Alcohol-related liver disease algorithm.
In patients in whom alcohol is suspected to be the main injurious factor, the extent of consumption influences early decision-making. For those drinking at harmful levels, ≥35 units/week women and ≥50 units/week men, an assessment of liver fibrosis is the critical next step. For other patients, administration of the AUDIT C questionnaire alongside brief intervention is recommended initially. For patients who continue to drink at hazardous levels consideration should be given to assessment as for the higher-risk category according to liver fibrosis evaluation. This is particularly important for those with a GGT of >100 U/L. Cut-off points for ARFI vary according to manufacturer and thus should be tailored to the device used. ARFI, acoustic radiation force impulse; ELF, enhanced liver fibrosis; GGT, γ-glutamyltransferase; HCC, hepatocellular carcinoma.
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