A patient with alcoholic liver failure referred for liver transplantation

✍ Scribed by Philippe Mathurin; Michael R. Lucey

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 76 KB
• Volume: 13
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21338

✦ Synopsis

A 47-year-old woman with liver failure due to alcoholism was referred for evaluation for liver transplantation. Approximately 1 year ago, she developed hepatic encephalopathic coma requiring admission into an intensive care unit and assisted ventilation. When she recovered, she agreed that she needed treatment for her alcoholism.

She has been drinking heavily for at least 20 years. Her primary alcoholic drug is vodka. She reports that she drank at home alone. She hid her drinking from her husband and her children. Her family doctor told her about 7 years ago that she had alcoholic liver disease, but she did not stop drinking. She decided to stop drinking 1 year ago on account of her hospital admission for coma. She entered a 7-day inpatient treatment program. She remained abstinent for 6 months. She then relapsed and began drinking covertly. After a few weeks, she developed ascites and swollen legs. After an intervention by the family, she acknowledged her problem drinking and agreed to more treatment. She then underwent a 28-day inpatient treatment for alcoholism. She claims to have been abstinent both during this experience and for 2 months since her discharge from inpatient rehabilitation. Her family confirms that she is abstinent. She attends Alcoholics Anonymous when she feels strong enough, but has been unable to attend for the past few days. She has smoked cigarettes for 30 years, previously anywhere between 20 and 30 cigarettes a day, and now 5 to 6 a day. Although she acknowledges occasional marijuana use, she denies any intravenous use of illicit drugs.

She is married. Her father and brother are recovered alcoholics. She lives with her husband and 2 children. Her husband drinks rarely and is supportive of her sobriety. She is not working outside the home on account of her illness.

Her current symptoms include decreased energy, intermittent pruritus, and intermittent muscle cramps in