Module 8: Cirrhosis and ESLD Flashcards
This type of liver disease (ESLD) is when the liver is badly damaged and severely dysfunctional.
End Stage Liver Disease (ESLD)
T/F: ESLD could be the result of any other liver disease.
T
What will improve the condition of ESLD?
A liver transplant
MNT for ESLD is to hopefully prevent _____________ and symptomatic management.
malnutrition
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.
Hepatic encephalopathy
Grade I severity of hepatic encephalopathy is:
mild confusion, poor coordination
Grade II severity of hepatic encephalopathy is:
asterixis, slurred speech
Grade III severity of hepatic encephalopathy is:
somnolence, confusion, incomprehensible speech
Grade IV severity of hepatic encephalopathy is:
loss of consciousness, coma
T/F: Altered neurotransmitters 2nd degree abnormal plasma amino acids may also cause hepatic encephalopathy. There is more AAA’s than BCAA’s present.
T
________ is an osmotic laxative that prevents the production of ammonia. Which may be prescribed as part of MNT for hepatic encephalopathy.
Lactulose
Entero tube feeding formulas may have higher concentrations of _________ compared to AAA’s.
BCAA’s
Avoid tube feedings that have _______ for MNT for ESLD because they increase ammonia levels.
glutamine
This is increased BP in the portal venous system.
Portal hypertension
This is the accumulation of fluid in the peritoneum (abdomen) caused by increased pressure from portal HTN and low hepatic albumin production.
Ascites
Portal hypertension and ascites are other complications you may see in patients with what type of liver disease?
ESLD
Portal HTN can lead to __________ varices which is dangerous because if those veins break open, this could cause severe bleeding.
esophageal
What type of diet should someone have if they have esophageal varices?
A soft low-residue diet
Portal HTN + inadequate albumin synthesis in the liver can lead to what?
Ascites
_________ can be treated with diuretics, fluid restrictions, low-sodium diet, and even paracentesis.
Ascites
Avoid _______ to prevent hypoglycemia and provide small frequent meals for MNT for ESLD.
fasting
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).
refeeding
What is the most common cause of ESLD?
Alcohol Liver Disease
This liver diseases causes liver damage caused by acetaldehyde, a byproduct of alcohol metabolism.
Alcohol Liver Disease
Chronic excessive alcohol intake leads to the buildup of _______ that favors FA biosynthesis in the liver and that can lead to ________ AKA fatty liver.
NADH, steatosis
T/F: Steatosis is irreverisble.
F (it’s reversible if alcohol consumption is decreased and the liver will metabolize the triglyceride and there won’t be any permanent damage)
Steatosis can progress into an _________ hepatitis where there’s inflammation & swelling of the liver, which could produce __________ damage, which could then proceed to ________.
alcoholic, irreversible, cirrhosis
What are the 3 stages of Alcohol Liver Disease?
1) Hepatic steatosis (fatty liver) - reversible
2) Alcoholic hepatitis - reversible
3) Cirrhosis - irreversible
Portal HTN, esophageal varices, ascites, hepatic encephalopathy, and Wernicke’s Encephalopathy are some complications of what type of liver disease?
Alcohol Liver Disease
Wernicke’s Encephalopathy is caused by ________ deficiency, induced by alcoholism. This is characterized by unsteady gait, mental confusion, and lack of fine motor skills.
thiamin (vitamin B1)
- R side HF
- Chronic hepatitis
- Biliary disorders
- Cholangitis (inflammation of the bile ducts)
- Chemical/Drug toxicity
Are all secondary causes of _________.
cirrhosis
T/F: Protein calorie malnutrition is very common in advanced liver disease.
T
What are the s/s of malabsorption?
Diarrhea, steatorrhea
What are the s/s of GI bleeding?
Tarry stools, anemia, vomiting blood
What are the s/s of fluid retention?
Ascites, peripheral edema
What are the s/s of vitamin deficiencies?
Cheilitis, glossitis, anemia, night-blindness, bruising
Pts with ongoing alcohol consumption are at higher risk for what 3 deficiencies?
thiamin, magnesium, and folate
Avoid excessive _______ and manganese supplementation for those with liver disease, since these are hepatically excreted.
copper
MNT for energy needs for advanced Cirrhotic Liver Disease/ESLD is how many kcal/kg dry weight?
~30-35
MNT for PRO needs for advanced Cirrhotic Liver Disease/ESLD is how many g/kg?
at least 0.8 g/kg (RDA recommendation) but optimal is 1-1.5 g/kg
____ metabolism is one of the primary roles of the liver.
CHO
Sodium and fluids are often restricted for someone with ________ or ________.
edema or ascites
_______ and ________ meals are best for pts with ascites.
Small and frequent
T/F: Anorexia & nausea are common in pts with Cirrhotic Liver Disease.
T
