1 / 30

Cirrhosis of the Liver with Resulting Hepatic Encephalopathy

Cirrhosis of the Liver with Resulting Hepatic Encephalopathy. By: Michelle Hoffman. Patient. Teresa Wilcox Physician: P. Horowitz, MD Education: doctoral graduate student Age: 26-years-old Height: 5’9” (1.7 m ) Current Weight: 125 lbs (56.8 kg) Usual Body Weight: 145 lbs

luana
Download Presentation

Cirrhosis of the Liver with Resulting Hepatic Encephalopathy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Cirrhosis of the Liver with Resulting Hepatic Encephalopathy By: Michelle Hoffman

  2. Patient • Teresa Wilcox • Physician: P. Horowitz, MD • Education: doctoral graduate student • Age: 26-years-old • Height: 5’9” (1.7 m) • Current Weight: 125 lbs (56.8 kg) • Usual Body Weight: 145 lbs • BMI:18.5 kg/m^2 • Underweight • Dx: Probable cirrhosis secondary to chronic hepatitis

  3. Patient History • Hepatitis C Dx 3 years ago • Complaints of fatigue, anorexia, N/V, weakness • Lost 10 lbs since last visit 6 months ago • Bruising and yellowish skin • Family hx cirrhosis (grandfather)

  4. Physical Exam • Tired in appearance • Enlarged esophageal veins • Warm and dry skin with bruising on lower arms and legs • Normal muscular tone and ROM • No edema or ascites

  5. Nutrition History • Has not an an appetite for last few weeks • Has not eaten in the last 2 days • Nutrition therapy of small, frequent meals with plenty of liquids 3 years ago • Breakfast: calcium-fortified orange juice • Lunch: soup and crackers with diet coke • Dinner: Chinese or Italian carry-out • Fluids: small sips of water, diet coke, or juice • Does not consume alcohol • Current diet order: Soft, 4-g Na, high-kcal

  6. Abnormal Chemistry • Albumin • Normal: 3.5-5 g/dL • Ms. Wilcox: 2.1 g/dL • Total protein • Normal: 6-8 g/dL • Ms. Wilcox: 5.4 g/dL • Bilirubin • Normal: ≤ 0.3 mg/dL • Ms. Wilcox 3.7 mg/dL

  7. Abnormal Hematology • RBC • Normal: 4.3-5.4 • Ms. Wilcox: 4.1x10^6/mm^3 • HGB • Normal: 12-15 g/dL • Ms. Wilcox: 10.9 g/dL • HCT (hematocrit) • Normal: 37-47% • Ms. Wilcox: 35.9%

  8. Abnormal Hematology • MCV (mean cell volume) • Normal: 80-96 μm^3 • Ms. Wilcox: 102 μm^3 • Ferritin(protein that stores iron) • Normal: 20-120 mg/mL • Ms. Wilcox: 18 mg/mL • PT (prothrombin time) • Normal: 11-16 sec • Ms. Wilcox: 18.5 sec

  9. Diagnosis • Cirrhosis • 12th leading cause of death in the U.S. • Ending stage of liver disease • Secondary to chronic hepatitis C • Replacement of healthy liver tissue with scar tissue • Blocks the flow of blood through the liver, causing kidney failure, enlarged liver, thickening of various tissues, portal hypertension, ascites, etc.

  10. Diagnosis

  11. Etiology • Common causes of cirrhosis: • Alcohol-related liver disease • Chronic hepatitis C • Chronic hepatitis B • Autoimmune hepatitis • Nonalcoholic fatty liver disease (NAFLD) • Bile duct disorders • Hereditary disorders

  12. Symptoms • Weakness • Fatigue • Loss of appetite • N/V • Weight loss • Abdominal pain and bloating • Itching

  13. Complications & Warning Signs • Edema &Ascites • Bruising and bleeding • Portal hypertension • Esophageal varices • Jaundice • Hepatic encephalopathy • Insulin resistance and type II diabetes

  14. Ascites

  15. Diagnosing Cirrhosis • Look at the clinical signs & symptoms • Biopsy, CT Scan, and MRI may reveal an enlarged liver, reduced blood flow, and /or ascites • Biopsy’s are less common because it it expensive, and usually only confirms a diagnosis

  16. Diagnosing Cirrhosis • Blood tests to measure: • Measures function of the liver • Albumin • Bilirubin • PT (Prothrombin Time) • Liver enzymes: • Measures injury to the liver • ALT • AST

  17. Severity • MELD • Model for end-stage liver disease • 6 - 40 score range—6 is a likelihood that patient will survive 90 days • Score comes from: • Bilirubin count—measures bile pigment in the blood • Creatine levels—tests kidney function • INR (international normalizes ratio)—tests blood clotting tendency

  18. Treating Cirrhosis • Primary medical treatments for cirrhosis: • Preventing further damage • Treatment of the complications • Liver transplant • Nutrition therapy

  19. Treating Cirrhosis • Preventing further damage: • The first thing doctors will recommend is abstaining from alcohol and any drugs that will damage the liver further • Consume a balanced diet and a multivitamin may be recommended (D and K especially) • Avoid nonsteriodalantinflammatory drugs (NSAIDS) • Ibuprofen

  20. Treating Cirrhosis • Treating complications: • Ascites • Antidiuretics • Bleeding from varices • Beta-blockers • Propanolol • Hepatic Encephalopathy • Laxatives (lactulose)

  21. Treating Cirrhosis • Liver Transplant: • Cirrhosis in irreversible, and many patients will eventually need a liver transplant as the only option left • 80% of patient live for 5 years after surgery

  22. Nutrition Therapy

  23. Energy & Protein • Ms. Wilcox’s energy needs: • Weight: 56.8 kg • 35 x 56.8= 1,988 calories • 40 x 56.8= 2,272 calories • 2,000-2,200 calories/day. • Ms. Wilcox’s protein needs: • 1.6 x 56.8=90.8 • ~ 91 g protein/day

  24. Nutrition Problems • Inadequate energy intake: NI-1.4 • Inadequate oral intake: NI-2.1 • Malnutrition: NI-5.2 • Inadequate protein-energy intake: NI-5.3 • Underweight: NC-3.1

  25. PES Statements • Inadequate energy intake related to decreased appetite, fatigue, and nausea by recent cirrhosis of the liver dx as evidenced and diet recall • Underweight related to decreased appetite in past three weeks as evidenced by diet recall, recent 10 lb weight loss, and BMI of 18.5 kg/m^2

  26. Nutrition Intervention & Support • Small frequent feedings • Encourage oral liquid supplements • High kcal and protein diet • Restrict sodium intake to ≤ 2-g • Abstain from alcohol consumption • Provide foods that are easy to chew and swallow • Optimize gastric emptying • Avoid excessive fiber • Control blood glucose • Liquids over solids if necessary

  27. Prognosis • Depends on stage of the disease • Once the liver has scarred over, it cannot be reversed, meaning it cannot return to its normal function • Survival is generally 10 years after dx (90%) • Complications of ascites, portal hypertension, jaundice, hepatorenal syndrome, hepatic encepalopathy, etc. • Liver transplant will most likely be needed as a result of cirrhosis

  28. Prognosis:Stages of Cirrhosis • Stage 1 • Patients without gastro-esophageal varices or ascites have mortality of ~1% per year • Stage 2 • Patients with gastro-esophageal varices but no ascites have mortality of ~4% per year • Stage 3 • Patients without gastro-esophageal varices but have ascites have mortality rate of ~20% per year • Stage 4 • Patients with GI bleeding from portal hypertension with/without ascites have mortality of ~57% per year

  29. References • Nelms, M., Sucher, K. P., Lacey, K., & Roth, S. L. (2011). Nutrition Therapy and Pathophysiology. Belmont, California: Wadsworth, Cengage Learning. • "Prognosis." Best Practice. BMJ Group, 14 June 2012. Web. 11 Nov. 2012. <http://bestpractice.bmj.com/best-practice/monograph/278/follow-up/prognosis.html>. • Longstreth, George F. "Cirrhosis: MedlinePlus Medical Encyclopedia." Medline Plus. U.S. National Library of Medicine, 16 Oct. 2011. Web. 11 Nov. 2012. <http://www.nlm.nih.gov/medlineplus/ency/article/000255.htm>. • Lee, Dennis. "Cirrhosis (Liver) Symptoms, Causes, Treatment - How Is Cirrhosis Treated? on MedicineNet." MedicineNet. N.p., 2012. Web. 11 Nov. 2012.<http://www.medicinenet.com/cirrhosis/page5.htm>. • "Cirrhosis." Cirrhosis. University of Maryland Medical Center, 2011. Web. 11 Nov. 2012. <http://www.umm.edu/patiented/articles/what_causes_cirrhosis_000075_2.htm>. • "National Digestive Diseases Information Clearinghouse (NDDIC)." Cirrhosis. N.p., Dec. 2008. Web. 11 Nov. 2012. <http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/>. • "Learning About Your Health." Cirrhosis of the Liver. CPMC Sutter Health, 2012. Web. 11 Nov. 2012. <http://www.cpmc.org/learning/documents/cirrhosis-ws.html>.

More Related