Liver Disease I

Over the last six months in the intensive care unit, I've found that one disease we underestimate in medicine is cirrhosis. When family practitioners see patients with decompensated congestive heart failure, oxygen-dependent chronic obstructive pulmonary disease, or metastatic cancer, they bring up the end of life. They talk about hospice, palliative care, and the fact that their disease is so severe, they will pass away from it. For whatever reason, liver disease doesn't seem to evoke the same responses. When I talk to patients admitted to the ICU with decompensated liver failure, they aren't aware of the mortality of their illness. They don't know what their liver disease, why liver disease affects every other organ in the body. For many, it's a black box, and it's our responsibility as physicians to fill that box in. The data is clear; MELD scores predict three month mortality, and these patients deserve a talk about the end of their life. I don't like being morbid, but I also don't think it's fair to surprise someone with the fact that they will die from a disease we've known about. In the same regard, this is why prevention of cirrhosis is so important; counseling for alcoholism, vaccines against hepatitis, and mechanisms to decrease acetaminophen overdose will save lives. It's imperative for us all to educate ourselves and our patients on what liver disease looks like and how to prevent it. Its imperative for us to guide our patients through the end of life if their liver disease is end stage. I see too many patients in the intensive care unit without a clue, a problem we need to address.

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