Alcohol-Related Cirrhosis

Cirrhosis, which is the end-stage of alcohol-related liver disease, can be classified as compensated or decompensated. A diagnosis of compensated cirrhosis can be difficult to make as while the liver is damaged, it continues to synthesise sufficient proteins and vitamins that are needed to sustain bodily function without symptoms and the liver continues to produce, clear and recycle bilirubin. This is a time of critical opportunity for a patient to stop drinking to prevent progressive liver disease leading to decompensation and death. Unfortunately, most patients with alcohol-related liver cirrhosis are diagnosed in the decompensated stage of cirrhosis, when symptoms become apparent, by which point prognosis is poor.  

Hepatic decompensation occurs when the liver is no longer able to produce and recycle the proteins for the body’s needs - when the albumin is low, prothrombin time prolonged and/or the bilirubin is elevated. Clinical decompensation can also occur predominantly with the symptoms and signs of portal hypertension (PHT) presenting with ascites, encephalopathy or upper gastrointestinal (GI) bleeding from varices.  

All patients with liver injury should be asked about alcohol intake. This is a key opportunity to assess for AUD using validated tests such as the alcohol use disorder identification test (AUDIT), even where alternative causes may be thought to be predominant, to assess the possible contribution of alcohol and the risk of progression. Any patient with cirrhosis of any cause should be abstinent from alcohol.  

Most medications are metabolised through the liver, and many can be harmful in decompensated liver injury. It is important to be aware of the impact of liver disease on drug metabolism when prescribing new medications. 

Patients with liver cirrhosis require a referral to a hepatology or gastroenterology specialist service to optimise management of their liver disease, screen for complications of end-stage liver disease and where appropriate, undergo assessment for liver transplantation when liver deterioration is irreversible and progressive.