Clinical Nurse Specialist Case Summary

The Clinical Nurse Specialist (CNS) can be found working in numerous specialties and having an understanding of alcoholic liver disease and the transplant process will help optimize care of the patient with alcoholic cirrhosis. Because there is no alternative treatment to liver transplantation for most patients with end-stage liver disease, it is important that the CNS understand that the 6-month rule could be lethal in some circumstances. Early detection and treatment can be life-saving. Clinicians commonly fail to screen patients, and thus fail to recognize or treat alcoholism appropriately. Clinical history that may suggest alcohol abuse or alcohol dependence includes the pattern, type, and amount of alcohol ingested, as well as evidence of social or psychological consequences of
For patients with a history of alcohol abuse or excess and evidence of liver disease, the CNS should order laboratory tests to exclude other etiologies and confirm the diagnosis of ALD. The CNS should discuss/recommend abstinence in patients with evidence of ALD because continued alcohol use is associated with disease progression. The CNS should be able to calculate a MELD score to ensure that referral to a transplant center is not delayed, as early treatment with abstinence has been shown to improve the outcome and histological features of hepatic injury, to reduce portal pressure and decrease progression to cirrhosis, and to improve survival at all stages in patients with ALD. There are few reliable predictors of relapse in alcoholic patients, whether or not they undergo liver transplantation. As stated throughout this paper, most transplant programs require patients with ALD to demonstrate a long-term commitment to alcohol abstinence prior to consideration for liver transplantation, typically for six months or