Ellen Shaw. M.D., Fellow in Hepatology: Mr. J is a forty-six-year-old white male who was initially seen on the medical service in July 1982. At that time he presented with hepatic encephalopathy, jaundice, and ascites. A liver biopsy was performed, confirming the clinical diagnosis of alcoholic hepatitis superimposed on cirrhosis. Following discharge it was difficult to maintain Mr. J as an outpatient. He did not follow dietary restrictions or take diuretics as prescribed. Additionally he was unable to control his drinking. Finally about a year ago a Levine shunt was implanted in an effort to control his ascites. Subsequently he did well for a period of several months. He was able to abstain from alcohol with a resulting decrease in his ascites and jaundice. Recently he has resumed drinking, with a return of his symptoms. He has missed his last several appointments in the clinic. Control of his medical problems remains problematic unless his alcohol abuse can be better controlled.
Blumenthal, MS, Bruce; Field, MD, Howard; Gottheil, MD, Ed; Guerra, MA, Linda; Maddrey, MD, Willis; Serota, MD, Ron; and Shaw, MD, Ellen
"Intractable Alcoholism in a Patient with a Levine Shunt,"
Jefferson Journal of Psychiatry:
1, Article 8.
Available at: http://jdc.jefferson.edu/jeffjpsychiatry/vol3/iss1/8