Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver.
This is because the condition causes few obvious symptoms in the early stages.
If a doctor suspects ARLD, they'll usually arrange a blood test to check how well your liver is working. They may also ask about your alcohol consumption.
It's important to be totally honest about how much and how often you drink alcohol to avoid 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. However, liver function tests can be normal at many stages of liver disease.
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. A low level of serum albumin suggests your liver isn't 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 on liver function tests.
If your symptoms or liver function test suggest an advanced form of ARLD – either alcoholic hepatitis or cirrhosis – you may need further tests. These are described below.
Scans may be needed to produce detailed images of your liver. This may include:
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, either as a day case or with an overnight stay in hospital.
Specialist doctors will 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 long, thin, 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.