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Delirium: a diagnostic dilemma. Part 1.Effective symptom management for a patient with a palliative diagnosis can be challenging. There are some symptoms that may be more difficult to control and understand than others. Delirium, as a symptom, may well prove to be a significant challenge for all involved, leaving family and health professionals perplexed and exhausted. Understanding the predisposing factors and the manifestations may aid the health professional in the assessment and identification of this distressing symptom, facilitating more effective management and care of those who are approaching the end of life. This article attempts to address some of the challenges and offer a number of suggestions that may aid in identifying delirium in patients at the end of life, but also examines some of the dilemmas when attempting to treat delirium.
FibroScan: assessing cirrhosis and advanced fibrosis with vibration-controlled transient elastographyThere are many causes of liver disease that can lead to progressive fibrosis and cirrhosis of the liver; chronic liver disease is the third most common cause of death for people under 65 in the UK. Advanced fibrosis and cirrhosis can be asymptomatic, making diagnosis difficult without the aid of the ‘gold standard’ biopsy to assess liver architecture. However, there are many disadvantages associated with this invasive procedure, and so researchers, over the past 15 years, have developed and patented a noninvasive device for measuring liver stiffness and scarring called a FibroScan. This device uses vibration-controlled transient elastography to send sound waves through the liver, from which a reading is taken. A higher reading correlates with an increased likelihood of fibrosis and cirrhosis. This technology is efficient, easy to use and provides immediate results. It allows clinicians to estimate the degree of liver damage, aiding management, treatment and prognosis. It is also an effective monitoring tool that allows liver health to be checked at allotted periods.
Primary biliary cholangitis: symptoms, diagnosis and treatmentPrimary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic but progressive disease that, over many years, causes damage to bile ducts, leading to cholestasis and, in some patients, cirrhosis. The rate at which PBC progresses varies from person to person, but significant damage takes decades to occur. It predominately affects women aged 40–60 years with a female to male ratio of 9:1, but can affect anyone from the age of 20. There is no cure for PBC other than liver transplant, but medications can be given to slow down disease progression and for the treatment of symptoms. Health professionals should monitor for complications, including the development of osteoporosis, vitamin deficiencies and liver cirrhosis, which caries the associated complications of portal hypertension, varices and ascites.