What is the diagnosis for a patient with a history of ethanol (ETOH) abuse and elevated liver function tests (LFTs) who underwent an upper quadrant sonogram?

From the Guidelines

Abstinence from alcohol is crucial to prevent further liver damage, and I strongly recommend that you discuss alcohol cessation with your doctor as soon as possible. The ultrasound performed on May 6,2025, shows fatty liver disease (hepatic steatosis) but is otherwise normal, which is consistent with your history of alcohol use and elevated liver function tests 1. This finding is concerning, as continued drinking can worsen liver damage and lead to severe alcoholic hepatitis, which has a high mortality rate within 90 days if left untreated 1.

Key Findings

• The fatty infiltration of your liver appears as increased echogenicity (brightness) on the ultrasound, which is a common finding in people who consume excessive alcohol.
• Your liver is normal in size with no masses or bile duct dilation.
• Your gallbladder, pancreas, blood vessels, and right kidney all appear normal.
• The common bile duct measures 4.8 mm, which is within normal limits.
• Your right kidney measures 9.7 x 3.8 x 5.2 cm with normal appearance and no concerning findings.

Recommendations

• Abstinence from alcohol is the cornerstone of treatment for alcoholic liver disease, and I strongly recommend that you discuss alcohol cessation with your doctor as soon as possible 1.
• A follow-up ultrasound in 6-12 months may be appropriate to monitor changes in your liver condition.
• Lifestyle modifications including a healthy diet, regular exercise, and weight management (if overweight) can help improve fatty liver disease.
• It is essential to work with your healthcare provider to develop a comprehensive treatment plan that addresses your liver disease and alcohol use disorder, as failure to maintain abstinence from drinking alcohol may lead to further deterioration in liver function 1.

From the Research

Upper Quadrant Sonogram Findings

• The sonogram findings indicate hepatic steatosis, which is a common liver disease characterized by the accumulation of fat in liver cells.
• The liver echo texture is increased in echogenicity, and the liver is within normal limits of size.
• There is no obvious mass or biliary dilatation, and the common bile duct measures 4.8 mm.
• The gallbladder is unremarkable, without wall thickening, pericholecystic fluid, sludge, or gallstones.

Hepatic Steatosis Treatment

• According to the study by 2, vitamin E therapy was associated with a significantly higher rate of improvement in nonalcoholic steatohepatitis (43% vs. 19%, P=0.001).
• The study by 3 found that a combination of vitamin E and pioglitazone produced a greater improvement in NASH histology, with significant decreases in steatosis, cytologic ballooning, and pericellular fibrosis.
• The study by 4 demonstrated that vitamin E treatment in NAFLD patients decreases steatosis through the downregulation of de-novo lipogenesis.
• A systematic review by 5 found that vitamin E supplementation significantly reduces serum aminotransferases and improves histological parameters such as steatosis and inflammation in patients with NAFLD/MASLD.

ETOH Abuse and Liver Disease

• The study by 6 discusses the treatment of alcohol withdrawal in hospitalized patients, but does not provide direct evidence for the treatment of liver disease caused by ETOH abuse.
• However, the sonogram findings suggest that the patient has hepatic steatosis, which may be related to ETOH abuse, and further evaluation and treatment may be necessary.