help Change can be either driven or restrained by forces, i.e. persons, habits, customs, attitudes. In a planning session, this can be visualised by a Force Field Diagram. Using three columns, list planned change in the middle column, the driving forces

in the left one, the opposing forces in the right one. Check whether the forces listed are appropriate and whether they can they be changed. Decide which ones are critical, and allocate a score to each (from 1 being extremely weak to 10 being

extremely strong). Decide as well whether any of the forces are actually amenable to change. Now, progress can occur if an opposing force can be reduced, and/or if a driving force can be strengthened. A force field analysis, if well carried out, will reveal opponents and allies, and suggest possible corrective action.

31 What are the criteria for knowing the prognosis of cirrhosis (Child's criteria)?

32 What is the recommended treatment for cirrhosis of the liver?

33 Is there any role for liver dialysis in hepatic

encephalopathy?

34 I have been asked to write essay on 'caring' for a client who

has been an alcohol abuser for more than 10 years and is in the 'recovery'

stage. I am aware there are many different factors, such as length of abuse,

amount consumed, age, gender etc. . . . My question is: how long will it take

the liver to 'recover' or to return to normal after stopping drinking? I am

especially interested in blood tests, fatty deposits and gammaglutamyl

transpeptidases (-GTs).

35 Can patients with liver cell failure suffer from myocardial

infarction?

36 What is the definition of liver cell failure (decompensated

liver disease)?

37 Flapping tremors: why do we get flapping tremors and no other

types of tremor in liver failure? What is their mechanism and in which other

conditions do they occur?

38 In a patient with liver cell failure, can there be resting

and action tremors or parkinsonian features if it is confirmed that the patient

does not have Wilson's disease?

39 Does the absence of any cirrhosis of the liver, together with

normal liver enzymes, in a 9-year-old boy complaining of chorea of a 5-year

duration, exclude Wilson's disease?

40 Can Wilson's disease be excluded in a patient complaining of

movement disorder for over 2 years, when there is an absence of cirrhotic liver

change?