Recognition
- Jaundice: Yellow sclera, skin, and mucous membranes — the most visible sign
- Bleeding and bruising: Petechiae, ecchymosis, gum bleeding, prolonged clotting time (failure of clotting factor synthesis)
- Ascites: Abdominal distension from fluid accumulation
- Hepatic encephalopathy: Spectrum from subtle personality change and confusion (Grade I-II) to coma (Grade IV). Asterixis (flapping hand tremor) is characteristic
- Fetor hepaticus: Sweet, musty breath odor from mercaptans
- Spider angiomata and palmar erythema: Vascular signs of chronic liver disease
- Profound fatigue and weakness
MT Relevance
- Acute liver failure: Absolute contraindication — the client is in a critical care setting
- Decompensated chronic liver failure (active encephalopathy, uncontrolled ascites, active bleeding): Contraindicated — requires medical stabilization and physician clearance
- Compensated chronic liver disease with history of decompensation: Physician clearance required. Gentle techniques only. Avoid abdominal massage. Light pressure throughout (coagulopathy makes even gentle massage a bruising risk)
- Coagulopathy precautions: Light effleurage only. No deep tissue, friction, percussion, or cupping. Bruising may occur even with gentle pressure
- Ascites and positioning: Prone is usually impossible. Side-lying or semi-reclined required
- Encephalopathy: Assess mental status at the start of every session — Grade II and above compromises informed consent capacity. Client may become confused or fatigued quickly. Keep sessions short and monitor cognitive clarity.
Required Actions
- Acute or decompensated liver failure: Do not treat — priority is medical stabilization
- Encephalopathy signs during session (increasing confusion, asterixis, somnolence): Cease treatment and contact the medical team
- Active bleeding (new bruising, gum bleeding, hematemesis): Cease treatment and refer
Key Takeaways
- Acute and decompensated liver failure are contraindications to massage — priority is medical stabilization
- Coagulopathy means even gentle massage can cause bruising — reduce pressure significantly and avoid all deep or aggressive techniques
- Hepatic encephalopathy affects consent capacity — assess mental status at the start of every session
- Abdominal massage is always contraindicated. Prone positioning is often impossible due to ascites
- Compensated clients with physician clearance can benefit from gentle comfort massage