Other Tests

Imaging and Non-invasive Assessment

Transient Elastography (FibroScan) is now widely used in UK pathways as a routine non-invasive tool to assess liver stiffness (fibrosis) and steatosis in alcohol-related liver disease. It provides immediate results at the bedside or outpatient clinic and helps stratify patients into mild fibrosis, significant fibrosis, or cirrhosis without invasive procedures. [11]

Ultrasound remains helpful to investigate liver damage. Fatty liver and alcoholic hepatitis are demonstrated by changes in liver parenchymal reflectivity. A cirrhotic liver appears irregular and shrunken. Doppler studies may show slow or reversed portal vein flow, splenomegaly and intra-abdominal varices indicating portal hypertension.

Liver biopsy is reserved for cases where diagnostic uncertainty remains after non-invasive testing, or where important clinical information cannot be obtained by safer non-invasive means (such as differentiating between alcohol-related hepatitis and other causes of acute liver injury). In patients with coagulopathy, the transjugular venous route is preferred. [11]