Live 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 cause – 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 to 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 Parliamentary Hepatology 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 computerized tomography or magnetic resonance imaging maybe required.