The Alcoholic Liver


European levels of liver disease related to alcohol consumption are in decline, but in Ireland it is on the increase. Why is this and who should get a new liver?

There are two major drivers of the increase in liver disease related to drinking in Ireland. They are the increased availability of alcohol and a recent dramatic reduction in price. As a consequence more people are dying.

Advertising has also had a major impact on alcohol consumption.

Liver disease related to heavy drinking has medical, psychological and public health issues.

If someone is referred to a liver transplant unit with liver disease, other causes rather than alcohol need to be excluded.

If the heavy drinking is the problem then one major question needs to be asked before going any further:

‘Do you want to stop drinking?’

If they do not want to stop drinking despite being told clearly that the drinking is causing their liver problems and all of the associated illnesses they have, then they should really be discharged. They are adults and make their own decisions about their lives. Any interventions would be a waste of valuable health resources.

Those who want to quit alcohol but cannot give up should be offered all of the available resources available locally to help them. As a result they will either be successful or unsuccessful at giving up.

If they fail, then perhaps there is an argument, dependent of course on the individual case, that they should not be put forward for a liver transplant. The decision is a clinical decision. Their liver disease may be considered as being comparable to someone with a terminal cancer, as nothing can really be done to help them quit alcohol.

If a cancer is deemed incurable and terminal, then attempts at a cure are discontinued and treatment is palliative. Perhaps in some cases in the heavy drinker who cant give up alcohol with liver disease there may be in the future an option to try and treat them again.

If they continue on treatment and abstain for alcohol for 3 months, then they can be put forward as candidates for a transplant. They will be referred for liver transplant assessment if there is no co-existing medical condition that precludes transplantation.

The outcome for transplant patients with alcohol liver disease is the same as for other forms of liver disease.

A liver biopsy may be required to distinguish between the patient who requires follow up for their rest of life or can be simply discharged.

For some patients, seeing the results of their liver biopsy and the damage may be a sufficient trigger to give up their heavy drinking habit. However, there will be some people will not give up alcohol no matter what is done for them. And if they have a normal liver biopsy and no visible damage they may see it as a license to continue drinking.

Measuring blood alcohol concentrations in the A&E proves unequivocal evidence that the patient has been drinking. It proves that the damage to the liver is from alcohol.

If the person has a negative blood alcohol, but have the symptoms of intoxication, such as confusion, they need to be tested for other causes of their behaviour.

If the person has high blood alcohol and is still drunk, it is very important that the medics get on top of this because the patients will have serious DTs and seizures. Benodiazepines can be given to combat symptoms, and should be given in a symptom triggered manner

Conor Caffrey is a science and medical writer.

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