2. CIRRHOSIS
final and irreversible form of alcoholic liver disease
There is development of fibrosis which replaces
hepatocytes that have permanently lost their function.
architectural distortion
formation of regenerative nodules
resulting in decreased
hepatocellular mass, function
and alteration of blood flow.
10. •Hepatic Encephalopathy
-altered level of consciousness due to accumulation of toxic metabolites,
especially ammonia
Tx:
-Lactulose - used in treatment of encephalopathy brought about by
hyperammonemia. It limits the proliferation of ammonia-forming gut organisms
and increase the clearance of protein load in the gut, metabolized in the colon
and is not absorbed
-Non-absorbable antibiotics- limits growth of intestinal bacteria
•Portal hypertension
-use of antihypertensive drugs
- Diuretics are given to reduce fluid retention in patients with ascites
11. Abstinence is the cornerstone of therapy for patients with
alcoholic liver disease.
12. Nutritional Therapy
Malnutrition is often a problem for people with cirrhosis.
In patients with severe malnutrition, inadequate caloric intake was
associated with 51% mortality compared with 19% mortality in
patients who received adequate oral nutrition
Causes of malnutrition in patients with cirrhosis is multifactorial
and includes decreased intake, altered metabolism and increased
nutrient losses.
13. Avoid foods that are high in sodium, such as canned soups,
many canned vegetables, processed meats and cheeses,
condiments, and many snack foods.
Avoid foods that may cause foodborne illnesses such as:
-unpasteurized milk, cheese, yogurt, and all other milk
products
-raw or undercooked meat, poultry, fish, seafood and raw tofu
-raw or undercooked eggs
-unwashed fresh fruits and vegetables
-all raw vegetable sprouts (radish, broccoli, mung bean)
14. Carbohydrates (57%)
food should be generally high in complex carbohydrates
(breads, cereals, grains, legumes, dried beans and peas,
pasta, rice).
Diet should include at least 21g of fiber (avoid excess fiber to
optimize gastric emptying)
15. Protein (19%)
approximately 40 grams of protein a day
too much protein can raise ammonia levels and trigger
hepatic encephalopathy. It is recommended to eat vegetable
protein such as soy, instead of animal protein.
Fats (24%)
low fat diet is indicated for patients with cirrhosis
16. A vegetarian diet may significantly improve
symptoms of hepatic encephalopathy.
Plant–based diets have more dietary fiber, which may
reduce hepatic encephalopathy by removing toxic
ammonia from the body.
Vegetable protein sources are also higher in arginine that
decreases blood ammonia levels; are lower in methionine
and tryptophan which increases the risk of hepatic
encephalopathy.
17. Sodium (2000mg)
Less sodium intake is recommended to prevent water
retention.
Foods with the highest salt content should be avoided such
as canned meats, soups, cheese, condiments, crackers and
junk foods.
Instead of adding salt, use herbs to add flavor to the food.
18. A diet high in vitamin A, antioxidants, and B–vitamins
Cirrhotic patients have significant reductions in
antioxidants in their blood.
The best way to supplement the body with antioxidants is
to eat plenty of fruits, vegetables, and whole grains.
They are likely to benefit from a daily multivitamins that
meets 100 percent of the dietary allowance for all vitamins
and minerals.
19. Probiotic supplementation may improve hepatic
encephalopathy.
-by decreasing the blood concentrations of toxic
ammonia and decrease the risk of life–threatening
infections.
20. Meal planning:
eat small amounts of food more often
choose foods that are high in calories (such as
whole milk and canned fruit packed with heavy syrup).
Try fresh or dried herbs, spices, oils, vinegar, or juices to
add flavor to the food.
Look for no-sodium or low-sodium versions of foods
21. Parenteral Nutrition
Parenteral nutrition is associated with increased infectious
and metabolic complications compared to enteral feeding.
Parenteral nutrition should be reserved only for those
patients who cannot receive enteral nutrients (ileus, small
bowel obstruction)
