The brutal fact is that experienced medical hands often recognize it before the blood
tests confirm it, because alcohol use leaves its fingerprints on multiple body systems
simultaneously, weaving together a clear story for anyone trained to read it.
There is the physical examination.
The flushing of the face, particularly the nose and cheek area, caused by the breaking of
blood vessels;
the swelling of the parotid glands, softening the jaw line;
the thickening of the palm of the hand from Dupuytren˙s contracture;
the spider angiomas on the upper chest;
the palpable liver edge beneath the rib cage;
the thin build with the bloated abdomen-these all add up to a diagnosis even before the
first question is asked.
There is the blood work, which usually verifies what the physical examination already
suspects.
The gamma-GT is elevated with good sensitivity to alcohol excess.
The MCV, or mean corpuscular volume, rises with the use of alcohol.
The AST and ALT, the liver enzymes, reflect the inflammation of the liver.
The ratio of the AST to the ALT has its own diagnostic fingerprint pointing to alcohol
rather than other causes of liver dysfunction.
The triglycerides are elevated. The uric acid rises.
And then there is the history, where the disconnect between the story the patient tells
and the results of the blood work is so large it becomes a diagnostic clue unto itself.
Most alcohol abusers underreport the amount of alcohol they use.
Not by chance, but by the math of shame applied to the honest admission of the amount
of alcohol use.
Clinicians quickly multiply the admitted amount by a factor derived not from any
algorithm but from experience.
The human body is a much louder narrator than the human patient.
It is a much more honest narrator than the human patient.
The human body has never lied to a physician who is trained to read it all at once.
Full story:
https://www.quora.com/How-does-a-doctor-know-if-a-patient-is-a-heavy-drinker
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* Origin: The Hobby Line! BBS (999:1/1)