End-Stage Liver Disease and Palliative Care
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Questions and Answers

What is a potential consequence of enlarged small veins in end stage liver disease?

  • Improved concentration
  • Bleeding (correct)
  • Improvement in brain function
  • Enhanced kidney function

    • What is a symptom of Hepatic Encephalopathy (HE)?

  • Trouble sleeping at night (correct)
  • Increased alertness
  • Improved sleep quality
  • Enhanced motor movements

    • What is a potential complication of ESend stage liver disease?

  • Enhanced coagulation
  • Hepatorenal syndrome (HRS) (correct)
  • Improved kidney function
  • Reduced bleeding risk

    • What is a common method of managing ascites in end stage liver disease?

    <p>Low-salt diet and oral diuretics</p> Signup and view all the answers

    What is the term used to describe advanced liver disease, liver failure, and decompensated cirrhosis?

    <p>End-stage Liver Disease (ESLD)</p> Signup and view all the answers

    What is a symptom of Hepatic Encephalopathy (HE)?

    <p>Personality or mood changes</p> Signup and view all the answers

    What is the only cure for End-stage Liver Disease (ESLD)?

    <p>Liver transplantation</p> Signup and view all the answers

    What is a potential complication of ESLD?

    <p>Bloating</p> Signup and view all the answers

    Which of the following is an uncommon physical symptom ofend stage liver disease??

    <p>Headache</p> Signup and view all the answers

    What is an alternative method for managing pain in end stage liver disease?

    <p>Acupuncture</p> Signup and view all the answers

    What is the term for the yellowing of the skin and eyes due to the buildup of bile?

    <p>Jaundice</p> Signup and view all the answers

    What is the complication of end stage liver disease characterized by the swelling of the abdomen due to fluid build-up?

    <p>Ascites</p> Signup and view all the answers

    What is a potential complication of end stage liver disease?

    <p>Spontaneous bruising</p> Signup and view all the answers

    What is the infection of the fluid from ascites that can cause fever, abdominal pain, and low blood pressure?

    <p>Spontaneous bacterial peritonitis</p> Signup and view all the answers

    What is the result of impaired blood flow through the liver in end stage liver disease?

    <p>Esophageal and gastric varices</p> Signup and view all the answers

    Why may a patient with end stage liver disease not eligible to receive a liver transplantation?

    <p>Due to wait times or other health issues that make them too sick to survive surgery</p> Signup and view all the answers

    What is the primary purpose of using laxatives in treating hepatic encephalopathy?

    <p>To reduce hyperammoniaemia</p> Signup and view all the answers

    Which organization offers palliative services in Quebec and provides an assessment form?

    <p>Bien chez soi</p> Signup and view all the answers

    What is the medication commonly used to treat itchiness in patients with ESLD?

    <p>Cholestyramine</p> Signup and view all the answers

    What is a key factor in predicting life expectancy for someone with end stage liver disease?

    <p>Alcohol intake</p> Signup and view all the answers

    What is the average life expectancy for someone with advanced stage cirrhosis?

    <p>2 years</p> Signup and view all the answers

    What is a common symptom associated with worsening disease and shorter life expectancy in ESLD?

    <p>Ascites that does not respond to treatment</p> Signup and view all the answers

    What is the name of the health region that offers Palliative services in Saskatchewan?

    <p>Cypress Health Region</p> Signup and view all the answers

    What is the purpose of the Advance Care Planning Group?

    <p>To educate on advance care planning</p> Signup and view all the answers

    What is the final stage of liver disease, often resulting from chronic liver damage or cirrhosis?

    <p>End-stage liver disease (ESLD)</p> Signup and view all the answers

    What is the term for the increased blood pressure in the portal vein, causing splenomegaly, esophageal varices, and ascites?

    <p>Portal hypertension</p> Signup and view all the answers

    What is the result of impaired ammonia detoxification and increased inflammation in liver disease?

    <p>Hepatic encephalopathy</p> Signup and view all the answers

    What is the term for the alteration of the gut microbiome, leading to increased toxins and inflammation in liver disease?

    <p>Dysbiosis</p> Signup and view all the answers

    What is the functional renal failure due to splanchnic vasodilation and decreased cardiac output in liver disease?

    <p>Hepatorenal syndrome</p> Signup and view all the answers

    What is the increased leakage of toxins and bacteria from the gut into the bloodstream, exacerbating liver damage in liver disease?

    <p>Increased intestinal permeability</p> Signup and view all the answers

    What is the imbalance of pro-inflammatory and anti-inflammatory cytokines, leading to further liver damage in liver disease?

    <p>Cytokine imbalance</p> Signup and view all the answers

    What is the stage of liver disease characterized by decreased liver cell mass and function, leading to impaired detoxification, protein synthesis, and metabolism?

    <p>Hepatocellular dysfunction</p> Signup and view all the answers

    Study Notes

    End-Stage Liver Disease (ESLD)

    • ESLD is a term used to describe advanced liver disease, liver failure, and decompensated cirrhosis.
    • ESLD develops after an inflammation of the liver, leading to fibrosis (scarring) and loss of regular liver function.
    • The only cure for ESLD is liver transplantation, but many patients may not receive a transplant due to wait times or other health issues.

    Symptoms of ESLD

    • Common physical symptoms include:
      • Abdominal pain
      • Fatigue
      • Confusion
      • Pruritis (itchiness)
      • Jaundice – a yellowing of the skin and eyes due to the buildup of bile
      • Muscle cramps
      • Edema (swelling) in the legs
      • Dyspnea - shortness of breath
      • Nausea and vomiting
      • Constipation
      • Diarrhea
      • Malnutrition

    Complications of ESLD

    • Complications of ESLD are related to portal hypertension or increased difficulty of blood flow through the liver.
    • Specific complications include:
      • Ascites - swelling of the abdomen due to fluid buildup
      • Spontaneous bacterial peritonitis - infection of the fluid from ascites
      • Esophageal and gastric varices - blood flow through the liver is impaired, resulting in blood flow being rerouted around the liver into small veins in the passageway between the throat, stomach, and abdomen.
      • Hepatic encephalopathy (HE) - deterioration of brain function, which can cause:
        • Trouble sleeping at night
        • Difficulty thinking clearly
        • Disorientation
        • Poor concentration or shortened attention span
        • Mild to severe confusion
        • Forgetfulness
        • Shortened attention span
        • Poor judgement
        • Personality or mood changes
        • Slow reaction time
        • Anxiety
        • Depression
        • Worsening of handwriting or fine motor movements
        • Unusual movements (shaking of hands or arms)
        • Slurred speech
        • Slowed movement
        • Decreased alertness and responsiveness
      • Hepatorenal syndrome (HRS) - impaired kidney function
      • Coagulopathy – prolonged bleeding
      • Spontaneous bruising
      • Bleeding inside the stomach or intestine
      • Bloating

    Managing Symptoms of ESLD

    • Pain management:
      • Medications may be used
      • Alternative methods include acupuncture and mindfulness
    • Ascites management:
      • Low-salt diet and oral diuretics (medication to help remove fluids from the body)
      • More invasive options may be considered if treatments begin to lose effect
    • Hepatic encephalopathy management:
      • Laxatives and antibiotics are used to help preserve brain function
    • Itchiness management:
      • Medication called cholestyramine is used to help with itchiness
    • Malnutrition management:
      • Ensuring sufficient calorie intake, especially protein, and vitamin replacement is recommended

    Life Expectancy with ESLD

    • Life expectancy is hard to predict due to many factors, including the degree of liver disease or complications and the presence of other diseases.
    • Certain symptoms are associated with worsening disease and shorter life expectancy, such as:
      • Ascites that does not respond to treatment
      • Kidney failure
      • Bleeding from the gastrointestinal tract
    • The Model for End-Stage Liver Disease (MELD) score is used to predict long-term outcomes for ESLD and prioritize patients waiting for a liver transplant.

    Advance Care Planning (ACP)

    • ACP is a process of thinking about and sharing wishes for future health and personal care.
    • It can help prepare everyone when a person becomes ill and unable to communicate.
    • Palliative care programs are available to support individuals with ESLD.

    Definition and Stages

    • End-stage liver disease (ESLD) is a condition where the liver can no longer perform its essential functions, leading to multi-organ failure.
    • ESLD is the final stage of liver disease, often resulting from chronic liver damage or cirrhosis.
    • The stages of liver disease progression are: inflammation and fibrosis, cirrhosis, decompensated cirrhosis, and end-stage liver disease (ESLD).

    Pathophysiological Changes

    • Hepatocellular dysfunction reduces liver cell mass and function, impairing detoxification, protein synthesis, and metabolism.
    • Portal hypertension increases blood pressure in the portal vein, causing splenomegaly, esophageal varices, and ascites.
    • Splanchnic vasodilation decreases vascular resistance in the splanchnic circulation, leading to increased blood flow and portal hypertension.
    • Systemic vasoconstriction increases vascular resistance in the systemic circulation, leading to decreased cardiac output and peripheral hypoperfusion.

    Complications

    • Ascites involves the accumulation of fluid in the peritoneal cavity, leading to abdominal distension and discomfort.
    • Spontaneous bacterial peritonitis (SBP) is an infection of ascitic fluid, leading to sepsis and mortality.
    • Hepatorenal syndrome (HRS) is a functional renal failure due to splanchnic vasodilation and decreased cardiac output.
    • Hepatic encephalopathy (HE) is a neurological dysfunction due to impaired ammonia detoxification and increased inflammation.

    Gut-Liver Axis

    • Dysbiosis alters the gut microbiome, leading to increased toxins and inflammation.
    • Increased intestinal permeability leads to leakage of toxins and bacteria from the gut into the bloodstream, exacerbating liver damage.
    • Cytokine imbalance increases pro-inflammatory cytokines and decreases anti-inflammatory cytokines, leading to further liver damage.

    Consequences

    • Mortality rates increase with ESLD disease progression.
    • ESLD significantly impairs quality of life, with symptoms including fatigue, jaundice, and abdominal pain.
    • Liver transplantation is the only curative treatment option for ESLD, but is limited by organ availability and surgical risks.

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    Related Documents

    End-Stage Liver Disease and Palliative Care PDF

    Description

    Learn about End-Stage Liver Disease (ESLD), its causes, symptoms, and treatment options, including liver transplantation and palliative care.

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