1.
Anna King
CSU ID# 829672579
FSHN 450: Fall Semester 2014
Case Study: Liver Disease & GERD
December 3, 2014
I have not given, received, or used any unauthorized assistance on this assignment.
Anna King 12/3/2014

2. What was the cause of the weight gain?
The third­spacing in his body was the cause of the weight gain. The patient is edemic and
had fluid buildup in his body in cavities/areas where there shouldn’t be excess fluids.
This is a side effect of his cirrhosis.
Why was a surgical jejeunostomy tube placed?
The jejeunostomy tube was placed to prevent complications of GI irritation of the
patient’s tract. He came in with black stools which indicates bleeding towards the
beginning of the GI, and the tube feeds the patient nutrients that are the least irritating to
his organs. The end of his esophagus is bleeding so the patient has major difficulty eating
food because of this damage­the tube bypasses this problem.
Evaluate the patient’s nutrient needs and prescribe a tube feeding including type (brand name),
total volume, and rate. Include a start rate and progression.
Kcal­ 1649 Kcal/day(Mifflin St­Joer equation)
Protein­ 86.5 g/day (1 g/Kg/day)
Fluid­ 1650 mL/day(1mL/Kcal)
**Prescribing Nutrihep: total volume=1,100 mL
rate= 45.8 mL hourly
(6/28) You do not have to calculate TPN but you should reevaluate protein and Kcal needs and
suggest protein sources for the TPN and explain why you selected this product.
Kcal­ 1650 Kcal (Mifflin St­Joer equation)
Protein­ 132.3 g (1.5 g/Kg/day)
Protein sources: Hepatamine because this product is manufactured for patients
with liver disease.
What is a drawback of to using this product?
Liver dyfunction can arise from using Hepatamine.

3. What is a paracentesis and why is it performed?
Paracentesis is removal of fluid from the abdominal cavity; it is performed when patients
have ascites/third spacing like this patient.
Conduct a nutrition assessment in ADIME for transition to oral diet (on 7/11). Develop three
PES statements, one to nutrition problem to deal with each of the three medical diagnoses
(esophageal varices, GERD, chronic cirrhosis). Suggest an intervention and follow­up for each
nutrition diagnosis.
Assessment
Age: 57
Sex: male
Dx: GERD, GI bleed, and cirrhosis
Hx: HTN, removal of gall bladder, and GERD.
Ht 5’7” (170.2 cm)
Wt 194 lb (88 kg) on 6/28
BMI 30.4 kg/m​2​
on 6/28
IBW 148 lb (Hamwai)
Lab Values: Na 122 mEq/L (low),
K 4.1 mEq/L (WNL)
Cl 98 mEq/L (low)
CO2 10 mmol/L (low)
Glu 93 mg/dL (WNL)
BUN 18 mg/dL (WNL)
Creat 1.6 mg/dL (low)
PTT 43.1 seconds (high)
RBC 2.88x10​6​
/mm​3​
(low)
Hgb 9.1 g/dL (low)
Hct 26.9% (low) on 7/1​1

4.
Medications: lactulose, octretide, vitamin K, famitodine, compazine, morphine,
MgSO4 IV, albumin IV (TUMS, zantac, lisinopril at home)
Assessment of Nutritional Needs:
Kcals: 3,080 kcals/day (35 kcal/kg/day) Based on nutrient recommendations for
males with liver disease to ensure no muscle is broken down for energy (35­40
kcal/kg/day).​2
Fat: ≤ 30 en % = 924 kcal = 103 g
Protein: 100 g/day Based on 1.5­2 g/kg/day recommendations not to exceed 100
g/day.​2
Sodium: 2400 mg/day Based on recommendations to treat edema and ascites.
Fluid: 2000 mL/day Fluid restriction recommendations for cirrhosis and to help
prevent edema and ascites.
Diagnosis:
1. Food and nutrition­related knowledge deficit related to esophageal varices as
evidence by 24­hour diet log [NB­1.1].
2. Undesirable food choices related to GERD as evidence by pt complaints of
heartburn and 24­hour dietary recall indicating sources of alcohol and coffee
[NC­1.4].
3. Excessive alcohol intake related to cirrhosis as evidence by 24­hour dietary
recall and lab values [NI­4.3].
Intervention:
1. Explain why he needs to change his diet and what he needs to change it to (a
soft diet with foods that will not irritate his esophagus). Explain the
consequences/effects of not following guidelines, and show him how his new diet
doesn’t have to control him or seem restricting.

5. 2. Show him how to reduce alcohol intake; provide resources to help initiate
long­term change and lifestyle. Provide alternate food choices to help curb
binging on undesirable food choices.
3. Educate him on the importance of decreasing alcohol consumption for his
cirrhosis, especially with the nutrient/drug interactions with his medications;
provide other outlets of his cravings.
Monitoring and Evaluation:
1. Monitor patient excrements (stools, urine, etc), monitor physical esophageal
conditions/improvements.
2. Track progress with the resources provided, monitor food log and heartburn.
3. Monitor condition of patient’s cirrhosis, check in with him on the progress he
makes with consuming alcohol.