Ongoing Management

Provide written information to the patient and family upon discharge. Ensure follow up with alcohol care teams and hepatology.

Complications of portal hypertension

As with other types of liver disease, complications of portal hypertension should be considered and managed appropriately, such as:

• Encephalopathy
• Oesophageal varices
• Ascites and liver synthetic function derangement
• Hypoglycaemia
• Coagulopathy

Caution should be taken when diagnosing encephalopathy in this patient group as the differentials include subdural haematoma, Wernicke’s encephalopathy and delirium tremens. [3]

Liver transplantation

Liver transplantation is the only curative treatment for advanced ArLD, however current or recent substance abuse is a contraindication for transplant. Selection requires a multi-disciplinary team approach including a hepatologist, surgeon, addiction specialist, psychiatrist and social worker. Patients must be motivated and compliant with immunosuppressive treatment. [7]

Transplant assessment principles updated to acknowledge that the old absolute six-month abstinence rule is no longer universally applied in the same rigid way, and that selected severe non-responders may be considered for early transplant assessment in specialist settings.

Learning Bite

Liver transplant is the only hope for cure in advanced ArLD.