When patients become symptomatic it is often too late for treatment and these patients may require liver transplant evaluation. All patients should be screened for excessive alcohol use with a CAGE questioner. By judicious screening of a healthy population, much liver disease can be discovered in the presymptomatic stages and treatments can be offered for viral hepatitis, alcoholic liver disease, early cirrhosis, and autoimmune and inherited forms of liver disease. When patients become symptomatic from chronic liver disease with the development of jaundice, ascites, encephalopathy, muscle wasting, gastrointestinal bleeding or coagulopathy, they need to be referred to a liver transplant center regardless of their age or etiology of liver disease. Many of these patients could be candidates for liver transplantation which is a life-saving procedure.
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