Aproximación a la cirrosis terminal en el adulto mayor, una revisión narrativa desde la perspectiva de la geriatría y los cuidados paliativos
Resumen
El envejecimiento poblacional se asocia con incremento en la prevalencia de enfermedades hepáticas y de enfermedades crónicas no transmisibles. Es necesario un abordaje multidimensional e interdisciplinario como la valoración geriátrica integral (VGI), como una herramienta diseñada para detectar problemas a nivel biológico, funcional, mental y social para realizar una evaluación, intervención, y seguimiento en las personas mayores de 60 años. La cirrosis es una condición irreversible de fibrosis hepática con múltiples etiologías. La enfermedad hepática en estadio terminal se ha definido en la literatura con el termino de cirrosis descompensada caracterizado por la presencia de alguna de las siguientes complicaciones: ascitis, encefalopatía hepática o hemorragia variceal. Existen herramientas como el CHILD PUGH para evaluar estadio y pronostico, sin embargo, síndromes como fragilidad, sarcopenia, y malnutrición identificados en la VGI, se han descrito como factores predictores de complicaciones en estos pacientes, por lo cual se deberían identificar de forma oportuna. Los pacientes con enfermedad hepática terminal reciben atención en cuidados paliativos cerca al final de la vida, existen herramientas como el NECPAL, que permiten identificar necesidades en atención paliativa en pacientes con enfermedades crónicas. Esta revisión tiene como propósito sensibilizar sobre la importancia de la VGI en pacientes con enfermedad hepática en estadio terminal, brindar herramientas para identificar y manejar complicaciones asociadas a la cirrosis, síndromes geriátricos y la necesidad de valoración temprana por cuidados paliativos.
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Derechos de autor 2024 Manuel Alejandro Nieto-González, Marcela Andrea Osorio-Osorio, Fredy Alexander Ávila-Almanza, Olga Lucía Morales-Mesa, Ronald Camilo Gómez-Arteaga
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