Liver Cirrhosis

KNH 411Morgan DeihsLydia Dysart

Objectives

Define Cirrhosis

Understand what MELD means

Name 3 SYMPTOMS of Cirrhosis

Name 3 Methods of TREATMENT for Cirrhosis

BackgroundTeresa (Terri) Wilcox:

Female, 26 y/o

Marital Status: Single- lives with roommate who is a law student

Number of Children: 0

Years education: Postgraduate- architecture

Language: English Only

Occupation: Doctoral graduate student in architecture

Hours of work: Teaches late morning and late afternoon; takes classes and conducts research during most evenings

Ethnicity: European American

Religious affiliation: Unitarian

Medical History Onset of disease:

Dx 3yrs ago with Hepatitis C- previously treated with alpha-interferon an ribavirin; seasonal allergies treated with antihistamines

Medical history: fatigue, anorexia, nausea,

vomiting, weakness; has lost 10lbs since last visit (6mo. Ago); bruising (not R/T injury)

Surgical History: No surgeries

Alcohol use: Yes

Family History: Mother: HTN, diverticulitis,

cholecystitis, carpal tunnel syndrome

Father: diabetes, peptic ulcer disease

Paternal Grandmother: cholecystitis, bilateral breast cancer

Maternal Grandmother: leukemia

Paternal Grandfather- cirrhosis

Paternal Grandmother- amyotrophic lateral sclerosis

Vital Signs

Temp: 96.9

Pulse: 72

Resp Rate: 19

BP: 102/65

Height: 5’8”

Weight 125 lb

BMI: 19kg/m2

Throat: Enlarged esophageal veins

Skin: bruising on lower arms & legs; telangiectasias on chest

Abdomen: mild distention, heptomegaly; non ascites

Urine: Amber, Cloudy

MELD ( Model For End-Stage Liver Disease) score: 23

What is Cirrhosis?Definition:

A condition when the liver deteriorates and loses function due to chronic injury. Scar tissue replaces the healthy liver and blocks the flow of blood through the liver.

Common Causes:

Alcohol Abuse

Hepatitis B

Hepatitis C

Nonalcholoic Fatty Liver Disease (NFLD)

Genetic diseases: Hemochromatosis CF Wilson’s disease

EtiologyCirrhosis Factors:

Alterations in serum biologic mediators: Tumor necrosis factor α, leptin, adiponectin

Hepatitis C (diagnosed 3 years ago) viral infection transmitted through blood contact

that causes inflammation, swelling, and damage to the liver.

Alcohol ConsumptionMay attribute to symptoms and onset of disease

AssessmentWt= 125lb Ht= 5’8”

BMI= 19kg/ m2

Current Wt= 125lb

Ideal Wt= 140lb

Rec. Cal Intake: 35-40kcal/kg 1,988-2,272kcal

Rec. PRO Intake: Up to 1.6g/kg 90.88 g of protein

Dietary IntakeGeneral Intake

Breakfast: Calcium- fortified Orange juice

Lunch: soup and crackers w/ Diet Coke

Dinner: Chinese or Italian Carryout

Usual Dietary Intake

Sips of water, juice, and Diet Coke only.

Has not eaten the past 2 days.

Lab ResultsReference Range 12/19 1012

ALT (U/L) 4-36 62

Alakine phosphatase (U/L)

30-120 275

AST 0-35 230

Albumin 3.5-5 2.1

PT 12.4-14.4 18.5

Bilirubin <0.3 3.7

Serum Ammonia (umol/L)

9-33 3

Hemoglobin (g/dL) 12-15 10.9

Hematocrit (%) 37-47 35/9

PESP- low energy intake

E- RT lack of appetite

S- AEB dietary recall, and recent weight loss ( 10 lbs in 6mo.), and low range of BMI

P- Low intake of protein

E- RT Low calorie intake

S- AEB lab values:

Total Protein 5.4 (6-8)

hemoglobin 10.9 (12-15)

Hematocrit 35.9 (ref 37-47)

TreatmentCurrent diet order: soft, 4 g. sodium, high- kcal

Our recommendation: TPN (2-5 days) to increase kcal and PRO intake

After TPN: Rec. Soft diet Fruits and vegetables Plant- based diet Lean PRO (legumes, poultry, or fish) Avoid Raw Seafood

Vitamin/ mineral intake: Continue taking Vit E, Calcium w/ Vit D, MVI, chicory &

ginger. Milk thistle not needed

Questions:What is Cirrhosis?

What does MELD stand for?

What are 3 SYMPTOMS?

What are 3 TREATMENTS?

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NIH. (2014). National Digestive Diseases Information Clearinghouse (NDDIC). U.S. Department of Health and Human Services. http://digestive.niddk.nih.gov/ddiseases/pubs/Cirrhosis/index.aspx

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Sutter Health. (2013). MELD and the Waiting Listfor Liver Transplanthttp://www.cpmc.org/advanced/liver/patients/topics/MELD.html

University of Maryland Medical Center. (2014) Cirrhosis. http://umm.edu/health/medical/reports/articles/cirrhosis

Viral Hepatitis. (2010, January 1). Retrieved September 23, 2014, from http://www.hepatitis.va.gov/provider/reviews/treatment-side-effects.asp