Palliative care and end of life care in decompensated cirrhosis

Article indépendant

MILLER, Kaela | BARMAN, Pranab | KAPPUS, Matthew

Cirrhosis is a progressive chronic illness that develops as a result of irreversible scarring and fibrosis of the liver parenchyma, ultimately disrupting liver architecture and function. Although it often begins as an asymptomatic condition when compensated, the clinical trajectory can deteriorate rapidly as patients develop decompensated cirrhosis, also referred to as end-stage liver disease (ESLD). Complications of ESLD include ascites, HE, variceal bleeding, spontaneous bacterial peritonitis, and coagulopathy. Physical and psychological symptoms associated with these conditions are often distressing and decrease both patient and caregiver quality of life. Commonly reported symptoms in the ESLD population include pain, fatigue, breathlessness, muscle cramps, anxiety, depression, sexual dysfunction, insomnia, and pruritis. The only curative treatment for cirrhosis is liver transplantation. In the absence of liver transplant, median survival for those with decompensated cirrhosis is 2 years, with improvement to 12 years in compensated cirrhosis. The remainder of the treatment arsenal is therefore aimed at palliation. Given the life-limiting nature of this disease, the high symptom burden, and the caregiver burden, this population has the potential to benefit greatly from palliative care (PC). [Introduction de l'article]

http://dx.doi.org/10.1097/CLD.0000000000000044

Voir la revue «Clinical liver disease, 22»

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