Liver disease is the fifth major cause
of mortality in England and Wales,
and one of the few causes of premature
death that is increasing
(Fig 1), yet the most common causes – obesity,
undiagnosed viral infection with hepatitis
B and C, and harmful drinking – are
avoidable. Rates of chronic liver disease
(CLD) and cirrhosis in people aged under
65 years have increased by around 20% over
the last 10 years in the UK, but many European
countries have seen cases of CLD fall
in the same period (Davies, 2012).
As there is no national strategy to
improve the detection and treatment of
liver disease, the All-Party ParliamentaryHepatology Group (2014) has recommended
20 actions to do this. The National
Confidential Enquiry into Patient Outcome
and Death’s (2013) report on hospital deaths
from alcohol-related liver disease revealed
a wide range of missed opportunities when
caring for these patients:
» Death was considered avoidable in 10%
of the cases reviewed;
» Care was rated as less than good in
more than half of patients admitted.
Nurses from all areas of practice must
be able to offer health information and
education to patients to raise awareness of
liver disease and promote healthy-living
strategies. As the mortality and morbidity
associated with CLD and cirrhosis
increase, nurses need to develop their
knowledge and skills in caring for people
who have advanced liver disease. The Royal
College of Nursing has developed a competency
framework for caring for people
with liver disease (RCN, 2013).
Table 1 lists common causes of liver disease,
and some of the tests and investigations
used to confirm its presence (British
Liver Trust, 2007). Ultrasound imaging
may be used to assess the size and shape of
the liver and surrounding organs, detect
the presence of ascites, observe the direction
of blood flow through the portal vein
and detect focal abnormalities indicative of
hepatocellular carcinoma. More imaging
with computerised tomography or magnetic
resonance imaging may be required