
|
N
|
N
|
N
|
↑
|
N
|
-
|
Anemia
|
Truma or surgery in history
|
|
References
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