Management of the Adult Patient with Cirrhosis Complicated by Ascites.

Ascites is the most common and often the first decompensating event that occurs in cirrhosis. It has both a high symptom burden and high mortality rate. Increased abdominal girth, generalized abdominal pain, early satiety, and shortness of breath have a negative impact on quality of life. Treatments used to manage ascites include dietary sodium restriction, diuretics, large volume paracentesis, and transjugular intrahepatic portosystemic shunt. Secondary complications of ascites include refractory ascites, hyponatremia, and hepatorenal syndrome and are associated with reduced survival. Consideration should be given to the appropriateness and timing of referrals for liver transplant and/or palliative care.

Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.