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End of Life Online Curriculum - Modules
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Home Hospice
: Home Care of the Dying Patient |
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End Stage Liver Disease
The patient has:
- Prothrombin time (PT) more than 5 seconds over control, or International
Normalized Ratio (INR) >1.5
- Serum albumin <2.5 gm/dL and
- One or more of the following conditions:
- Ascites, refractory to treatment or patient non-compliant
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome; elevated creatinine and BUN; oliguria
{< 400 ml/day}; urine sodium concentration < 10 mEq/l;
cirrhosis and ascites
- Hepatic encephalopathy, refractory to treatment or patient
non-compliant
- Recurrent variceal bleeding, despite intensive therapy.
- Supporting documentation:
- Progressive malnutrition
- Muscle wasting with reduced strength and endurance
- Continued active alcoholism (>80 gm ethanol/day)
- Hepatocellular carcinoma
- HBsAg (Hepatitis B) positivity.
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©End
of Life Curriculum Project, a joint project of the US Veterans Administration
and SUMMIT,
Stanford University Medical School.
Funded by a grant to the Veterans
Administration Nationwide Palliative Care Network by
the National Library of Medicine. VJ Periyakoil, MD, Director.
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