Erica Frank
5/17/12
NUTR 420
Case Study: Cirrhosis of Liver
1. Identify 3 functions of the liver for each for the following
a. Carbohydrate Metabolism
1. Gluconeogenesis occurs in liver
2. The liver stores glucose as glycogen molecules for energy use
3. Glycogenolysis occurs in the liver
b. Protein Metabolism
1. Liver is primary site of the uptake of amino acids following digestion of food.
2. Liver synthesizes protein form the uptake of amino acids from the portal blood circulation
3. Transamination occurs in the liver
c. Lipid Metabolism
1. Synthesis of VLDL’s occurs in the liver
2. The liver synthesizes new lipids from non-lipid precursors such as glucose and amino acids.
3. Chylomicron remnants (remains of lipid digestion) can be converted into bile salts and secreted
in the bile to aid with lipid digestion
2. Cirrhosis is a disease in which severe destruction of liver cells occurs and leads to malfunctioning in the
liver. It is cause by chronic degradation of liver cells and thickening of the surrounding tissues. Its
symptoms may vary and can mimic the symptoms of alcoholic hepatitis. Patients can develop GI
bleeding, hepatic encephalopathy, or elevated blood pressure in the portal venous system. Once
damage ahs occurred in the liver from cirrhosis, it can not be reversed, but treatment can delay or stop
further damage.
3. What are additional causes of cirrhosis, besides alcohol ingestion? What is this patient’s cause?
Hepatitis C is a common cause, and this is what caused Teresa Wilcox to develop cirrhosis.
8. What are the current medical treatments for cirrhosis?
Food intake should be monitored and proper intake of fat, carbs, and protein needs to be determined.
Increased energy is needed and fat is the preferred fuel for cirrhosis. Tube feeding and parenteral
nutrition can be administered if necessary. Malnutrition is a common side effects of extreme liver
damage and must be monitored and treated. Medications for encephalopathy may be needed as well
as diuretic therapy.
10. PEM is common in cirrhosis. What are potential causes of malnutrition in cirrhosis?
-Inadequate Oral Intake- caused by anorexia, dysguesia, satiety, nausea, or vomiting. Dietary
restrictions may lead to inadequate intake as well.
-Maldigestion and malabsorption lead to malnutrition. Nutrients are not being properly absorbed from
the impact of a malfunctioning liver.
12. Measurements used to assess nutritional status may be affected by the disease process and not
necessarily be reflective of nutritional status. Are there any components of nutrition assessment that
would be affected by cirrhosis?
Protein status would be affected, as liver damage impedes the function of the liver to properly
metabolize nutrients, especially protein. Gluconeogenesis is greatly reduced and therefor assessing
carbohydrate needs is challenging in patients with cirrhosis. In general, overall nutrient absorption is
reduced from the inability of the liver to synthesis, store, and catabolize various nutrients properly.
19. Why was a soft, 4-g Na high kcalorie diet ordered? Should there be any other modification?
Energy needs are increased in cirrhosis, so a high kcalorie diet is a proper modification. Soft foods were
recommended, applesauce and rice for example, to aid with easy digestion as she is experiencing
nausea and vomiting. A 4-g sodium restriction was given to aid with the weakened liver from cirrhosis.
The sodium levels could be decreased, depending on the level of water retention and if ascites occurs.
Supplements either from food intake or supplement of B-complex vitamins, vit C and K, zinc, and
magnesium is a good idea due to a decrease in nutrient absorption/metabolism. I woulr recommend an
increase in high bioavailable proteins as well.
22. Examine patient’s hematology values. Which are abnormal and why?
Patients Value
Normal Value
RBC
4.1 L
4.2-5.4
HGB
10.9 L
12-15
HCT
35.9 L
37-47
Ferritin
18 L
20-120
MCV
102 H
80-96
Due to an impaired liver, iron absorption, synthesis, and uptake via liver receptors and mediators is
diminished. This leads to a decrease in iron containing compounds.
Ferritin is synthesized in the liver, and in cirrhosis its’ synthesis is decreased.
Mean Corpuscular Volume represents large RBC. Her high MCV count is from malabsorption/low intake of
vitamin B12 which cause megaloblastic macrocytic anemia
25. Dr. Horowitz prescribes two medications to assist with the patient’s symptoms. What is the rational for
these medications, and what are the pertinent nutritional implications of each?
Rationale for Rx
Sprionolactone
Given to treat fluid retention from liver failure. It
prevents the body from absorbing too much salt
and keeps potassium levels from getting too low.
Nutritional Implications
Alcohol intake should be monitored
Low sodium diet is needed
Loss of appetite may occur-leading to malnutrition
Propranolol
Nausea/Vomiting, stomach pains may occur.
A beta-blocker; used to prevent the occurrence of
high portal blood pressure.
Food intake needs to be assessed fro these possible
side effects
32. When you see Mrs. Wilcox 1 month later, her weight is now 140 lbs. She is wearing flip-flops because
she says her shoes don’t fit. What condition is she probably experiencing? How could you confirm this?
She is probably experiencing edema. This condition results from a decreased ability to excrete water. Fluid
intake must be monitored and tips on how to avoid dry mouth and need for water should be given.