Question

Liver Case Study

M.J. is a 48 year-old Caucasian male who was admitted for confusion due to alcoholic liver disease and GI bleed. He is on disability as he is no longer able to work with his progressive liver disease.

Ht. 5’8” Wt; 135#

Elevated liver function tests; albumin low; sodium low; glucose 160 mg/dl; ammonia elevated

Medications: neomycin; lactulose; diuretics; Multivitamin

Physical appearance: tired, thin male with both muscle wasting and subcutaneous fat loss; ascites; jaundice

Medical history: several admissions for encephalopathy, drainage of ascites, esophageal bleeding

Social Hx: first drink at approximately 14 years of age; does not admit to drinking at the present

Diet Hx: gets full fast—small meals c/o diarrhea

1.Using SGA what is his nutritional status?

2.What are his calorie and protein requirements?

3.Explain the mechanism for his esophageal varices and ascites.

4. Explain the reason for his elevated ammonia.

5.What diet should he be on?

6.What supplements would you recommend?

Answer 1

1. Based of Subjective Global Assessment (SGA) his nutritional status is C-that is severely malnourished.

2.Protein is 1.0 to 1.8 g/kg is recommended and 35 to 40 kcal/kg

3.Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring cuts down on blood flowing through the liver. As a result, more blood flows through the veins of the esophagus. The extra blood flow causes the veins in the esophagus to balloon outward.Ascites occurs when there is a disruption in the pressure forces between intravascular and extravascular fluid spaces, which allows extravascular fluid to accumulate in the anterior peritoneal cavity

4. The ammonia detoxification occurs through urea cycle i.n the liver. Patient with chronic liver disease accumulates ammonia. Another reason is muscle wasting is common in chronic liver disease. Muscle is an important site for extra hepatic ammonia removal.

5. Eat fruits, vegetables and lean protein from poultry or fish.

6.Multivitamin and micronutrients such as zinc 50mg/day.