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Alcoholic Liver Disease — RACP Adult Medicine MCQ

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EasyGastroenterologyAlcoholic Liver DiseaseRACP Adult Medicine

A 30-year-old man presents with mildly elevated ALT (80 U/L) and AST (65 U/L). He drinks 60 g alcohol daily. GGT is 180 U/L. MCV is 102 fL. Hepatitis serology negative. AST:ALT ratio is 2.3. Liver USS shows hepatomegaly with diffuse steatosis. He has spider naevi and palmar erythema. What is the most likely diagnosis?

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Correct answer: E — Alcoholic liver disease

AST:ALT ratio >2 (typically >2:1 in ALD), elevated GGT (sensitive marker of alcohol use), macrocytosis (alcohol-related), heavy alcohol intake (>40 g/day in men), hepatomegaly with steatosis, and stigmata of chronic liver disease is alcoholic liver disease. The AST:ALT ratio >2 is highly suggestive (mitochondrial AST release + pyridoxal phosphate deficiency reducing ALT). Management: alcohol abstinence is the single most important intervention.

Reference: GESA – 2024 – ALD; EASL 2024