Liver Failure in Adults: Management of Chronic Liver Disease

Scope

This research provides recommendations for the testing, evaluation, and management of chronic liver disease in adults. It focuses on the clinical conditions of ascitic cases of cirrhosis, its symptoms, and management of the liver condition.

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Background

Clinical tests and medical records have revealed that cirrhosis, a medical condition resulting from the development of a scar during liver tissue regeneration is one of the leading causes of death with Ascites having the highest prevalence rate among the three cirrhosis complications. Observations indicate that about 50% of liver patients develop cirrhosis without succumbing to other forms of complications that are associated with the medical condition and a number resort to transplants since at that stage there is no viable alternative. When the elderly are exposed to poor living conditions, they are likely to degenerate into parenchyma that leads to cirrhosis. Runyon (2004) has found that the quality of life has a direct bearing on the liver condition of an individual. Add to that, chronic liver conditions are gradual implying that poor quality of life has a gradual bearing on the health of one’s liver. Other potential risks associated with poor living conditions include the threat of infections which have lasting adverse effects with potentially damaging consequences.

Abstract

This qualitative research was based on the review and analysis of available literature and policy guidelines on prevention, care, and management of liver failure conditions in adults and attempts to characterize the quality of research and evidence available on the medical condition in adults. Specifically, the research focused on what clinical medicine identifies as Ascites. The research does not include those with medical conditions that are detectable through imaging techniques due to the deficiency of information on the topic. Liver failure in adults has been statistically identified to be one of the leading causes of death in patients clinically diagnosed with liver conditions. A chronic liver condition in an adult is a progressive medical condition that regenerates and damages liver parenchyma gradually deteriorating to the medical conditions of fibrosis and cirrhosis. When liver tissue replacement occurs due to the chronic effects of the liver disease, cirrhosis results in the development of a scar during liver tissue regeneration leading to liver dysfunction. One of the most common causes of cirrhosis has been diagnosed to be the over-consumption of alcohol. In addition to that, hepatitis B and hepatitis C have been identified to be additional causes. Fatty liver disease and other causes have also been chronicled causes of the chronic liver condition (Runyon, 2004).

Retention of fluids in the cavity of the abdomen, a condition clinically referred to as Ascites has been identified to be the most prevalent complication of cirrhosis. Clinical research has identified the direct cause of cirrhosis to be poor living Conditions.

Research Question

What are the medical causes of liver failure in adults, what qualitative tests are conducted to diagnose these conditions, what are the recommendations for treating this condition, and how do families with these patients cope with their patients?

To answer the research question, a literature review on the causes and symptoms of liver failure was conducted by focusing on Ascites and cirrhosis. The research endeavored to provide answers through an in-depth analysis of how the medical condition affects patients, testing strategies, recommendations, and coping approaches, and a recommendation of the action research to be conducted.

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Introduction

Liver failure in adults has been identified to be one of the leading causes of death among the adult population diagnosed with the condition. This condition progresses with age and if not detected early may lead to the development of cirrhosis, a much worse condition that may lead to liver transplant and at times death. The regeneration of damaged liver tissue causes cirrhosis patients to develop a scar and damage of liver parenchyma leading to liver dysfunction.

Early detection in elderly patients depends on qualitative tests done on one suspected with the condition. Tests start with diagnosing a patient with symptoms and if the condition is not pronounced, other tests may result in a patient suspected of Ascites.

The research will focus on qualitative methods of detecting the condition in elderly patients, diagnosis, causes of the disease particularly the quality of life, recommendations on the treatment, and how to cope with the medical condition.

Cost-effective methods should be the option for diagnosing ascites in patients suspected to be with the liver condition. The physical examination followed by laboratory tests and culture should be the order depending on the resulting outcomes of the tests. Further discussions span how families with liver disease patients cope with them. Action research should narrow to concurrent effects of other liver conditions on the gradual condition of a patient, effects of fluid retention and reduction strategies, and bed rest recommendations. It should span the administration of drugs and physical methods of curbing the condition.

Literature review

Chronic liver condition in an adult is a progressive medical condition that regenerates and damages liver parenchyma gradually deteriorating to fibrosis and cirrhosis medical condition. When liver tissue replacement occurs due to the chronic effects of the liver disease, cirrhosis results in the development of a scar during liver tissue regeneration leading to liver dysfunction. One of the most common causes of cirrhosis has been diagnosed to be the over-consumption of alcohol. In addition to that, hepatitis B and hepatitis C have been identified to be additional causes. Fatty liver disease and other causes have also been chronicled causes of chronic liver disease.

Retention of fluids in the cavity of the abdomen, a condition clinically referred to as Ascites has been identified to be the most prevalent complication of cirrhosis. Clinical research has identified one of the direct causes of cirrhosis to be poor living conditions. When the elderly are exposed to poor living conditions, they are likely to degenerate into parenchyma that leads to cirrhosis. Thus the quality of life has a direct bearing on the liver condition of an individual. Add to that, chronic liver conditions are gradual implying that poor quality of life has a gradual bearing on the health of one’s liver. Other potential risks associated with poor living conditions include the threat of infections which have lasting adverse effects with potentially damaging consequences (Runyon, 2004).

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When the chronic condition progresses, life-threatening hepatic encephalopathy coupled with the execration of blood from the esophageal varices leads to the irreversible chronic condition of the liver identified as cirrhosis. Thus, prevention has been identified to be a key component in managing the medical condition. However, at an advanced stage, clinicians recommend liver transplant as the only viable solution.

In general, therefore, the causes of the medical condition are diverse and can be classified as viral, toxic, metabolic, and autoimmune.

Research Aim

The research aims to investigate, evaluate, and diagnose symptomatic causes of cirrhosis as a prelude to Ascites with a recommendation of therapy specific to the medical condition.

Methodology

Conduct an investigation on the clinical data of a patient, conduct a physical examination of the patient to detect ascitic symptoms with 1500mL of liquid, and provide appropriate recommendations on the treatment of the liver disease.

Qualitative Methods

These could include hepatocellular with ALT and ASP tests. Acetaminophen tests on the prevalence of drug toxicity on a three months basis, abdominal paracentesis, and differential analysis.

Research Question

What is the best approach in investigating, evaluating, and providing therapy for liver disease in adults?

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Significance of the Research

The significance of the research will be in providing recommendations for the study, evaluation, tests, and recommendations for providing therapy for patients with liver disease conditions.

Choice of Methodology

The methodology is cost-effective, the tests, and evaluations of the patient’s medical condition are progressive and non-toxic.

Rationale

Liver disease is a medical condition that is prevalent among elderly people and is a condition that progresses with age. In particular ascitic prevalence can be detected either physically and other associated conditions before progressing to more complicated tests. Physical tests can provide a clear indication of the diseases without conducting blood tests and the condition can be detectable at early stages.

Symptoms

One of the best strategies for clinicians to manage liver failure in adults is early diagnosis of symptoms. Symptoms can be classified as Nausea a prevalent feeling, loss of appetite for food, fatigue, and diarrhea in the patient. It has been known that early liver diagnosis is initially difficult to diagnose. On the other hand, advanced liver failure has been identified to be symptomatic of sleepiness, easy bleeding in the patient, mental disorientation with the patient, and an adverse coma condition.

The investigation, Evaluation, and Diagnosis

Cirrhosis has been diagnosed to be highly prevalent in patients with Ascites. Fluid retention in this case is nonhepatic. Accurate diagnosis of the medical condition leads to successful treatment of the patient. Implying each therapeutic approach is condition-specific else no response will be experienced. Runyon (2004) asserts that Clinical data about a patient diagnosed with a medical condition should be collected before therapy. Risk factors should be identified in Ascites patients to critically identify and pinpoint the specific cause of the medical condition. When Ascites symptomatic information is lacking in a patient, a clinician should investigate the body mass weight of a patient for the patient’s lifetime. Research has revealed that nonalcoholic steatohepatitis has been identified to be the relevant cause of the latter condition. Conditions such as tuberculosis should be investigated as one of the likely causes in addition to heart failure and liver cancer conditions.

On the other hand, a physical examination of a patient suspected of the disease should be done. If flank dullness is detected when a physical examination has been done, then the probability of a patient having Ascites is high. 1500 mL of fluid provides an appropriate environment for detecting the condition. When alcoholic cardiomyopathy is detected as a possible cause of Ascites, keen interest should specify if it is due to alcoholic cirrhosis. The presence of jugular venous distension should be classified appropriately. In addition to that, obese patients should be tested using an ultrasound strategy to detect the presence of fluids. The history of a patient, physical tests, and analysis of ascitic fluids reveal the medical condition of a patient. Other conditions such as hepatocellular carcinoma are diagnosed through liver imaging though they are less likely to influence or yield further information (Runyon, 2004).

Patients should be subjected to cost-effective methods of diagnosing Ascetic causes. Abdominal paracentesis is a method that readily distinguishes fluids due to portal hypertension and other fluids. Unexpected infections may also be detected in a highly infected ascitic fluid at the time a patient is admitted.

Recent studies have not shown any mortality rate in patients with paracentesis complications. In comparison, patients with abnormal prothrombin time were prevalently higher than those with abdominal wall hematomas. In addition to that, the performance of the procedure can not be impeded by hemoperitoneum, a serious complication due to the entry of a needle into the bowel of the patient. When conducting the test on the patient, coagulopathic patients need routine platelets before paracentesis since prophylactic transfusions are importantly risked and cost-effective strategies. If physical means fail to locate the fluid, ultrasonography is strongly recommended. Paracentesis has far less contraindications. When clinical evidence indicated fibrinolysis or intravascular coagulation, then coagulopathy should preclude paracentesis.

Recommendations

  1. Liver failure patients should undergo abdominal paracentesis tests and the ascitic fluid for tests should be collected from both inpatients and outpatients. Clinical trials on these samples should be done with cost-effective methods.
  2. The use of platelets should be uncommon to these patients since research has shown bleeding to be uncommon.

Analysis of the Ascetic Fluid

A qualitative analysis of a large number of specimens can be ordered as an optimal testing strategy. The clinician should identify the cirrhosis condition of the patient to determine the testing strategy. The initial specimen should undergo albumin, protein tests, and cell count evaluations to determine the degree of these effects. Results may demand further tests. These may include bacterial culture, and urine tests to detect any occurrence of infections in the ascetic fluid. Cells can accurately be counted as this approach has been proven to be accurate and additional tests based on clinical judgment should be done. The clinician may determine the presence of gurt perforation into the ascitic fluid by the prevalence levels of carcinoembryonic antigen in the ascitic fluid.

Other research studies have identified the serum-ascites albumin differential or gradient to be the differentiating measurements obtained in one day and those that are obtained from another serum value as specific alternatives.

Various categories of patients need different treatment strategies. For those outpatients on serial therapeutic paracentesis, the formidable approach is cell count analysis with cytology ordered after a high incidence of the disease has been identified in the case.

Recommendations

  1. SAAG should be the testing strategy when an initial investigation on the ascetic fluid is being tested.
  2. Samples suspected to be infected should be cultured in blood culture bottles of the ascitic fluid.
  3. Other strategies can be factored in depending on a clinician’s decision.

Research indicates a summary of ascetic fluid data.

Routine Number of cells and Albumin The sum of protein
Optional Cultures blood Presence of glucose Lactate dehydrogenate
Unusual Smear and culture Cytology Bilirubin
Unhelpful Ph
Fibrocectin
Lactate Fibronectin

Differential Analysis

Cirrhosis has been identified to be the cause of ascitic formation in patients though other causes have been identified to cause ascites. These include cancer among others.

Knowledge and Information Resulting Thereof

According to Ballinger (2006), the knowledge accruing will enable medical practitioners to detect early symptoms of the disease and its development at early stages, an analysis of the causes of Ascites in liver disease patients, and therapeutic approaches that are cost-effective and testing and evaluation strategies. The integrity of information and knowledge will be enforced.

Coping with Ascites in Adults

The treatment of ascites in patients with chronic liver conditions should be based on data about causes that lead to fluid retention. A clinician should make a decision based on an analysis of data obtained from tests done on the patient. Examinations have indicated that no restrictions on salt should be placed on patients with low SAAG Ascites while those with high levels of SAAG Ascites should be restricted accordingly.

Patients who have had alcohol as the underlying cause and who take in the advice and stop drinking show drastic improvements with gradually diminishing levels of the reversible element of the liver disease. Research has indicated that patients who do not heed the advice and stop drinking once diagnosed have a chance of dying in 3 years while those who stop drinking have a 3-year extension on life.

Another approach is dietary education and improvement of the quality of life for the patient. Sodium restriction is a fundamental component in liver fluid retention and weight loss effects. An analysis of sodium concentrations in the urine on a twenty-four hours cycle as opposed to random tests may be more accurate and informative on the status and regulation of the salt on male and female patients.

Recommendations

  1. Abstinence from the consumption of alcohol for ascitic patients is strongly recommended.
  2. Sodium restrictions should be a first-line component in the treatment of ascetically cirrhosis patients.
  3. A liver transplant is a final option when other therapies fail to reverse a deteriorating liver condition.

How Families Cope With Their Patients

Some families resort to alternative care for their patients such as the use of herbal supplements, discouraging their patients from excessive consumption of alcohol, encouraging their patients not to use illicit drugs or off the shelf drugs without medical advice, and encouraging their patients to get vaccinated against potential risks such as hepatitis A and B. Encourage patients to live and eat wisely to avoid putting on a lot of weight and avoiding contact with fluids of patients suspected to have the liver disease.

References

Ballinger, C. (2006). Demonstrating rigor qualitative research for allied health Professionals. West Sussex. John Willey & Sons.

Runyon, B.A. (2004). Management of adult patients with ascites due to cirrhosis. Hepatomology. American Association for the study of Liver Diseases. Wiley Intercience.

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NerdyTom. (2022, March 18). Liver Failure in Adults: Management of Chronic Liver Disease. Retrieved from https://nerdytom.com/liver-failure-in-adults-management-of-chronic-liver-disease/

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"Liver Failure in Adults: Management of Chronic Liver Disease." NerdyTom, 18 Mar. 2022, nerdytom.com/liver-failure-in-adults-management-of-chronic-liver-disease/.

1. NerdyTom. "Liver Failure in Adults: Management of Chronic Liver Disease." March 18, 2022. https://nerdytom.com/liver-failure-in-adults-management-of-chronic-liver-disease/.


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NerdyTom. "Liver Failure in Adults: Management of Chronic Liver Disease." March 18, 2022. https://nerdytom.com/liver-failure-in-adults-management-of-chronic-liver-disease/.

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NerdyTom. 2022. "Liver Failure in Adults: Management of Chronic Liver Disease." March 18, 2022. https://nerdytom.com/liver-failure-in-adults-management-of-chronic-liver-disease/.

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NerdyTom. (2022) 'Liver Failure in Adults: Management of Chronic Liver Disease'. 18 March.

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