Question

As discussed in the section on cirrhosis, many patients develop protein-energy malnutrition and wasting during the course of illness. Review Table 19-4 on p. 542 to find examples of problems that may lead to malnutrition.

6. Select three nutrition or medical problems (from the “Examples” column). Indicate which three nutrition or medical problems were selected and why were they selected.

7. Discuss how complications of liver disease may cause the problems you selected.

8. What dietary or medical treatments can help manage these three problems?

Possible Causes of Malnutrition in Liver Disease TABLE 19-4 Examples Abdominal discomfort, altered mental status, altered taste sensation, anorexia, early sati- ety (due to ascites), effects of medications (including GI disturbances and taste changes), fasting for medical procedures, fatigue, nausea and vomiting, dietary restrictions Diarrhea, effects of medications (including malabsorption and nutrient losses from diuretic use), fat malabsorption (due to reduced bile flow), GI bleeding, vomiting Hypermetabolism, impaired protein synthesis, infections or inflammation, muscle catabo- lism, reduced nutrient storage and metabolism in the liver Mechanism Reduced nutrient intake Malabsorption or nutrient losses Altered metabolism or increased nutrient needs

Answer 1

6. Three Problems that are selected are

1. Nausea and vomiting
2. Diarrhea
3. Infection or inflammation

Reasons for selection.

Nausea and vomiting & Diarrhea are the primary problem of any liver diseases .Infection or inflammation are the supporting causes for any liver disease .These are the common symptoms in any liver disease ,that is why it is selected .

7. Complications of liver diseases which causes problems :

If the metabolism is not happening in the Liver it may leads to the complications of the Liver Disease .

Because of the improper metabolism of the proteins ,it is not absorbed in the gut which leads to nausea and vomiting

Inflammation or infection are caused by the bacteria which affect  the liver also a cause

8. Dietary Management /Medical management:

The People affected with any liver disease must have a special diet to be followed .

This diet helps the liver function and protects it from working too hard.

Function of Liver :

Proteins normally help the body repair tissue. They also prevent fatty buildup and damage to the liver cells.

In people with badly damaged livers, proteins are not properly processed. Waste products may build up and affect the brain.

Dietary changes for liver disease may involve:

• Cutting down the amount of protein that is consumed . This will help limit the buildup of toxic waste products.
• Increasing the  intake of carbohydrates to be in proportion with the amount of protein eat.
• Taking vitamins and medicines prescribed by the  health care provider for low blood count, nerve problems, or nutritional problems from liver disease.
• Limiting the  salt intake. Salt in the diet may worsen fluid buildup and swelling in the liver.

Medical Management:

Although there is no cure for cirrhosis, there are treatments that delays the progress of damage , decrease the damage to liver cells and reduce complications:

• For Liver damage  caused by alcohol abuse, the person must stop drinking alcohol.
• For other patients with liver damage caused by autoimmune diseases, Wilson’s disease, or hemochromatosis, the Physician  will recommend the proper treatments for cirrhosis as well as for the underlying disease.
• Medications may be given to control the symptoms of cirrhosis.
• Edema (fluid retention) and ascites (fluid in the abdomen) are treated by reducing salt in the diet. Diuretics (water pills) are used to remove excess fluid and to prevent edema.
• Diet and drug therapies can help improve the confused mental state that cirrhosis can cause. For instance, decreasing the amount of salt in the diet results in less fluid retention in the abdomen and legs. Laxatives such as lactulose may be given to help absorb toxins.
• Some people with irreversible  damage  may need a liver transplant.