Ataxia, GI bleeds, ascites, jaundice… patient’s with long term, heavy alcohol consumption can have head-to-toe problems. Dr. Natalie Htet, emergency physician and intensivist, and I go over the expected assessment findings of the ETOH patient, what to look out for, and long-term management of alcoholic cirrhosis.
Classic presentation of patients with long-term heavy alcohol consumption:
- Ataxia: loss of balance, tremors
- Dilated cardiomyopathy that ultimately leads to a decrease in ejection fraction
- Hypotension
- Weakness
- Beer potomania: expect all electrolytes, especially Na+, to be low
- Renal failure
- Jaundice, bruising, coagulopathies
- Ascites, gastritis
- Shortness of breath when sitting or standing-up due to hepatopulmonary syndrome
Keep an eye out for the following potential disasters:
- Subdural hematoma. Patients may have an undiagnosed head bleed due a forgotten fall. Remember: a headache is never just a headache for an alcoholic patient
- Aspiration pneumonia due to an impaired gag reflex (among other reasons)
- Upper GI bleed. An esophageal variceal rupture can cause life-threatening bleeding
- Lower GI bleed: hemorrhoids
Long Term Management of Chronic Alcoholic Cirrhosis
The Liver Transplant Route
- Calculate the Model For End-Stage Liver Disease (MELD score) to determine the level of liver disease
- Frequent paracentesis to decompress ascites
- The Molecular Adsorbent Recirculating System (MARS®), aka liver dialysis, can serve as a bridge to transplant
The Palliative Route
- Indwelling peritoneal catheter to decompress ascites
- Transjugular intrahepatic portosystemic shunt (TIPS) procedure to decrease the amount of fluid that accumulates in the abdomen