Complications such as ascites, spontaneous bacterial peritonitis, encephalopathy,
variceal bleeding, hepatorenal syndrome, osteoporosis, and hepatopulmonary
syndrome may occur in patients with decompensated alcoholic
cirrhosis and must be managed carefully (Chapter 156). Liver transplantation
is a reasonable option in patients with decompensated alcoholic cirrhosis, but
6 months of abstinence and strong social support are generally required for
eligibility (Chapter 157). Patients with alcoholic cirrhosis are at risk for hepatocellular
carcinoma (Chapter 202) and should be screened with semiannual liver
imaging and serum α-fetoprotein levels. They are also at risk for extrahepatic
malignancy, notably head and neck, lung, and esophageal cancer. For Dupuytren’s
contracture, injection of collagenase clostridium histolyticum can reduce
the severity and improve the range of motion significantly. 3