KNH 411 Morgan Deihs Lydia Dysart Liver Cirrhosis KNH 411 Morgan Deihs Lydia Dysart

Objectives Define Cirrhosis Understand what MELD means Name 3 SYMPTOMS of Cirrhosis Name 3 Methods of TREATMENT for Cirrhosis

Background Teresa (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: Medical history: 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: Common Causes: 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. Alcohol Abuse Hepatitis B Hepatitis C Nonalcholoic Fatty Liver Disease (NFLD) Genetic diseases: Hemochromatosis CF Wilson’s disease

Etiology Cirrhosis Factors: Hepatitis C (diagnosed 3 years ago) 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 Consumption May attribute to symptoms and onset of disease

Assessment Wt= 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 Intake General Intake Usual Dietary Intake Breakfast: Calcium- fortified Orange juice Lunch: soup and crackers w/ Diet Coke Dinner: Chinese or Italian Carryout Sips of water, juice, and Diet Coke only. Has not eaten the past 2 days.

Lab Results Reference 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

PES P- 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)

Treatment Current 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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