Module 8: Cirrhosis and ESLD

Question 1

This type of liver disease (ESLD) is when the liver is badly damaged and severely dysfunctional.

Answer 1

End Stage Liver Disease (ESLD)

Question 2

T/F: ESLD could be the result of any other liver disease.

Answer 2

T

Question 3

What will improve the condition of ESLD?

Answer 3

A liver transplant

Question 4

MNT for ESLD is to hopefully prevent _____________ and symptomatic management.

Answer 4

malnutrition

Question 5

This is the major complication of ESLD. It is an alteration in someone’s mental condition that occurs when the liver can no longer convert toxic ammonia to urea.

Answer 5

Hepatic encephalopathy

Question 6

Grade I severity of hepatic encephalopathy is:

Answer 6

mild confusion, poor coordination

Question 7

Grade II severity of hepatic encephalopathy is:

Answer 7

asterixis, slurred speech

Question 8

Grade III severity of hepatic encephalopathy is:

Answer 8

somnolence, confusion, incomprehensible speech

Question 9

Grade IV severity of hepatic encephalopathy is:

Answer 9

loss of consciousness, coma

Question 10

T/F: Altered neurotransmitters 2nd degree abnormal plasma amino acids may also cause hepatic encephalopathy. There is more AAA’s than BCAA’s present.

Answer 10

T

Question 11

________ is an osmotic laxative that prevents the production of ammonia. Which may be prescribed as part of MNT for hepatic encephalopathy.

Answer 11

Lactulose

Question 12

Entero tube feeding formulas may have higher concentrations of _________ compared to AAA’s.

Answer 12

BCAA’s

Question 13

Avoid tube feedings that have _______ for MNT for ESLD because they increase ammonia levels.

Answer 13

glutamine

Question 14

This is increased BP in the portal venous system.

Answer 14

Portal hypertension

Question 15

This is the accumulation of fluid in the peritoneum (abdomen) caused by increased pressure from portal HTN and low hepatic albumin production.

Answer 15

Ascites

Question 16

Portal hypertension and ascites are other complications you may see in patients with what type of liver disease?

Answer 16

ESLD

Question 17

Portal HTN can lead to __________ varices which is dangerous because if those veins break open, this could cause severe bleeding.

Answer 17

esophageal

Question 18

What type of diet should someone have if they have esophageal varices?

Answer 18

A soft low-residue diet

Question 19

Portal HTN + inadequate albumin synthesis in the liver can lead to what?

Answer 19

Ascites

Question 20

_________ can be treated with diuretics, fluid restrictions, low-sodium diet, and even paracentesis.

Answer 20

Ascites

Question 21

Avoid _______ to prevent hypoglycemia and provide small frequent meals for MNT for ESLD.

Answer 21

fasting

Question 22

If the pt is severely malnourished from ESLD, start slow to avoid __________ syndrome (which may cause a sharp decline in serum phosphorus, magnesium, and potassium).

Answer 22

refeeding

Question 23

What is the most common cause of ESLD?

Answer 23

Alcohol Liver Disease

Question 24

This liver diseases causes liver damage caused by acetaldehyde, a byproduct of alcohol metabolism.

Answer 24

Alcohol Liver Disease

Question 25

Chronic excessive alcohol intake leads to the buildup of _______ that favors FA biosynthesis in the liver and that can lead to ________ AKA fatty liver.

Answer 25

NADH, steatosis

Question 26

T/F: Steatosis is irreverisble.

Answer 26

F (it’s reversible if alcohol consumption is decreased and the liver will metabolize the triglyceride and there won’t be any permanent damage)

Question 27

Steatosis can progress into an _________ hepatitis where there’s inflammation & swelling of the liver, which could produce __________ damage, which could then proceed to ________.

Answer 27

alcoholic, irreversible, cirrhosis

Question 28

What are the 3 stages of Alcohol Liver Disease?

Answer 28

1) Hepatic steatosis (fatty liver) - reversible
2) Alcoholic hepatitis - reversible
3) Cirrhosis - irreversible

Question 29

Portal HTN, esophageal varices, ascites, hepatic encephalopathy, and Wernicke’s Encephalopathy are some complications of what type of liver disease?

Answer 29

Alcohol Liver Disease

Question 30

Wernicke’s Encephalopathy is caused by ________ deficiency, induced by alcoholism. This is characterized by unsteady gait, mental confusion, and lack of fine motor skills.

Answer 30

thiamin (vitamin B1)

Question 31

• R side HF
• Chronic hepatitis
• Biliary disorders
• Cholangitis (inflammation of the bile ducts)
• Chemical/Drug toxicity

Are all secondary causes of _________.

Answer 31

cirrhosis

Question 32

T/F: Protein calorie malnutrition is very common in advanced liver disease.

Answer 32

T

Question 33

What are the s/s of malabsorption?

Answer 33

Diarrhea, steatorrhea

Question 34

What are the s/s of GI bleeding?

Answer 34

Tarry stools, anemia, vomiting blood

Question 35

What are the s/s of fluid retention?

Answer 35

Ascites, peripheral edema

Question 36

What are the s/s of vitamin deficiencies?

Answer 36

Cheilitis, glossitis, anemia, night-blindness, bruising

Question 37

Pts with ongoing alcohol consumption are at higher risk for what 3 deficiencies?

Answer 37

thiamin, magnesium, and folate

Question 38

Avoid excessive _______ and manganese supplementation for those with liver disease, since these are hepatically excreted.

Answer 38

copper

Question 39

MNT for energy needs for advanced Cirrhotic Liver Disease/ESLD is how many kcal/kg dry weight?

Answer 39

~30-35

Question 40

MNT for PRO needs for advanced Cirrhotic Liver Disease/ESLD is how many g/kg?

Answer 40

at least 0.8 g/kg (RDA recommendation) but optimal is 1-1.5 g/kg

Question 41

____ metabolism is one of the primary roles of the liver.

Answer 41

CHO

Question 42

Sodium and fluids are often restricted for someone with ________ or ________.

Answer 42

edema or ascites

Question 43

_______ and ________ meals are best for pts with ascites.

Answer 43

Small and frequent

Question 44

T/F: Anorexia & nausea are common in pts with Cirrhotic Liver Disease.

Answer 44

T