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.