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

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

3. 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

4. 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

5. 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

6. 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

7. 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

9. 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  g of protein

10. 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.

11. 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
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

12. 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)

13. 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

14. Questions:
What is Cirrhosis? What does MELD stand for? What are 3 SYMPTOMS? What are 3 TREATMENTS?

15. References
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Kabadi, U.M., Eisenstein, A.B., Konda, J. (1985) Elevated plasma ammonia level in hepatic cirrhosis: role of glucagon. Gastroenterology (3)
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