alcohol-related%20liver%20disease
ALCOHOL-RELATED LIVER DISEASE

Alcoholic liver disease diagnosis is suggested by an established history of habitual alcohol intake of sufficient length and intensity.
Signs of alcohol abuse and hepatic injury include malnutrition and muscle wasting, cutaneous telangiectasia, palmar erythema, finger clubbing, Dupuytren's contracture, peripheral neuropathy, parotid gland enlargement and signs of gynecomastia and hypogonadism may also be present. Patient may also be asymptomatic.

 

Surgical Intervention

Liver Transplantation

  • Patients with advanced ALD or end-stage liver disease secondary to ALD cirrhosis (Child-Pugh C or MELD-Na ≥21) may be considered for liver transplantation
    • Sick patients unable to complete rehabilitation therapy may also be considered for liver transplantation and can finish their rehabilitation therapy after surgery
  • May also be considered in select patients with severe alcoholic hepatitis and favorable psychosocial profiles who are unresponsive to medical treatment
  • Survival rate is comparable to patients who had transplantation from nonalcoholic liver disease
    • Patients classified as Child-Pugh C and/or MELD ≥15 gain survival benefit
  • Carefully evaluate the patient for:
    • Ability and commitment to abstain from alcohol, eg abstinence from alcohol of a minimum of 6 months
      • The 6-month abstinence criterion alone should not be used as a basis in patient selection as evidence to document its validity in predicting alcohol relapse is limited 
    • Damage to other organs (eg heart, brain)
    • Malignancy in the upper gastrointestinal tract or the upper airways
  • Immunosuppressive agents (eg Sirolimus or Everolimus) should be used at the lowest effective dose for prevention of graft rejection  
  • Screen posttransplant patients during each follow-up for use of alcohol and other substances (eg cannabis, tobacco) 
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Yesterday
A recent study reports a mean growth rate of proximal aorta of about 0.1 mm/year in hypertensive patients with known aortic dilatation. In addition, those with increased rather than normal aortic z score have slower dilatation over time.
5 days ago
Knee osteoarthritis (OA), whether symptomatic or radiographic, contributes to an increased risk of all-cause mortality, with the risk increase from symptomatic knee OA partially attributed to its effect on disability and quality of life (QoL).
Pearl Toh, 3 days ago
It takes just less than 4 days for COVID-19 to spread from one person to another and cause symptoms, and more than 10 percent of the cases are infected by a person who has caught the virus but yet to show symptoms, recent studies suggest.
Audrey Abella, 4 days ago
A prospective study has shown the potential of a new algorithm – the FibroScan-AST (FAST) score – to identify patients with nonalcoholic steatohepatitis (NASH) with significant activity and fibrosis.