SON DÖNEM KARACİĞER HASTALIKLARINDA PALYATİF BAKIM

Yıl 2018, Cilt: 34 Sayı: 2, 98 - 111, 28.08.2018

Sadik Hançerlioğlu Yasemin Yıldırım Fisun Şenuzun Aykar

Öz

Başlık:

SON DÖNEM
KARACİĞER HASTALIKLARINDA PALYATİF BAKIM

Özet:

Son
Dönem Karaciğer Hastalığı (SDKH) olan
bireylerin, karşı karşıya kaldıkları kötü prognoz, semptom yükü ve yaygın
mental sorunlardan dolayı yaşam kaliteleri olumsuz olarak etkilenmektedir. Palyatif bakım, yaşamı
tehdit eden hastalıkla karşı karşıya kalan hastaların ve ailelerinin, yaşam
kalitelerini yükseltmek için başta ağrı olmak üzere fiziksel, psikososyal ve
ruhsal problemlerinin erken tanılanıp ve değerlendirilerek, tedavi ve bakımının
yapılmasını amaçlayan yaklaşım olarak tanımlanmaktadır. Bugüne
kadar yapılan çalışmalar incelendiğinde, SDKH hastalarında palyatif bakıma
yönelik çok az sayıda çalışma olduğu görülmektedir. Son Dönem Karaciğer
Hastalıklarının palyatif bakımında tedavinin potensiyel etki ve yan etkileri
iyi değerlendirilmeli, mevcut semptomun daha da kötüleşmesi veya yeni
semptomların ortaya çıkması engellenmelidir. Sağlık bakım alanındaki en büyük
iş gücünü oluşturan hemşirelerin kompleks bakım gereksinimleri olan SDKH’daki
rolü büyüktür. Hemşireler karaciğer hastalıklarının yaygın neden ve
komplikasyonları konusunda bilgi sahibi olmalı ve karmaşık semptom yönetimi
sürecinde hasta gereksinimlerini anlamalı ve diğer sağlık bakım profesyonelleri
ile iletişim içinde olarak hastaların yaşam kalitesini optimum düzeyde tutacak
şekilde bakım vermelidir. Bu derlemede karaciğer hastalıklarının palyatif bakım
sürecinde en sık görülen ve yaşam kalitesini olumsuz olarak etkileyen semptomlar
ve bu semptomların bakım yönetimi incelenecektir. 

Anahtar kelimeler:  

son dönem karaciğer hastalığı, palyatif bakım

Destekleyen kurumlar:

Kaynakça:

Als-Nielsen B,
Gluud LL. Non-absorbable disaccharides for hepatic encephalopathy: Systematic
review of randomised trials. BMJ 2004;328:1046.

Benson GD, Koff RS.
The therapeutic use of acetaminophen in patients with liver disease. Am J Ther
2005;12:133–141

Bergasa NV, Mehlman
JK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. Baillieres
Best Pract Res Clin Gastroenterol 2000;14:643-55.

Bernhard JD. Itch
and Pruritus: What are They, and How Should Itches be Classified? Dermatol Ther
2005; 8 (4): 288-91.

Beuers U, Boberg
KM, Chapman RW, et al. EASL clinical practice guidelines: management of
cholestatic liver diseases. J Hepatol 2009;51:237-67

Bjork IT, Naden D.
Patients’ experiences of waiting for a liver transplantation. Nurs Inq
2008;15:289–298.

Bramstedt KA: Hoping for a miracle: Supporting
patients in transplantation and cardiac assist programs. Curr Opin Support
Palliat Care 2008;2:252–255

Brown J, Sorrell
JH. Waiting for a liver transplant. Qual Health Res 2006;16:119–136.

Cauch-Dudek K,
Abbey S, Stewart DE, et al. Fatigue in primary biliary cirrhosis. Gut
1998;43:705-10

Chandok N, Watt KD. Pain management in the cirrhotic
patient: the clinical challenge. Mayo Clin Proc. 2010;85(5):451–8.

Chaudhuri A, Behan
PO. Fatigue in neurological disorders. Lancet 2004;363:978-88

Cook NF, Boore JR.
Managing patients suffering from acute and chronic fatigue. Br J Nurs
1997;6:8115.

Cordoba J, Cabrera
J, Lataif L, Et Al. High prevalence of sleep disturbance in cirrhosis.
Hepatology 1998;27:339-45

Dbouk N, McGuire
BM. Hepatic encephalopathy: a review of its pathophysiology and treatment.Curr
Treat Options Gastroenterol 2006;9:464-74.

Desbiens NA, Wu AW. Pain and satisfaction with pain control in seriously ill
hospitalized patients: Findings from SUPPORT research investigators. Crit Care Med 1996;24:1957–1961

Dooley JS,
Lok A, Burroughs AK,  Heathcote J. (Eds.)
Sherlock's diseases of the liver and biliary system. John Wiley &
Sons. 2011

Everhart
JE,  Ruhl CE.  Burden of digestive diseases in the United
States Part III: Liver, biliary tract, and pancreas. Gastroenterology, 2009;136(4), 1134-1144

Freeborne N, Lynn J. Insights about dying from the
SUPPORT project. The Study to Understand Prognoses and Preferences for Outcomes
and Risks of Treatments. J Am Geriatr Soc 2000;48:S199–205.

Geenes V,
Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol
2009;15:2049-66.

Ginès P, Cárdenas
A, Arroyo A, et al. Management of Cirrhosis and Ascites. N Engl J Med
2004;350:1646-54. 6.

Gordon FD. Ascites Clin Liver Dis. 2012;16(2):285–99.

Graydon JE, Bubela
N, Irvine D, et al. Fatigue-reducing strategies used by patients receiving
treatment for cancer. Cancer Nurs 1995;18:23-8.

James O, Macklon
AF, Watson AJ. Primary biliary cirrhosis — a revised clinical spectrum. Lancet
1981;1:1278-81.

Kanwal F, Hays RD.
Are physician-derived disease severity indices associated with health-related
quality of life in patients with end-stage liver disease? Am J Gastroenterol
2004;99:1726–1732.

Kim SH, Oh EG. Symptom experience in Korean patients with liver cirrhosis. J Pain Symptom
Manage 2006;31:326–334

Kinoshita
H, Maeda I, Morita T, et al. Place of death and the differences in patient
quality of death and dying and caregiver burden.J Clin Oncol. 2015
Feb;33(4):357-63

Koulentaki M,
Ioannidou D, Stefanidou M, et al. Dermatological manifestations in primary
biliary cirrhosis patients: a case control study. Am J Gastroenterol
2006;101:541-6.

Kremer AE, Elferink RPO, Beuers U. Pathophysiology and
current management of pruritus in liver disease. Clinics
and research in hepatology and gastroenterology, 2011;35(2), 89-97.

Larson AM.
Palliative care for
patients with end-stage liver disease Curr Gastroenterol Rep. 2015 May;17(5):440.

Martin SC, Stone
AM. Medical, personal, and social forms of uncertainty across the
transplantation trajectory. Qual Health Res 2010;20:182–196.

McPhedran NT,
Henderson RD. Pruritus and jaundice. Can Med Assoc J 1965;92:1258-60.          

Moore KP, Wong
F, Gines P,  et al. The management of
ascites in cirrhosis: report on the consensus conference of the International
Ascites Club. Hepatology 2003; 38: 258-66. 

Murphy ME.
Pruritus. In: Kuebler KK, Esper P, eds. Palliative Practices From A-Z for the
Bedside Clinician, 2 st ed. Oncology Nursing, Pitshburg PA, ONS Press, 2002.
p.223-228.

National
End of Life Care Intelligence Network Deaths From Liver Disease: Implications
for End of Life Care in England. London: NEoLCIN. 2012.

Peng, JK, Hepgul N,
Higginson IJ, et al. Symptom prevalence of patients with end-stage liver
disease: a systematic review. BMJ Supportive & Palliative Care, 2016;6(3),
401-402.

Poonja Z, Brisebois
A. Patients with cirrhosis and denied liver transplants rarely receive adequate
palliative care or appropriate management. Clin Gastroenterol Hepatol 2014;
12:692–698.

Potosek J, Curry M, Buss M, et al. Integration of palliative
care in end-stage liver disease and liver transplantation. Journal
of palliative medicine, 2014;17(11), 1271-1277.

Rakoski MO,  Volk ML.
Palliative care for patients with end‐stage liver disease: An overview. Clinical
Liver Disease, 2015;6(1), 19-21.

Rhee C, Broadbent AM. Palliation and liver failure:
palliative medications dosage guidelines. JPalliatMed.2007;10(3):677–85

Roth K, Lynn J. Dying with end stage liver disease
with cirrhosis: Insights from SUPPORT. J Am Geriatr Soc 2000; 28:S122–130.

Sanchez
W, Talwalkar JA. Palliative care for patients with endstage liver disease
ineligible for liver transplantation. Gastroenterol Clin North Am.
2006;35(1):201–19.

Seccareccia D,
Gebara N. Pruritus in PalliativeCare. Can Fam Physician 2011; 57: 1010-3. 5.

Scaglione S, Kliethermes S, Cao G, et al.
The epidemiology of cirrhosis in the United States: a population-based study. J
Clin Gastroenterol. 2014;8.

Shaheen NJ, Hansen RA. The burden of
gastrointestinal and liver disease. Am J Gastroenterol 2006;101:2128–2138.

Shawcross D, Jalan
R. The pathophysiologic basis of hepatic encephalopathy: central role for
ammonia and inflammatio. Cell Mol Life Sci 2005;62:2295-304.

Sherlock S, Scheuer
PJ. The presentation and diagnosis of 100 patients with primary biliary
cirrhosis. N Engl J Med 1973;289:674-8.

Sonsuz A. Karaciğer sirozunda
hasta takibi ve klinik sorunlar. Dobrucalı A, Tetikkurt C (editörler).
Türkiye'de Sık Karşılaşılan Hastalıklar II. Sindirim Sistemi Hastalıkları,
Akciğer Kanserine Güncel Yaklaşım Sempozyum Dizisi No: 58. İstanbul: Cerrahpaşa
Tıp Fakültesi Yayınları, 2007; 99-112.

Swain MG. Fatigue in liver disease: pathophysiology and
clinical management. Canadian Journal of Gastroenterology and
Hepatology, 2006;20(3), 181-188.

Verbeeck RK. Pharmacokinetics and dosage adjustment
in patients with hepatic dysfunction. Eur J Clin Pharmacol 2008;64:1147–1161.

Vilstrup H, Amodio
P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014
practice guideline by the American Association for the Study of Liver Diseases
and the European Association for the Study of the Liver. Hepatology
2014;60(2):715-35.

Wachter RM, Luce JM. Decisions about resuscitation:
inequities among patients with different disease but similar prognoses. Ann
Intern Med 1989;111:525–532. 

WHO Definition of
Palliative Care. 2014

Wright G, Jalan R.
Management of hepatic encephalopathy in patients with cirrhosis. Best Practice
& Research Clinical Gastroenterology. 2007;21:95-11

Anahtar Kelimeler

son dönem karaciğer hastalığı, palyatif bakım

Kaynakça

• Als-Nielsen B, Gluud LL. Non-absorbable disaccharides for hepatic encephalopathy: Systematic review of randomised trials. BMJ 2004;328:1046.
• Benson GD, Koff RS. The therapeutic use of acetaminophen in patients with liver disease. Am J Ther 2005;12:133–141
• Bergasa NV, Mehlman JK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis.
• Baillieres Best Pract Res Clin Gastroenterol 2000;14:643-55.
• Bernhard JD. Itch and Pruritus: What are They, and How Should Itches be Classified? Dermatol Ther 2005; 8 (4): 288-91.
• Beuers U, Boberg KM, Chapman RW, et al. EASL clinical practice guidelines: management of cholestatic liver diseases. J Hepatol 2009;51:237-67
• Bjork IT, Naden D. Patients’ experiences of waiting for a liver transplantation. Nurs Inq 2008;15:289–298.
• Bramstedt KA: Hoping for a miracle: Supporting patients in transplantation and cardiac assist programs. Curr Opin Support Palliat Care 2008;2:252–255
• Brown J, Sorrell JH. Waiting for a liver transplant. Qual Health Res 2006;16:119–136.
• Cauch-Dudek K, Abbey S, Stewart DE, et al. Fatigue in primary biliary cirrhosis. Gut 1998;43:705-10
• Chandok N, Watt KD. Pain management in the cirrhotic patient: the clinical challenge. Mayo Clin Proc. 2010;85(5):451–8.
• Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet 2004;363:978-88
• Cook NF, Boore JR. Managing patients suffering from acute and chronic fatigue. Br J Nurs 1997;6:8115.
• Cordoba J, Cabrera J, Lataif L, Et Al. High prevalence of sleep disturbance in cirrhosis. Hepatology 1998;27:339-45
• Dbouk N, McGuire BM. Hepatic encephalopathy: a review of its pathophysiology and treatment.Curr Treat Options Gastroenterol 2006;9:464-74.
• Desbiens NA, Wu AW. Pain and satisfaction with pain control in seriously ill hospitalized patients: Findings from SUPPORT research investigators. Crit Care Med 1996;24:1957–1961
• Dooley JS, Lok A, Burroughs AK, Heathcote J. (Eds.) Sherlock's diseases of the liver and biliary system. John Wiley & Sons. 2011
• Everhart JE, Ruhl CE. Burden of digestive diseases in the United States Part III: Liver, biliary tract, and pancreas. Gastroenterology, 2009;136(4), 1134-1144
• Freeborne N, Lynn J. Insights about dying from the SUPPORT project. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Am Geriatr Soc 2000;48:S199–205.
• Geenes V, Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol 2009;15:2049-66.
• Ginès P, Cárdenas A, Arroyo A, et al. Management of Cirrhosis and Ascites. N Engl J Med 2004;350:1646-54. 6.
• Gordon FD. Ascites Clin Liver Dis. 2012;16(2):285–99.
• Graydon JE, Bubela N, Irvine D, et al. Fatigue-reducing strategies used by patients receiving treatment for cancer. Cancer Nurs 1995;18:23-8.
• James O, Macklon AF, Watson AJ. Primary biliary cirrhosis — a revised clinical spectrum. Lancet 1981;1:1278-81.
• Kanwal F, Hays RD. Are physician-derived disease severity indices associated with health-related quality of life in patients with end-stage liver disease? Am J Gastroenterol 2004;99:1726–1732.
• Kim SH, Oh EG. Symptom experience in Korean patients with liver cirrhosis. J Pain Symptom Manage 2006;31:326–334
• Kinoshita H, Maeda I, Morita T, et al. Place of death and the differences in patient quality of death and dying and caregiver burden.J Clin Oncol. 2015 Feb;33(4):357-63
• Koulentaki M, Ioannidou D, Stefanidou M, et al. Dermatological manifestations in primary biliary cirrhosis patients: a case control study. Am J Gastroenterol 2006;101:541-6.
• Kremer AE, Elferink RPO, Beuers U. Pathophysiology and current management of pruritus in liver disease. Clinics and research in hepatology and gastroenterology, 2011;35(2), 89-97.
• Larson AM. Palliative care for patients with end-stage liver disease Curr Gastroenterol Rep. 2015 May;17(5):440.
• Martin SC, Stone AM. Medical, personal, and social forms of uncertainty across the transplantation trajectory. Qual Health Res 2010;20:182–196.
• McPhedran NT, Henderson RD. Pruritus and jaundice. Can Med Assoc J 1965;92:1258-60.
• Moore KP, Wong F, Gines P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003; 38: 258-66.
• Murphy ME. Pruritus. In: Kuebler KK, Esper P, eds. Palliative Practices From A-Z for the Bedside Clinician, 2 st ed. Oncology Nursing, Pitshburg PA, ONS Press, 2002. p.223-228.
• National End of Life Care Intelligence Network Deaths From Liver Disease: Implications for End of Life Care in England. London: NEoLCIN. 2012.
• Peng, JK, Hepgul N, Higginson IJ, et al. Symptom prevalence of patients with end-stage liver disease: a systematic review. BMJ Supportive & Palliative Care, 2016;6(3), 401-402.
• Poonja Z, Brisebois A. Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or appropriate management. Clin Gastroenterol Hepatol 2014; 12:692–698.
• Potosek J, Curry M, Buss M, et al. Integration of palliative care in end-stage liver disease and liver transplantation. Journal of palliative medicine, 2014;17(11), 1271-1277.
• Rakoski MO, Volk ML. Palliative care for patients with end‐stage liver disease: An overview. Clinical Liver Disease, 2015;6(1), 19-21.
• Rhee C, Broadbent AM. Palliation and liver failure: palliative medications dosage guidelines. JPalliatMed.2007;10(3):677–85
• Roth K, Lynn J. Dying with end stage liver disease with cirrhosis: Insights from SUPPORT. J Am Geriatr Soc 2000; 28:S122–130.
• Sanchez W, Talwalkar JA. Palliative care for patients with endstage liver disease ineligible for liver transplantation. Gastroenterol Clin North Am. 2006;35(1):201–19.
• Seccareccia D, Gebara N. Pruritus in PalliativeCare. Can Fam Physician 2011; 57: 1010-3. 5.
• Scaglione S, Kliethermes S, Cao G, et al. The epidemiology of cirrhosis in the United States: a population-based study. J Clin Gastroenterol. 2014;8.
• Shaheen NJ, Hansen RA. The burden of gastrointestinal and liver disease. Am J Gastroenterol 2006;101:2128–2138.
• Shawcross D, Jalan R. The pathophysiologic basis of hepatic encephalopathy: central role for ammonia and inflammatio. Cell Mol Life Sci 2005;62:2295-304.
• Sherlock S, Scheuer PJ. The presentation and diagnosis of 100 patients with primary biliary cirrhosis. N Engl J Med 1973;289:674-8.
• Sonsuz A. Karaciğer sirozunda hasta takibi ve klinik sorunlar. Dobrucalı A, Tetikkurt C (editörler). Türkiye'de Sık Karşılaşılan Hastalıklar II. Sindirim Sistemi Hastalıkları, Akciğer Kanserine Güncel Yaklaşım Sempozyum Dizisi No: 58. İstanbul: Cerrahpaşa Tıp Fakültesi Yayınları, 2007; 99-112.
• Swain MG. Fatigue in liver disease: pathophysiology and clinical management. Canadian Journal of Gastroenterology and Hepatology, 2006;20(3), 181-188.
• Verbeeck RK. Pharmacokinetics and dosage adjustment in patients with hepatic dysfunction. Eur J Clin Pharmacol 2008;64:1147–1161.
• Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology 2014;60(2):715-35.
• Wachter RM, Luce JM. Decisions about resuscitation: inequities among patients with different disease but similar prognoses. Ann Intern Med 1989;111:525–532.
• WHO Definition of Palliative Care. 2014
• Wright G, Jalan R. Management of hepatic encephalopathy in patients with cirrhosis. Best Practice & Research Clinical Gastroenterology. 2007;21:95-11