1. Cirrhosis of the Liver
Kayla Shoaf

2. Objectives Be able to define Cirrhosis and the etiology
Identify symptoms and complications
Able to identify between compensated and decompensated cirrhosis
Describe 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 inflamed
Fibrosis: 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. Prevalence
More 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 disease
Four million Americans are infected with hepatitis C and more than 1 million Americans are infected with hepatitis B
Approximately 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 abuse
Hepatitis B or C
Fat accumulating in the liver (nonalcoholic fatty liver disease)
Destruction of the bile ducts
Hardening and scarring of the bile ducts
Iron 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 functions
Minimal symptoms and complications from liver disease
Energy needs should be increased by 20-40%
Protein: 1-1.3g/kg

8. Decompensated Cirrhosis
Disease is becoming life threatening
Experience more symptoms and complications
Energy needs should be increased to 50-75%
Protein: 1.5g/kg

9. Cirrhosis often has no signs or symptoms until liver damage is extensive.
Fatigue
Weakness
Bleeding/ bruising easily
Itchy Skin
Jaundice
Loss of appetite/ nausea
Weight loss
Swollen legs

10. Complications of cirrhosis can include:
Portal hypertension (increase in the pressure within the portal vein)
Swelling in the legs and abdomen
Infections
Bleeding
Insulin resistance and type 2 diabetes
Malnutrition
High levels of toxins in the blood (hepatic encephalopathy)
Increased risk of liver cancer

12. B. A. C.

13. Ascites Results from portal HTN and low levels of albumin
Accumulation of fluid in the abdominal cavity between
abdominal organs
Developed in decompensated cirrhosis
Management of ascites focuses on low sodium diet and diuretics
Diuretic therapy: goal of weight loss of 1-3 kg/d
Nutrition depletion can occur if left untreated

14. Diagnosis Liver Enzyme Tests ALT ALP Bilirubin Tests AST Liver Biopsy
GGT
Liver Protein Test
Albumin
Globulin
Prothrombin

15. Medical Treatment Diuretic therapy Management of portal hypertension
Monitoring of blood glucose
Liver Transplant

16. MNT Guidelines
Eat 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’t
Protein 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 Statements
Altered 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.

21. References
Escott-Stump S,. Nutrition and Diagnosis Related Care. 6th ed. Lippincott Williams & Wilkins;
Krause's Food and Nutrition Care Process (13th ed., pp ).