End Stage Liver Disease

The liver plays an important role in the body – it filters out toxic substances, helps digest food, and helps with blood clotting. The liver fails to work properly when you develop a disease called cirrhosis in which scar tissue replaces the normal liver tissue. In some cases, the damage is so severe that it leads to failure – this is called end stage liver disease (ESLD). Keep reading to learn about treatment options and preventions.

What Causes End Stage Liver Disease?

End-stage liver disease (ESLD) is the 12th leading cause of death in the United States. When not treated early, you may notice several complications, including variceal hemorrhage, ascites, renal impairment, and hepatic encephalopathy. End-stage liver disease usually develops into cirrhosis, and the most common causes of cirrhosis are hepatitis B infection, alcohol abuse, non-alcoholic fatty liver disease, and hepatitis C infection.

Some less common causes of cirrhosis are primary biliary cirrhosis, haemochromatosis, autoimmune hepatitis, primary sclerosing cholangitis, inherited metabolic disorders, and drugs and toxins including amiodarone, methotrexate, and isoniazid.

Biliary obstruction caused by cystic fibrosis or congenital biliary cysts and venous outflow obstruction in Budd-Chiari syndrome may also lead to cirrhosis. Some infections such as congenital and tertiary syphilis as well as congestive heart failure are some other less common causes of cirrhosis.

What Are the Symptoms?

You will experience several symptoms when you develop end stage liver disease. For instance, you will bleed easily, experience fatigue, have trouble sleeping at night, and have intense itching. Persistent yellowing of your skin and eyes, nausea, loss of appetite, and swelling in your legs and abdomen are other common symptoms. Some people also have problems with memory and concentration and even notice bleeding of the gastrointestinal tract. Brain and nervous system damage are not uncommon when you have end stage liver disease.

Care of Patient with ESLD

The life expectancy with end stage liver diseaseis usually around 6 months. The only exception is when the patient goes for liver transplantation. During this time, it is important to pay special attention to the patient’s diet to ensure they provide their body with all-important nutrients. This also helps keep their body weight in check and makes them feel better.

When people have cirrhosis, they need to include protein rich food in their diet. If they do not provide their body with enough protein, it will use up other nutrients for sustenance and that can aggravate the problem. They should eat food both fresh and natural to provide their body with essential nutrients, including protein. The patients need at least 1g of protein for every kilogram of body weight a day. For this, it would be good to add stuff like lentils, fruit salad, beans, chicken salad, egg whites, low-fat cheese, turkey, low-fat milk, salmon, fish, yogurt, and tofu in their diet.

Hospice Care for End Stage Liver Disease

1.    When Is the Time for Hospice?

You need to have clear information about when someone you know with end stage liver disease should go for hospice care. It is not easy though considering the slow decline of a patient. Once a patient receives hospice care, they usually have six months or even less to live. It is important to work with a doctor who will make a clinical determination of life expectancy for someone with end stage liver disease. Still, you may take the patient for hospice services if you notice reduced oral intake, sudden loss of functional independence, and inability to work.

If you notice that patient has abdominal distention, confusion, bowel dysfunction, itchy skin, and breathing difficulties and is unable to sit or lie, you should consider going for hospice care. Restlessness, malaise, and altered mood and behavior are also some of the signs that the disease has progressed to a stage where the patient needs hospice care.

2.    What Can Hospice Do for an ESLD Patient?

Many people have confusions about what hospice can do for ESLD patients. You need to understand that hospice teams really help manage things better by evaluating patients' status and any change in their symptoms and conditions. The main goal of hospice is to relieve emotional and physical distress to help keep patients relatively comfortable.

Hospice offers several services for patients with end stage liver disease. For instance:

  • Symptom control: Hospice teams help manage bowel and breathing difficulties, abdominal discomfort, itchy skin, confusion, restlessness, and other symptoms associated with end-stage liver disease.
  • Care plan for each individual: It becomes difficult for patients to express their needs as the disease progresses. The team will design a more effective plan to address hydration, pain, skin care, nutrition, bleeding, agitation, and other symptoms commonly associated with the diagnosis.
  • Care for patients wherever they live: Hospice teams may offer long-term care facilities to wherever the patient lives. Inpatient hospice services are also available in cases when symptoms are hard to manage at home.
  • Coordinated care at every level: These teams develop a plan of care after discussing everything with the patient's gastroenterologist. There will be a team manager to make sure that information travels from physicians to nurses to social workers in a seamless way. Moreover, hospice provides all medications, medical equipment, and medical supplies related to the diagnosis and management of end-stage liver disease.

Above all, hospice offers spiritual and emotional support to patients to help them have some peace of mind. It is because of all these services that it is important to have clear knowledge of when someone with endstage liver disease really needs hospice services.

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