Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show that the liver has been damaged.
This is because the condition causes few obvious symptoms in the early stages.
If a doctor suspects you may have ARLD, they will usually arrange a blood test to check how well your liver is working. They may also ask you about your alcohol consumption.
It is important to be totally honest about how much and how often you drink alcohol. If you say you drink less alcohol than you do or deny drinking any alcohol, you may be referred for further unnecessary testing. This could lead to a delay in the treatment you need.
Blood tests used to assess the liver are known as liver function tests. They can detect enzymes in your blood that are normally only present if your liver has been damaged.
Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. Low levels of serum albumin suggest that your liver is not functioning properly.
A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage.
Lab Tests Online has more information about liver function tests.
If your symptoms or liver function test suggest that you may have an advanced form of alcohol-related liver disease, either alcoholic hepatitis or cirrhosis, you may need further tests to assess the state of your liver. These are described below.
An ultrasound scan, computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may also be carried. These scans can produce detailed images of your liver. Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred.
During a liver biopsy, a fine needle is inserted into your body (usually between your ribs). A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope. The biopsy is usually carried out under local anaesthetic, as a day case or with an overnight stay in hospital.
Specialist doctors are able to examine the liver biopsy tissue under the microscope to determine the degree of scarring in the liver and the cause of the damage.
An endoscope is a thin, long, flexible tube with a light and a video camera at one end. During an endoscopy, the instrument is passed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach.
Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varices), which are a sign of cirrhosis.