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16 Cards in this Set
- Front
- Back
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Objectives of Body Composition Measurement in Liver Cirrhosis study by Peng etal. 2007
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- measured total body protein
- significant protein depletion was seen in 51% of pts - as the grade of cirrhosis became more severe, protein depletion worsened |
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Nutritional Issues in Liver Disease
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1. Malnutrition
2. Hepatic Encephalopathy - protein and nitrogen metabolism 3. |
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Theory #1 of cause of hepatic encephalopathy
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Imbalance of aromatic amino acids:BCAA in blood lead to imbalance of neurotranmitters
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Theory #2 of cause of hepatic encephalopathy
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- ammonia levels increase in brain leading to an increase in glutamine which may contribute to HE, glutamin enters circulation and is exchanged for aromatic amino acids
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Treatment of HE
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- identify and reverse the precipitating factor. e.g. stop GI bleeding, treat sepsis
- lactulose - a hyperosmotic laxative |
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Is protein restriction effective for HE
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No
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Objective of the Effects of BCAA Supplementation in Pts with Cirrhosis and a Previous Episode of HE: A Randomized Study by Les et al, 2011
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to study the effects of long term oral BCAA supplementation on recurrence of HE, neurospychological tests and body composition
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Results of the Effects of BCAA Supplementation in Pts with Cirrhosis and a Previous Episode of HE: A Randomized Study by Les et al, 2011
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- no difference in HE-free survival
- no difference in the recurrance of HE - no difference in # of pts that developed HE |
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Nutrition Therapy for Liver Disease - Protein
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No HE: 1-1.5g/kg depending on nutritional status
With HE: reduce if HE persists for several weeks (emphasize veg. proteins if possible for oral diets) |
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Nutrition Therapy for Liver Disease - Fat
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may need to provide low fat diet if malabsoption exists
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Nutrition Therapy for Liver Disease - Vitamins & Minerals
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- problems with storage, transport, malabsorption and altered metabolism - thiamine, folic acid, B vit, Vit C - supplementation in malnourished pts
- vit. A, zinc, iron - mg - supplement usually required |
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Additional nutrition therapies for liver disease
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- may need fluid restriction (ascites)
- Na restriction (ascites) - 1-2 gm/d - symptoms of illnesses may necessitate multiple small meals daily - use of nutr support may or may not be appropriate |
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Assessing Nutritional Status in Cirrhosis
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- wt. and wt change, skinfolds - affected by altered body comp due to fluid retention
- serum albumin/transferrin - decr production in liver - diet and alcohol histories - GI symptomology - physical exam |
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Objective of the study: Degree of Preoperative Malnutrition is Predictive of Postoperative Morbidity and Motality in Liver Transplant Recipients by Pikul, J (Canadin from London, ON)
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To examine whether malnutrition at time of transplant is related to patient outcome
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Results of the study: Degree of Preoperative Malnutrition is Predictive of Postoperative Morbidity and Motality in Liver Transplant Recipients by Pikul, J (Canadin from London, ON
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Severely malnourished pts were in the ICU longer than normal and mild
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Nutritional Issues in Liver Disease - Malnutrition due to...
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- anorexia/nausia/vomiting
- early satiety - empty calories from alcohol - effects of HE, gastritis, esophagitis - malabsorption: decr bile salt production = decr. fat and fat soluble vitamin absorption |
