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Liver Disease for Physicians

Liver Disease - For Physicians

The patient has both 1 and 2:

1.  Synthetic liver failure as demonstrated by a or and c.

a. Prothrombin time (PTT) prolonged more than five seconds over    control OR

b. International Normalized Ratio (INR) > 1.5 AND

c. Serum albumin < 2.5 gm/dl

AND

2.  End-stage liver disease is present and the patient has one or more of the following conditions:

  • Ascites, refractory to treatment, or patient declines or is non-compliant
  • History of spontaneous bacterial peritonitis
  • Hepatorenal syndrome (elevated creatinine with oliguria [<400 ml/day])
  • Hepatic encephalopathy, refractory to treatment or patient non-compliant
  • History of recurrent variceal bleeding despite intensive therapy or patient declines therapy

Supporting evidence for hospice eligibility:

  • Progressive malnutrition
  • Muscle wasting with reduced strength
  • Ongoing alcoholism (>80 gm ethanol/day)
  • Hepatocellular carcinoma
  • Hepatitis B surface antigen positive
  • Hepatitis C refractory to interferon treatment

In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care.