Palliave care for advanced liver disease
This will be the page to provide details about advanced and end-staged liver disease (ESLD). Information is being collected to start this content from published journal articles. Not much has been published about ESLD and palliative care.
"Although the average layperson associates liver disease with alcohol abuse, alcohol itself causes only a small percentage of chronic liver disease in the world." --Lissi Hansen, PhD, RN, Anna Sasaki, MD, PhD, Betsy Zucker, MSN, FNP
The above is a statement from the article "End-stage liver disease: Challenges and practice implications." [Nurs Clin North Am. 2010 Sep;45(3):411-26. PubMed] The article provides information about palliative care by noting that "Palliative care should be provided well before end-of-Iife care. It emphasizes a focus on living well with the disease and addresses how symptoms, and other issues, affect the goals of care. Members on the team often include nurses, physicians, chaplains, and social workers. When addressing the needs and challenges of patients with ESLD and their family members, other professionals should also be included in the care, such as dieticians, psychologists, and pharmacists." The article includes a brief overview of the common complications of end-staged liver disease (ESLD), such as acites and peritonitis, hepatic encephalopathy, malnutrition, altered drug metabolism, renal insufficiency and hyponatremia, hepatocellular carcinoma, pain, and psychosocial responses. They also note that "Palliative care can be beneficial even to patients who are likely to receive a liver transplant."
Chronic liver disease results in more than 1 million physician visits and more than 300 000 hospitalizations per year in the United States. More than 27 000 patients annually progress to end-stage liver disease (ESLD), liver failure, or death. --Anne M. Larson, MD and J. Randall Curtis, MD, MPH
The above statement is from the article "Integrating Palliative Care for Liver Transplant Candidates “Too Well for Transplant, Too Sick for Life”. [JAMA. 2006;295:2168-75. PubMed]. The article includes a nice list of common complications associated with liver disease, as well as management strategies. The article also provided an overview of why liver disease can benefit from palliative care. That is "Patients with ESLD experience such complications as encephalopathy, malnutrition, muscle wasting, ascites, esophagogastric variceal hemorrhage, spontaneous bacterial peritonitis, fatigue, and depression. Despite significant improvements in palliation, patients’ quality of life diminishes and their disease will often inexorably progress. Liver transplantation, a valid treatment option, increases life and reduces many symptoms. With the current shortage of organs, up to10%to15%of these patients die without receiving an organ. Many patients also are not candidates for transplantation due to comorbid illness. In addition, some patients receive a transplant but succumb to complications of the transplant itself. Such patients and families face the conundrum of a potentially treatable yet often fatal illness."
"Although frequently thought of in the context of a patient with incurable malignancy, palliative care also is appropriate for patients ‘‘with a persistent or recurring condition that adversely affects their daily functioning or will predictably reduce life expectancy’’. Patients with advanced chronic disease states including ESLD are candidates for palliative care." --William Sanchez, MD, Jayant A. Talwalkar, MD, MPH
The above statement is from the article "Palliative Care for Patients with End-Stage Liver Disease Ineligible for Liver Transplantation." [Gastroenterol Clin North Am. 2006;35:201-19. PubMed]. This is a very comprehensive article that provides a good overview of this topic. To emphasize the need for palliative care in liver disease, they noted that "An estimated 5.5 million people (2% of the US population) are affected by cirrhosis, its consequences from portal hypertension, and the attendant risk for carcinogenesis. Approximately 26,000 patients die of chronic liver disease and cirrhosis in the United States each year, making this condition the seventh leading cause of death among people between the ages of 25 and 64. An additional 18,000 patients die of hepatobiliary cancer related most often to cirrhosis. The major causes of death in the absence of liver transplantation are liver failure, hepatocellular carcinoma (HCC), gastrointestinal bleeding, sepsis, and renal failure. With the development of ascites or hepatic encephalopathy, the estimated 2-year survival of patients with ESLD is less than 50%." And palliative care should be instituted from the onset of diagnosis of this life-limiting disease since, as they pointed out, "Patients with compensated cirrhosis can expect an estimated median survival of nearly 10 years."