2 Objectives Be able to define Cirrhosis and the etiology Identify symptoms and complicationsAble to identify between compensated and decompensated cirrhosisDescribe appropriate MNT and treatment options for Cirrhosis
3 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.
4 The Progression of Liver Disease Inflammation: In the early stage of any liver disease, your liver may become inflamedFibrosis: 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
5 PrevalenceMore 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 diseaseFour million Americans are infected with hepatitis C and more than 1 million Americans are infected with hepatitis BApproximately 15,000 children are hospitalized every year with pediatric liver disease or disorders
6 Etiology of Cirrhosis Chronic alcohol abuse Hepatitis B or C Chronic alcohol abuseHepatitis B or CFat accumulating in the liver (nonalcoholic fatty liver disease)Destruction of the bile ductsHardening and scarring of the bile ductsIron buildup in the body (hemochromatosis)Liver disease caused by your body's immune system (autoimmune hepatitis)Wilson's disease
7 Compensated Cirrhosis Liver is heavily scarred but can still perform many important bodily functionsMinimal symptoms and complications from liver diseaseEnergy needs should be increased by 20-40%Protein: 1-1.3g/kg
8 Decompensated Cirrhosis Disease is becoming life threateningExperience more symptoms and complicationsEnergy needs should be increased to 50-75%Protein: 1.5g/kg
9 Cirrhosis often has no signs or symptoms until liver damage is extensive. FatigueWeaknessBleeding/ bruising easilyItchy SkinJaundiceLoss of appetite/ nauseaWeight lossSwollen legs
10 Complications of cirrhosis can include: Portal hypertension (increase in the pressure within the portal vein)Swelling in the legs and abdomenInfectionsBleedingInsulin resistance and type 2 diabetesMalnutritionHigh levels of toxins in the blood (hepatic encephalopathy)Increased risk of liver cancer
13 Ascites Results from portal HTN and low levels of albumin Accumulation of fluid in the abdominal cavity betweenabdominal organsDeveloped in decompensated cirrhosisManagement of ascites focuses on low sodium diet and diureticsDiuretic therapy: goal of weight loss of 1-3 kg/dNutrition depletion can occur if left untreated
14 Diagnosis Liver Enzyme Tests ALT ALP Bilirubin Tests AST Liver Biopsy GGTLiver Protein TestAlbuminGlobulinProthrombin
15 Medical Treatment Diuretic therapy Management of portal hypertension Monitoring of blood glucoseLiver Transplant
16 MNT GuidelinesEat 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 milligrams per day)If tube feeding is needed avoid glutamine enriched formulas, this could increase ammonia levels.Avoid alcohol
17 MNT Guidelines Con’tProtein 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
18 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.
19 PES StatementsAltered 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.