Chapter 1 Epidemiology of alcohol use
Methods of measuring alcohol use
Changes in national alcohol consumption over time
National alcohol consumption estimates
The burden of alcohol use
Chapter 2 Epidemiology of alcohol-related liver disease
Alcohol and liver disease: a historical perspective
Current trends in alcohol consumption and cirrhosis
Changing trends in alcohol consumption
Associated risk factors for liver disease
Methods for reducing the burden of liver disease attributable to alcohol
Population strategies to reduce the burden of disease
Individual strategies to reduce the burden of disease
Methods for early detection of liver disease
Chapter 3 Alcoholism: diagnosis and natural history in the context of medical disease
Natural history and clinical assessment
Differentiation by natural course
Physiological dependence: tolerance and withdrawal (ICD‐10 categories 1 and 2)
Alcohol withdrawal syndrome
Loss of control phenomenon (ICD-10 category 4)
Abuse rather than dependence
Assessing ambivalence and continuing LOC risk
Behavioral versus hepatic diagnosis
Vaillants four prognostic factors
Social or physical decline (ICD-10 categories 5 and 6)
DSM-5 and alcoholism diagnosis: evolution of the new diagnostic criteria
Other psychiatric assessment
Does liver transplant change the natural history of alcoholism?
Chapter 4 Alcohol and other substance misuse
Alcohol and liver disease
Disorders of alcohol regulation
Nature of alcohol use disorders
Spectrum of alcohol use and misuse
Implications of dependence
Neurobiology of alcohol dependence
Alcohol and other substance use
Reasons for multiple substance use
Pathways to alcohol and other substance use
Making the diagnosis of alcohol and substance use disorders
Approaches to the history
Key aspects of physical examination
Screening, assessment, and diagnostic schedules
Chapter 5 Risk factors for alcohol-related liver disease
Evidence for risk modifiers in ARLD
Environmental risk factors
Gene
environment interactions
Chapter 6 Mechanisms of alcohol toxicity
Alcohol metabolism and impact
Metabolic impact and lipotoxicity
Lipopolysaccharide and endotoxemia
Immunologic mechanisms inducing inflammation
Other contributing factors
Chapter 7 Extrahepatic manifestations of alcohol excess
Overarching systemic effects
Central and peripheral nervous system
Oral cavity and esophagus
Alcohol consumption and pregnancy
Chapter 8 Patterns of alcohol-associated liver damage
Determinants of injury pattern
Distinction from nonalcoholic fatty liver disease
Chapter 9 Cofactors and alcohol-related liver disease
Body weight, obesity, and diabetes mellitus
Alfa-1 antitrypsin phenotype
Cofactors and liver histology
Chapter 10 Impact of alcohol and liver disease on prescribing
Effect of liver disease on the metabolism of drugs
Effect of alcohol on metabolism of drugs
Specific prescribing problems: hepatology
Specific drug interactions: psychiatry
Drugs used for treatment of alcohol abuse
Other commonly used drugs
Monitoring therapy in liver disease
Chapter 11 Psychiatric examination of liver transplant patients with alcohol use disorders
The patients perspective
Myth 1: Youre the last one I have to see to pass the test so I can get my liver
Myth 2: “I feel badly that someone died so I can live”
Myth 3: “There are so many others who deserve a liver more than I do, and besides, I am probably not going to get a liver anyway”
Myth 4: Youre saying Im an alcoholic, but Ill bet you think that because you never took a drink in your life
Myth 5: Im depressed, but I have to live with it because my doctors told me I cant take any medicine for depression; its not good for my liver
Myth 6: I dont need rehab, I am strong willed and I know I will never drink again
The psychiatrists perspective
Structure of the psychiatric interview
Chapter 12 Abnormal liver tests in the context of alcohol excess
Transaminases (ALT and AST)
Gamma-glutamyl transpeptidase
Liver function tests in asymptomatic individuals
Patterns of liver function tests in alcoholic liver disease
Cirrhosis of the liver secondary to alcohol excess
Chapter 13 Biochemical determination of alcohol consumption
Traditional biomarkers for alcohol consumption
Carbohydrate deficient transferrin
Gamma-glutamyl transferase
Mean corpuscular erythrocyte volume
Combination of individual markers
Ethanol metabolites and liver transplantation
Chapter 14 The role of histology
Acute alcoholic hepatitis
Pathology of alcoholic liver disease
Summary of typical features of steatosis, steatohepatitis, and AAH
Differentiation of ALD from NASH and other diseases with overlaping features
Information in the pathology report
Post-transplant liver histology
Recurrent disease and de novo NAFLD or NASH
Chapter 15 General assessment and management
Assessing the severity of liver disease
Assessment and management of extrahepatic manifestations
Heart and vascular system
Chapter 16 Brief alcohol interventions
What is brief intervention?
Brief intervention structure and practice
Brief intervention theory
Evidence for brief interventions
Implementing brief interventions
Key messages for practitioners
Chapter 17 Alcohol withdrawal syndrome: diagnosis and treatment
Alcohol withdrawal syndrome, early experience and syndrome definition
Methods of treatment of AWS
Pharmacology of treatment
Chapter 18 Psychosocial treatments of alcohol use disorders
Challenges unique to ALD patients with alcohol use disorders
Psychosocial treatments and Alcoholics Anonymous for alcohol use disorders in the general population
Cognitive behavioral therapy
Motivational enhancement therapy
Network support and couples therapy
12-step facilitation and AA
Pre-liver transplant alcohol treatment interventions
Post-liver transplant alcohol treatment interventions
Chapter 19 Pharmacologic interventions
Treatment of alcohol withdrawal
Agents for reducing alcohol consumption
Extended-release naltrexone
Selective serotonin reuptake inhibitors
Chapter 20 Treatment of extrahepatic manifestations of alcohol abuse
Reasons for the multisystemic effects of ethanol
Evaluation of alcohol toxicity
Organ-specific damage in alcohol abuse
Baseline considerations for treatment
Treatment of systemic organ damage in alcohol abuse
Specific points of treatment of organ damage
Chapter 21 Treatment of liver disease
Detection and management of complications of portal hypertension
Renal impairment and hyponatremia
Spontaneous bacterial peritonitis
Cardiorespiratory problems
Chapter 22 Treatment of alcoholic hepatitis
Diagnosis of alcoholic hepatitis
Determination of disease severity
Maddreys discriminant function
Model for end-stage liver disease
Age, bilirubin, INR, and creatinine score
Management of nutrition and fluid status
Screening and treatment of infection
Antitumor necrosis factor biologic therapies
N-acetylcysteine and antioxidants
Future therapeutic directions
Chapter 23 Liver transplantation in people with alcohol‐related liver disease
Importance of abstinence in recovery from ALD
Referral of the patient with ALD for liver transplantation
Spectrum of alcoholic liver disease
Timing for liver transplantation and the concept of survival benefit
Contrasting perspectives of addiction and transplant medicine
How should abstinence be assessed and maintained?
Outcome of liver transplantation in patients with ALD
Relapse to alcohol use before or after liver transplantation
Specific work-up for ALD candidate
Role of liver transplantation in alcoholic hepatitis
Chapter 24 Future directions: the need for early identification and intervention for patients with excessive alcohol use
Primary intervention strategies
Secondary intervention strategies
Tertiary intervention strategies
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