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Nutrition 4347
Liver Disease Case Study
Weekly Assignment #1

1. The most common cause of cirrhosis is alcohol ingestion. What are other
potential causes of cirrhosis? What is the cause of this patient’s condition?

Potential causes of cirrhosis include alcoholism and hepatitis.

This patient’s condition was likely caused by her history of hepatitis C.

2. Which clinical manifestations of cirrhosis does this patient possess? Discuss

these clinical manifestations.

This patient has jaundice, weakness, fatigue, reduced appetite, abdominal

distention.

3. Uncontrolled glucose levels is a symptom commonly observed in cirrhotic

patients. What is the physiological basis for this? Discuss Ms. Nguyen’s
glucose levels.

Glucose is stored in the liver in the form of glycogen. The stored glycogen is
released into the bloodstream when blood glucose levels drop. In the
presence of liver dysfunction, the liver is unable to store glycogen and
release it as necessary to aid in maintaining normal glucose levels. As a
result, patient’s may benefit from 6 small meals, which provides a frequent
and readily available source of glucose.

4. Examine the patient’s chemistry values. Which labs support the diagnosis of
cirrhosis

This patient has a low albumin level, elevated AST, and elevated bilirubin l
levels.

Pertinent lab values (LFTs):

Elevated ALT, AST, and LDH
Elevated bilirubin levels
Decreased albumin levels

Labs that may also support:

Elevated triglyceride (TG) levels
Elevated creatinine protein kinase (CPK) levels
Elevated/Decreased glucose level
Altered glucose levels depending on fed or starved state of the patient.
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5. Outline the nutrition therapy of for cirrhosis and discuss the rationale for
each modification.

Nutrition Therapy for Cirrhosis:

Kcals: 35-40 kcal/kg
Protein: 1.0-1.2 g/kg and advance to 1.2-1.5 g/kg

CHO adequate for sparing protein

Fat: 25% of kcals from fat (due to impaired fat metabolism)
Na: 2 g or less

6. Calculate the patient’s energy and protein needs. Provided the rationale for
the standards you used.

Dry Weight 120# (54.5 kg)

Recommendations for Cirrhosis:

35-40 kcals/kg

Protein:
w/Encephalopathy – lower protein needs
Recommend 55-65 gm pro/kg ( 1.0-1.2 gm pro/kg)
Current guidelines suggest that even with encephalopathy, cirrhosis patients
should not receive less protein. Only a small amount of patients are
considered “protein intolerant”. Most patients can consume normal levels of
protein without developing hepatic encephalopathy.
It was previously thought that lowering values to 0.6-0.8 temporarily is
acceptable. However, current research indicates adequate protein intake
should be achieved. Conservatively, I have recommended 1-1.2 gm pro/kg
with a goal to advance to 1.2- 1.5 gm pro/kg

Recommendations for this Tammi:

Calorie Needs: 1909-2181 kcals/g (35-40 kcals/kg)
Protein Needs: 65-82 gm pro/kg (1.2-1.5 gm pro/kg)

7. Review this patient’s medications. Discuss the purpose of each medication.

Biscadoyl- has a laxative effect and is often used to treat constipation. Taking this
medication may increase the patient’s number of bowel movements and eliminate
extra bilirubin.

Prilosec- This medication treats acid reflux by reducing the amount of acid in the
stomach.
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Lactulose- has a laxative effect which softens stools and increases the frequency.
This medication, along with biscadoyl, may help to reduce bilirubin levels.

Vitamin K- is often given to patients with liver disease correct deficiencies and
improve coagulopathy (impaired clot formation)

Zoysn- combination medication that contains piperacillin and tazobactam to treat

bacterial infections. May be used to treat bacterial periotonitis

Morphine sulfate-opoid based analgesic (pain medication). Patient has abdominal

pain.
Oxycodone HCl – pain medication. Patient has abdominal pain.

8. Select two nutrition problems and complete the PES statements for each.

Inadequate oral intake related to catabolic illness AEB pt’s report of a decrease in
normal intake.

Inadequate protein/energy intake related to increase needs (catabolic illness) AEB

insufficient intake compared to estimated needs.