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Cirrhosis of the Liver. Kayla Shoaf . Objectives . Be able to define Cirrhosis and the etiology Identify symptoms and complications Able to identify between compensated and decompensated cirrhosis Describe appropriate MNT and treatment options for Cirrhosis . What is Cirrhosis? . - PowerPoint PPT Presentation
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Cirrhosis of the Liver
Kayla Shoaf
Objectives
• Be able to define Cirrhosis and the etiology
• Identify symptoms and complications
• Able to identify between compensated and decompensated cirrhosis
• Describe appropriate MNT and treatment options for Cirrhosis
What is Cirrhosis?
• Blood flow is hampered because scarred tissue replaces normal tissue and prevents normal blood flow to liver. As scar tissue begins to replace healthy tissue liver functions decline and liver cells die.
The Progression of Liver Disease• Inflammation: In the early stage of any liver disease, your liver
may become inflamed• Fibrosis: If left untreated, the inflamed liver will start to scar. As
excess scar tissue grows, it replaces healthy liver tissue. This process is called fibrosis.• Cirrhosis: If still untreated, your liver may become so seriously
scarred that it can no longer heal itself. This stage – when the damage cannot be reversed – is called cirrhosis.• Liver failure
Prevalence More than 30 million people in the U.S. have liver disease – or 1 in 10 Americans.
Up to 25% of Americans may have non-alcoholic fatty liver disease
Four million Americans are infected with hepatitis C and more than 1 million Americans are infected with hepatitis B
Approximately 15,000 children are hospitalized every year with pediatric liver disease or disorders
Etiology of Cirrhosis
Chronic alcohol abuse Hepatitis B or C Fat accumulating in the liver
(nonalcoholic fatty liver disease) Destruction of the bile ducts Hardening and scarring of the bile ducts Iron buildup in the body
(hemochromatosis) Liver disease caused by your body's
immune system (autoimmune hepatitis) • Wilson's disease
Compensated Cirrhosis
• Liver is heavily scarred but can still perform many important bodily functions
• Minimal symptoms and complications from liver disease
• Energy needs should be increased by 20-40%
• Protein: 1-1.3g/kg
Decompensated Cirrhosis
• Disease is becoming life threatening
• Experience more symptoms and complications
• Energy needs should be increased to 50-75%
• Protein: 1.5g/kg
Cirrhosis often has no signs or symptoms until liver damage is extensive.
oFatigue oWeakness oBleeding/ bruising easily oItchy Skin oJaundiceoLoss of appetite/ nausea oWeight lossoSwollen legs
Complications of cirrhosis can include:• Portal hypertension (increase in the pressure within the
portal vein)• Swelling in the legs and abdomen• Infections• Bleeding• Insulin resistance and type 2 diabetes• Malnutrition• High levels of toxins in the blood (hepatic encephalopathy)• Increased risk of liver cancer
A.
B.
C.
Ascites
• Results from portal HTN and low levels of albumin
• Accumulation of fluid in the abdominal cavity between
abdominal organs
• Developed in decompensated cirrhosis
• Management of ascites focuses on low sodium diet and diuretics
• Diuretic therapy: goal of weight loss of 1-3 kg/d
• Nutrition depletion can occur if left untreated
Diagnosis • Liver Enzyme Tests
• ALT
• ALP
• AST
• GGT
• Liver Protein Test
• Albumin
• Globulin
• Prothrombin
• Bilirubin Tests
• Liver Biopsy
Medical Treatment
• Diuretic therapy
• Management of portal hypertension
• Monitoring of blood glucose
• Liver Transplant
MNT Guidelines
• Eat large amounts of carbohydrate foods. Carbohydrates should be the major source of calories in this diet.
• Eat a moderate intake of fat, as prescribed by the health care provider. The increased carbohydrates and fat help prevent protein breakdown in the liver.
• Reduce the amount of salt you consume (typically less than 1500 milligrams per day)
• If tube feeding is needed avoid glutamine enriched formulas, this could increase ammonia levels.
• Avoid alcohol
MNT Guidelines Con’t• Protein rich nutrition at early stage of cirrhosis can help maintain or increase
muscular volume.
• When Plasma aromatic amino acid (AAA) (Phe, Trp, Try) are high, they increase muscle breakdown and decrease synthesis of proteins. Thus making BCAAs imbalanced, this contributes to hepatic encephalopathy.
• Increase BCAAs to improve cognitive status
Supplements • Multivitamin
• Antioxidants: have significant reductions in antioxidant enzymes and lower blood levels of certain antioxidant nutrients, such as carotenoids, vitamin E, and zinc. This is an important consideration, because oxidative stress contributes significantly to liver damage.
• Probiotic: An imbalance in gut flora and bacterial translocation in cirrhosis patients contributes significantly to ammonia production, Providing these patients with supplemental combinations of probiotics reduces blood concentrations of ammonia.
PES Statements
• Altered nutrition related lab values related to liver dysfunction as evidence by elevated ALT, AST, ALP, NH3, albumin.
• Inadequate energy intake related to anorexia from cirrhosis as evidence by >10% unintentional weight loss in 3 months.
References
• www.mayoclinic.org/diseases-conditions/cirrhosis/basics/definition/con-20031617• http://www.liverfoundation.org/chapters/lam2010• http://www.nlm.nih.gov/medlineplus/ency/article/002441.htm• http://www.liverfoundation.org/abouttheliver/info/liverfunctiontests/• http://www.nutritionmd.org/health_care_providers/gastrointestinal/cirrhosis_nutrition.ht
ml• http://www.nlm.nih.gov/medlineplus/ency/article/000286.htm• Escott-Stump S,. Nutrition and Diagnosis Related Care. 6th ed. Lippincott Williams &
Wilkins; 2007. • Krause's Food and Nutrition Care Process (13th ed., pp. 665-661).