SON DÖNEM KARACİĞER HASTALIKLARINDA PALYATİF BAKIM
SON DÖNEM KARACİĞER HASTALIKLARINDA PALYATİF BAKIM
Yazar: Hançerlioğlu, Sadik; Yıldırım, Yasemin; Şenuzun Aykar, Fisun
Dergi: Ege Üniversitesi Hemşirelik Fakültesi Dergisi, Vol. 34 No. 2, 2018
Anahtar kelimeler: son dönem karaciğer hastalığı,palyatif bakım

Başlık:SON DÖNEMKARACİĞER HASTALIKLARINDA PALYATİF BAKIMÖzet:SonDönem Karaciğer Hastalığı (SDKH) olanbireylerin, karşı karşıya kaldıkları kötü prognoz, semptom yükü ve yaygınmental sorunlardan dolayı yaşam kaliteleri olumsuz olarak etkilenmektedir. Palyatif bakım, yaşamıtehdit eden hastalıkla karşı karşıya kalan hastaların ve ailelerinin, yaşamkalitelerini yükseltmek için başta ağrı olmak üzere fiziksel, psikososyal veruhsal problemlerinin erken tanılanıp ve değerlendirilerek, tedavi ve bakımınınyapılmasını amaçlayan yaklaşım olarak tanımlanmaktadır. Bugünekadar yapılan çalışmalar incelendiğinde, SDKH hastalarında palyatif bakımayönelik çok az sayıda çalışma olduğu görülmektedir. Son Dönem KaraciğerHastalıklarının palyatif bakımında tedavinin potensiyel etki ve yan etkileriiyi değerlendirilmeli, mevcut semptomun daha da kötüleşmesi veya yenisemptomların ortaya çıkması engellenmelidir. Sağlık bakım alanındaki en büyükiş gücünü oluşturan hemşirelerin kompleks bakım gereksinimleri olan SDKH’dakirolü büyüktür. Hemşireler karaciğer hastalıklarının yaygın neden vekomplikasyonları konusunda bilgi sahibi olmalı ve karmaşık semptom yönetimisürecinde hasta gereksinimlerini anlamalı ve diğer sağlık bakım profesyonelleriile iletişim içinde olarak hastaların yaşam kalitesini optimum düzeyde tutacakşekilde bakım vermelidir. Bu derlemede karaciğer hastalıklarının palyatif bakımsürecinde en sık görülen ve yaşam kalitesini olumsuz olarak etkileyen semptomlarve bu semptomların bakım yönetimi incelenecektir. Anahtar kelimeler:   son dönem karaciğer hastalığı, palyatif bakımDestekleyen kurumlar:Kaynakça:Als-Nielsen B,Gluud LL. Non-absorbable disaccharides for hepatic encephalopathy: Systematicreview of randomised trials. BMJ 2004;328:1046. Benson GD, Koff RS.The therapeutic use of acetaminophen in patients with liver disease. Am J Ther2005;12:133–141Bergasa NV, MehlmanJK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. BaillieresBest Pract Res Clin Gastroenterol 2000;14:643-55. Bernhard JD. Itchand Pruritus: What are They, and How Should Itches be Classified? Dermatol Ther2005; 8 (4): 288-91. Beuers U, BobergKM, Chapman RW, et al. EASL clinical practice guidelines: management ofcholestatic liver diseases. J Hepatol 2009;51:237-67Bjork IT, Naden D.Patients’ experiences of waiting for a liver transplantation. Nurs Inq2008;15:289–298. Bramstedt KA: Hoping for a miracle: Supportingpatients in transplantation and cardiac assist programs. Curr Opin SupportPalliat Care 2008;2:252–255Brown J, SorrellJH. 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. Gut1998;43:705-10Chandok N, Watt KD. Pain management in the cirrhoticpatient: the clinical challenge. Mayo Clin Proc. 2010;85(5):451–8. Chaudhuri A, BehanPO. Fatigue in neurological disorders. Lancet 2004;363:978-88Cook NF, Boore JR.Managing patients suffering from acute and chronic fatigue. Br J Nurs1997;6:8115. Cordoba J, CabreraJ, Lataif L, Et Al. High prevalence of sleep disturbance in cirrhosis.Hepatology 1998;27:339-45Dbouk N, McGuireBM. Hepatic encephalopathy: a review of its pathophysiology and treatment.CurrTreat Options Gastroenterol 2006;9:464-74.Desbiens NA, Wu AW. Pain and satisfaction with pain control in seriously illhospitalized patients: Findings from SUPPORT research investigators. Crit Care Med 1996;24:1957–1961Dooley JS,Lok A, Burroughs AK,  Heathcote J. (Eds.)Sherlock's diseases of the liver and biliary system. John Wiley &Sons. 2011EverhartJE,  Ruhl CE.  Burden of digestive diseases in the UnitedStates Part III: Liver, biliary tract, and pancreas. Gastroenterology, 2009;136(4), 1134-1144Freeborne N, Lynn J. Insights about dying from theSUPPORT project. The Study to Understand Prognoses and Preferences for Outcomesand Risks of Treatments. J Am Geriatr Soc 2000;48:S199–205. Geenes V,Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol2009;15:2049-66.Ginès P, CárdenasA, Arroyo A, et al. Management of Cirrhosis and Ascites. N Engl J Med2004;350:1646-54. 6. Gordon FD. Ascites Clin Liver Dis. 2012;16(2):285–99.Graydon JE, BubelaN, Irvine D, et al. Fatigue-reducing strategies used by patients receivingtreatment for cancer. Cancer Nurs 1995;18:23-8. James O, MacklonAF, Watson AJ. Primary biliary cirrhosis — a revised clinical spectrum. Lancet1981;1:1278-81. Kanwal F, Hays RD.Are physician-derived disease severity indices associated with health-relatedquality of life in patients with end-stage liver disease? Am J Gastroenterol2004;99:1726–1732.Kim SH, Oh EG. Symptom experience in Korean patients with liver cirrhosis. J Pain SymptomManage 2006;31:326–334KinoshitaH, Maeda I, Morita T, et al. Place of death and the differences in patientquality of death and dying and caregiver burden.J Clin Oncol. 2015Feb;33(4):357-63Koulentaki M,Ioannidou D, Stefanidou M, et al. Dermatological manifestations in primarybiliary cirrhosis patients: a case control study. Am J Gastroenterol2006;101:541-6.Kremer AE, Elferink RPO, Beuers U. Pathophysiology andcurrent management of pruritus in liver disease. Clinicsand research in hepatology and gastroenterology, 2011;35(2), 89-97.Larson AM.Palliative care forpatients with end-stage liver disease Curr Gastroenterol Rep. 2015 May;17(5):440. Martin SC, StoneAM. Medical, personal, and social forms of uncertainty across thetransplantation 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, WongF, Gines P,  et al. The management ofascites in cirrhosis: report on the consensus conference of the InternationalAscites Club. Hepatology 2003; 38: 258-66. Murphy ME.Pruritus. In: Kuebler KK, Esper P, eds. Palliative Practices From A-Z for theBedside Clinician, 2 st ed. Oncology Nursing, Pitshburg PA, ONS Press, 2002.p.223-228.NationalEnd of Life Care Intelligence Network Deaths From Liver Disease: Implicationsfor End of Life Care in England. London: NEoLCIN. 2012.Peng, JK, Hepgul N,Higginson IJ, et al. Symptom prevalence of patients with end-stage liverdisease: a systematic review. BMJ Supportive & Palliative Care, 2016;6(3),401-402.Poonja Z, BriseboisA. Patients with cirrhosis and denied liver transplants rarely receive adequatepalliative care or appropriate management. Clin Gastroenterol Hepatol 2014;12:692–698.Potosek J, Curry M, Buss M, et al. Integration of palliativecare in end-stage liver disease and liver transplantation. Journalof palliative medicine, 2014;17(11), 1271-1277.Rakoski MO,  Volk ML.Palliative care for patients with end‐stage liver disease: An overview. ClinicalLiver Disease, 2015;6(1), 19-21.Rhee C, Broadbent AM. Palliation and liver failure:palliative medications dosage guidelines. JPalliatMed.2007;10(3):677–85Roth K, Lynn J. Dying with end stage liver diseasewith cirrhosis: Insights from SUPPORT. J Am Geriatr Soc 2000; 28:S122–130.SanchezW, Talwalkar JA. Palliative care for patients with endstage liver diseaseineligible 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. JClin Gastroenterol. 2014;8.Shaheen NJ, Hansen RA. The burden ofgastrointestinal and liver disease. Am J Gastroenterol 2006;101:2128–2138. Shawcross D, JalanR. The pathophysiologic basis of hepatic encephalopathy: central role forammonia and inflammatio. Cell Mol Life Sci 2005;62:2295-304. Sherlock S, ScheuerPJ. The presentation and diagnosis of 100 patients with primary biliarycirrhosis. N Engl J Med 1973;289:674-8. Sonsuz A. Karaciğer sirozundahasta 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: CerrahpaşaTıp Fakültesi Yayınları, 2007; 99-112.Swain MG. Fatigue in liver disease: pathophysiology andclinical management. Canadian Journal of Gastroenterology andHepatology, 2006;20(3), 181-188.Verbeeck RK. Pharmacokinetics and dosage adjustmentin patients with hepatic dysfunction. Eur J Clin Pharmacol 2008;64:1147–1161.Vilstrup H, AmodioP, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014practice guideline by the American Association for the Study of Liver Diseasesand the European Association for the Study of the Liver. Hepatology2014;60(2):715-35.Wachter RM, Luce JM. Decisions about resuscitation:inequities among patients with different disease but similar prognoses. AnnIntern Med 1989;111:525–532.  WHO Definition ofPalliative Care. 2014Wright G, Jalan R.Management of hepatic encephalopathy in patients with cirrhosis. Best Practice& Research Clinical Gastroenterology. 2007;21:95-11

Başlık:SON DÖNEMKARACİĞER HASTALIKLARINDA PALYATİF BAKIMÖzet:SonDönem Karaciğer Hastalığı (SDKH) olanbireylerin, karşı karşıya kaldıkları kötü prognoz, semptom yükü ve yaygınmental sorunlardan dolayı yaşam kaliteleri olumsuz olarak etkilenmektedir. Palyatif bakım, yaşamıtehdit eden hastalıkla karşı karşıya kalan hastaların ve ailelerinin, yaşamkalitelerini yükseltmek için başta ağrı olmak üzere fiziksel, psikososyal veruhsal problemlerinin erken tanılanıp ve değerlendirilerek, tedavi ve bakımınınyapılmasını amaçlayan yaklaşım olarak tanımlanmaktadır. Bugünekadar yapılan çalışmalar incelendiğinde, SDKH hastalarında palyatif bakımayönelik çok az sayıda çalışma olduğu görülmektedir. Son Dönem KaraciğerHastalıklarının palyatif bakımında tedavinin potensiyel etki ve yan etkileriiyi değerlendirilmeli, mevcut semptomun daha da kötüleşmesi veya yenisemptomların ortaya çıkması engellenmelidir. Sağlık bakım alanındaki en büyükiş gücünü oluşturan hemşirelerin kompleks bakım gereksinimleri olan SDKH’dakirolü büyüktür. Hemşireler karaciğer hastalıklarının yaygın neden vekomplikasyonları konusunda bilgi sahibi olmalı ve karmaşık semptom yönetimisürecinde hasta gereksinimlerini anlamalı ve diğer sağlık bakım profesyonelleriile iletişim içinde olarak hastaların yaşam kalitesini optimum düzeyde tutacakşekilde bakım vermelidir. Bu derlemede karaciğer hastalıklarının palyatif bakımsürecinde en sık görülen ve yaşam kalitesini olumsuz olarak etkileyen semptomlarve bu semptomların bakım yönetimi incelenecektir. Anahtar kelimeler:   son dönem karaciğer hastalığı, palyatif bakımDestekleyen kurumlar:Kaynakça:Als-Nielsen B,Gluud LL. Non-absorbable disaccharides for hepatic encephalopathy: Systematicreview of randomised trials. BMJ 2004;328:1046. Benson GD, Koff RS.The therapeutic use of acetaminophen in patients with liver disease. Am J Ther2005;12:133–141Bergasa NV, MehlmanJK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. BaillieresBest Pract Res Clin Gastroenterol 2000;14:643-55. Bernhard JD. Itchand Pruritus: What are They, and How Should Itches be Classified? Dermatol Ther2005; 8 (4): 288-91. Beuers U, BobergKM, Chapman RW, et al. EASL clinical practice guidelines: management ofcholestatic liver diseases. J Hepatol 2009;51:237-67Bjork IT, Naden D.Patients’ experiences of waiting for a liver transplantation. Nurs Inq2008;15:289–298. Bramstedt KA: Hoping for a miracle: Supportingpatients in transplantation and cardiac assist programs. Curr Opin SupportPalliat Care 2008;2:252–255Brown J, SorrellJH. 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. Gut1998;43:705-10Chandok N, Watt KD. Pain management in the cirrhoticpatient: the clinical challenge. Mayo Clin Proc. 2010;85(5):451–8. Chaudhuri A, BehanPO. Fatigue in neurological disorders. Lancet 2004;363:978-88Cook NF, Boore JR.Managing patients suffering from acute and chronic fatigue. Br J Nurs1997;6:8115. Cordoba J, CabreraJ, Lataif L, Et Al. High prevalence of sleep disturbance in cirrhosis.Hepatology 1998;27:339-45Dbouk N, McGuireBM. Hepatic encephalopathy: a review of its pathophysiology and treatment.CurrTreat Options Gastroenterol 2006;9:464-74.Desbiens NA, Wu AW. Pain and satisfaction with pain control in seriously illhospitalized patients: Findings from SUPPORT research investigators. Crit Care Med 1996;24:1957–1961Dooley JS,Lok A, Burroughs AK,  Heathcote J. (Eds.)Sherlock's diseases of the liver and biliary system. John Wiley &Sons. 2011EverhartJE,  Ruhl CE.  Burden of digestive diseases in the UnitedStates Part III: Liver, biliary tract, and pancreas. Gastroenterology, 2009;136(4), 1134-1144Freeborne N, Lynn J. Insights about dying from theSUPPORT project. The Study to Understand Prognoses and Preferences for Outcomesand Risks of Treatments. J Am Geriatr Soc 2000;48:S199–205. Geenes V,Williamson C. Intrahepatic cholestasis of pregnancy. World J Gastroenterol2009;15:2049-66.Ginès P, CárdenasA, Arroyo A, et al. Management of Cirrhosis and Ascites. N Engl J Med2004;350:1646-54. 6. Gordon FD. Ascites Clin Liver Dis. 2012;16(2):285–99.Graydon JE, BubelaN, Irvine D, et al. Fatigue-reducing strategies used by patients receivingtreatment for cancer. Cancer Nurs 1995;18:23-8. James O, MacklonAF, Watson AJ. Primary biliary cirrhosis — a revised clinical spectrum. Lancet1981;1:1278-81. Kanwal F, Hays RD.Are physician-derived disease severity indices associated with health-relatedquality of life in patients with end-stage liver disease? Am J Gastroenterol2004;99:1726–1732.Kim SH, Oh EG. Symptom experience in Korean patients with liver cirrhosis. J Pain SymptomManage 2006;31:326–334KinoshitaH, Maeda I, Morita T, et al. Place of death and the differences in patientquality of death and dying and caregiver burden.J Clin Oncol. 2015Feb;33(4):357-63Koulentaki M,Ioannidou D, Stefanidou M, et al. Dermatological manifestations in primarybiliary cirrhosis patients: a case control study. Am J Gastroenterol2006;101:541-6.Kremer AE, Elferink RPO, Beuers U. Pathophysiology andcurrent management of pruritus in liver disease. Clinicsand research in hepatology and gastroenterology, 2011;35(2), 89-97.Larson AM.Palliative care forpatients with end-stage liver disease Curr Gastroenterol Rep. 2015 May;17(5):440. Martin SC, StoneAM. Medical, personal, and social forms of uncertainty across thetransplantation 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, WongF, Gines P,  et al. The management ofascites in cirrhosis: report on the consensus conference of the InternationalAscites Club. Hepatology 2003; 38: 258-66. Murphy ME.Pruritus. In: Kuebler KK, Esper P, eds. Palliative Practices From A-Z for theBedside Clinician, 2 st ed. Oncology Nursing, Pitshburg PA, ONS Press, 2002.p.223-228.NationalEnd of Life Care Intelligence Network Deaths From Liver Disease: Implicationsfor End of Life Care in England. London: NEoLCIN. 2012.Peng, JK, Hepgul N,Higginson IJ, et al. Symptom prevalence of patients with end-stage liverdisease: a systematic review. BMJ Supportive & Palliative Care, 2016;6(3),401-402.Poonja Z, BriseboisA. Patients with cirrhosis and denied liver transplants rarely receive adequatepalliative care or appropriate management. Clin Gastroenterol Hepatol 2014;12:692–698.Potosek J, Curry M, Buss M, et al. Integration of palliativecare in end-stage liver disease and liver transplantation. Journalof palliative medicine, 2014;17(11), 1271-1277.Rakoski MO,  Volk ML.Palliative care for patients with end‐stage liver disease: An overview. ClinicalLiver Disease, 2015;6(1), 19-21.Rhee C, Broadbent AM. Palliation and liver failure:palliative medications dosage guidelines. JPalliatMed.2007;10(3):677–85Roth K, Lynn J. Dying with end stage liver diseasewith cirrhosis: Insights from SUPPORT. J Am Geriatr Soc 2000; 28:S122–130.SanchezW, Talwalkar JA. Palliative care for patients with endstage liver diseaseineligible 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. JClin Gastroenterol. 2014;8.Shaheen NJ, Hansen RA. The burden ofgastrointestinal and liver disease. Am J Gastroenterol 2006;101:2128–2138. Shawcross D, JalanR. The pathophysiologic basis of hepatic encephalopathy: central role forammonia and inflammatio. Cell Mol Life Sci 2005;62:2295-304. Sherlock S, ScheuerPJ. The presentation and diagnosis of 100 patients with primary biliarycirrhosis. N Engl J Med 1973;289:674-8. Sonsuz A. Karaciğer sirozundahasta 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: CerrahpaşaTıp Fakültesi Yayınları, 2007; 99-112.Swain MG. Fatigue in liver disease: pathophysiology andclinical management. Canadian Journal of Gastroenterology andHepatology, 2006;20(3), 181-188.Verbeeck RK. Pharmacokinetics and dosage adjustmentin patients with hepatic dysfunction. Eur J Clin Pharmacol 2008;64:1147–1161.Vilstrup H, AmodioP, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014practice guideline by the American Association for the Study of Liver Diseasesand the European Association for the Study of the Liver. Hepatology2014;60(2):715-35.Wachter RM, Luce JM. Decisions about resuscitation:inequities among patients with different disease but similar prognoses. AnnIntern Med 1989;111:525–532.  WHO Definition ofPalliative Care. 2014Wright G, Jalan R.Management of hepatic encephalopathy in patients with cirrhosis. Best Practice& Research Clinical Gastroenterology. 2007;21:95-11