Documente Academic
Documente Profesional
Documente Cultură
of Liver Cirrhosis
CARLY SPIRITO
Objectives
1.Provide an overview of liver cirrhosis
Risk factors:
o Chronic viral infections (Hepatitis B and C)
o Fatty liver associated with obesity and
diabetes
o Alcohol abuse
Liver Cirrhosis: Symptoms
oFluid retention, swelling in the ankles, legs, abdomen
oAscites
oLoss of appetite
oDecrease in energy, fatigue
oWeight loss or sudden weight gain
oYellowing of the skin or whites of the eyes (jaundice)
oConfusion, disorientation, mood changes
oTaste changes
Nutrition Risk Factors
oInadequate dietary intake – ascites and associated discomfort,
impaired gastric and gut motility, deficiency of certain minerals may
impact taste, low sodium diet impacts palatability, fasting for clinical
investigation, irregular and poor eating habits
oMalabsorption – deficiency of vitamins/minerals and decreased fat
absorption d/t bile salt deficiency or exocrine pancreatic insufficiency
oMetabolic Disturbances – hypermetabolic state results in depleted
hepatic glycogen stores. Cirrhosis can result in an accelerated rate of
starvation.
How can we help?
oEnergy Intake: BEE + 20%, adjustments made for hypermetabolism or
desired weight loss
oProtein Intake: 1.2 -1.5 gm/kg protein or 2.0-2.5 g/kg IBW (obese)
o Avoid restricting protein with HE as it can increase protein catabolism
Current Weight in Kgs: 135.5 kg Current Weight in Kgs: 137.4 kg Current Weight in Kgs: 134.1 kg
Standard Body Weight/Dry Standard Body Weight/Dry Standard Body Weight/Dry
Weight: 128.5 kg Weight: 128.5 kg Weight: 128.5 kg
Weight Comments: ascites, +3 Weight Comments: pt. up 1.7 kg Weight Comments: pt. down 3.3
pitting edema since last visit r/t continued kg since last visit r/t hemodialysis,
ascites and edema ascites continues
Height: 182.88 cm
Height: 182.88 cm Height: 182.88 cm
Body Mass Index: 40.5 (Class III
Obesity) Body Mass Index: 41.1 (Class III Body Mass Index: 40.1 (Class III
Obesity) Obesity)
Pertinent Labs
9/24/19 9/26/19 9/28/19
Hgb: 9.7 gm/dl (13.6-17.0)
Hct: 27.9% (40.0-54.0) WBC: 3.7 K/mm3 (3.9-10.5) Hgb: 7.6 gm/dl (13.6-17.0)
BUN: 26 mg/dL (9-20) Hgb: 8.9 gm/dl (13.6-17.0) Hct: 21.3% (40.0-54)
GFR: 44 (>60) Hct: 25.3% (40.0-54) BUN: 30 mg/dL (9-20)
Creatinine: 1.60 mg/dL (0.66-1.25) Sodium: 136 mmol/L (137-145) Creatinine: 1.70 mg/dL (0.66-1.25)
Bilirubin: 10.3mg/dL (0.3-1.2) BUN: 29 mg/dL (9-20) AST: 76 U/L (17-59)
AST: 131 U/L (17-59) Creatinine: 1.60 mg/dL (0.66-1.25) Albumin: 3.1 g/dL (3.5-5.0)
ALT: 51 U/L (<50)
Alkaline Phos: 137 U/L (38-126)
Pertinent Medications
Medication Nutrition Side Effects/Contraindications
Lasix ↑K, ↑Mg, ↓cal, ↓Na, may be recommended
Hydrocodone Anorexia, delays digestion
Dilaudid Anorexia, ↓wt., ↑ thirst, dehydration
Lactulose High fiber w/ 1500-2000mL fluid/day to prevent
constipation, ↑ absorption of Ca & Mg
Protonix May ↓ absorption of Fe & vitamin B12
Spironolactone Avoid excessive K intake, K supp., salt substitutes
Inadequate oral intake related to acute on chronic illness, as evidenced
by recorded daily intake meeting <75% energy and <50% protein needs
according to minimum recommendations.
Medical Food
GI symptoms
Supplement Weight Changes
improvement
Intake