Alcoholic Cirrhosis

00:01 Next topic Under the syndrome of Alcoholic liver disease now officially is cirrhosis.

00:08 I ask you a question.

00:10 Do you have to go through hepatitis first to get to cirrhosis? A lot of patients would, I'll give you that. But you don't have to.

00:19 See, you have your patient that has been drinking quite a bit and the developing cirrhosis, end-stage liver disease.

00:26 I would then extract a topic called end-stage liver disease and the reason for that is because just like we've talked about with end-stage heart disease, Congestive Heart Failure You can have many, many, many, many causes of end-stage liver disesase.

00:42 Here, our focus is...

00:44 Alcoholic end-stage liver disease Welcome to cirrhosis.

00:50 Alcoholic Cirrhosis Most patients have no history of alcholic hepatitis Is that clear? So don't ever think, Ohh. there is no hepatits Oh, I don't find increase in AST Oh, I don't find...

01:04 my patient having mallary bodies It can't be cirrhosis. No, that's not true.

01:10 Most of your patients probably don't even have the history.

01:13 5-year survival, with abstinence it's 89%.

01:17 However, look at this.

01:19 You continue to drink which a lot of your patients with cirrhosis would It goes from an 89% to a 34%. My goodness.

01:28 You want to know this statement how important it is to make sure that you set up an abstinence program, that your next step of management isn't? An abstinence program for this patient To make sure that they dont have such a drop in...

01:43 Prognosis.

01:44 Liver transplantation Used for abstinent patients.

01:48 At some point, why...

01:51 That could be answer choice.

01:53 What do you mean? If your patient has not exhibited to you as a condition.

01:57 Successful abstinence from alcohol.

02:00 What are you doing? So you gave this new patient who is not abstinence a new liver.

02:06 What do you think here she's going to continue doing? Drink, drink, drink, drink.

02:10 And the cycle continues.

02:12 Is that clear? Use proper clinical judgement.

02:15 Make sure that abstinence is absolutely successful, or...

02:19 as successful as possible in your patient has shown you good progress in terms of abstinence. It is only then, you think about giving or providing transplantation.