Chronic diseases and conditions related to alcohol use with Dr. Natalie Htet

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

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.