title: End-stage liver disease: challenges and practice implications.
abstract: As the seventh leading cause of death among people aged 25 to 64 years, end-stage liver disease (ESLD) affects many Americans in the most productive years of their lives. Despite the increasing number of individuals who are dying of ESLD, little is documented about their end of life challenges as the disease progresses. The purpose of this article is to highlight specific challenges for people with ESLD, their families, and their implications for health care providers: ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, malnutrition, altered drug metabolism, renal insufficiency and hyponatremia, hepatocellular carcinoma, and pain. The authors also present a case study to illustrate disease progression and difficulties facing patients, family members, and providers.
authors.affiliation: School of Nursing, Oregon Health & Science University, SN 6S, 3455 South West US Veterans Hospital Road, Portland, OR 97239, USA. hansenli@ohsu.edu
authors.forename: Lissi
authors.initials: L
authors.lastname: Hansen
authors.forename: Anna
authors.initials: A
authors.lastname: Sasaki
authors.forename: Betsy
authors.initials: B
authors.lastname: Zucker
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D002908:Chronic Disease; D019698:Hepatitis C, Chronic / Q000150:complications / Q000628:therapy; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy* / Q000821:virology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000628:therapy; D017093:Liver Failure / Q000150:complications / Q000628:therapy* / Q000821:virology; D008297:Male; D044342:Malnutrition / Q000209:etiology; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010166:Palliative Care; D051437:Renal Insufficiency / Q000209:etiology; D013727:Terminal Care