CASE STUDY-3

CHRONIC LIVER DISEASE

ACUTE KIDNEY INJURY
TYPE-2 DIABETES MELLITUS
HYPERTENSION

PRESENTED TO - MRS. RUMA SINGH

PRESENTED BY - NAVNOOR KAUR
 PATIENT’S PROFILE
NAME-XYZ
AGE- 56 YEARS
GENDER- MALE
OCCUPATION- Farmer
WARD- 28
UNIT NUMBER-8126295
HEIGHT- 179 cms.
WEIGHT- 88 kgs.
BMI- 27.5 kgs/m2
IBW- 79 kgs.
SOCIO-ECONOMIC STATUS- Middle- class
ACTIVITY- Sedentary
DATE OF ADMISSION- 09/11/23
DATE OF DISCHARGE- 18 /11/23
CHEIF COMPLAINTS
Breathlessness x 3 Days
MEDICAL
Decreased Urine output
Pedal Oedema
PROFILE
PAST MEDICAL HISTORY
In Family- Mother was Hypertensive
In Patient - Hypertension (24-25 Years )
- Type-2 Diabetes Mellitus (17-18 years)

MEDICAL DIAGNOSIS
Chronic Liver Disease
Acute Kidney Injury
ANATOMY OF THE ORGANS AFFECTED

LIVER KIDNEY HEART

PANCREAS
LIVER

The liver is the largest gland in the body,

which plays a vital role in performing
many complex functions essential for life.
Liver serves as our body’s internal
chemical power plant.

STRUCTURE - The liver is organized into

microscopic units called lobules.
Each lobule is hexagonal in shape and
consists of plates of hepatocytes
radiating outward from a central vein.
 FUNCTIONS
OF LIVER
Some of the important functions of liver include-
To convert carbohydrates in the food to stored energy
and chemicals necessary for life

To manufacture proteins, metabolise proteins, absorbs

fat products, make them available.

To produce bile , essential for digestion of fats .

To store iron, copper and other minerals for use in the

metabolism

To ensure storage, absorption, and function of fat

soluble vitamins A, D, E and K

To act as filter to remove alcohol and other toxic

substances from the blood
CHRONIC LIVER DISEASE
Chronic liver disease is a progressive
deterioration of liver functions..
This is a continuous process of
inflammation, destruction, and
regeneration of liver parenchyma leading
to fibrosis and cirrhosis.
Cirrhosis is characterized by the
replacement of normal liver tissue with
scar tissue, affecting liver function.
The scar tissue progressively diminishes
the blood flow through the liver.
As the normal liver tissue is lost, the liver
can no longer effectively process nutrients,
hormones, drugs and poisons.
 ETIOLOGY SYMPTOMS
The most common causes include-
Viral infection-The hepatitis viruses B,C,D
Loss of appetite
and G are more likely to produce cirrhosis
Long term alcohol abuse Unexplained weight loss
Nutrition- Malnutrition aggravates any injury Muscle loss and weakness
to the liver particularly vitamin A, Vitamin E Abdominal swelling
and Vitamin C Nausea and vomiting
Toxins of food- Alfatoxins may be one of the Swelling in the legs and ankles
reasons of cirrhosis
Metabolic Disturbances -
Haemochromatosis (no control on iron
absorption) or Wilson’s disease(Disturbance
in copper metabolism) can lead to cirrhosis
COMPLICATIONS
Portal Hypertension
Enlarged blood vessels
Ascites
Kidney Disease or failure
Easy bruising or bleeding
Type 2 Diabetes
KIDNEY

The kidneys are two bean-shaped organs,

each about the size of a fist.

LOCATION- The kidneys are two bean-

shaped organs, each about the size of a
fist. They are located just below the rib
cage, one on each side of your spine.
 Waste removal: The kidneys remove
waste products, drugs, and acid from the
FUNCTIONS OF body

KIDNEY Fluid balance: The kidneys balance the

body's fluids, including water, salts, and
minerals

Blood pressure regulation: The kidneys

produce hormones that regulate blood
pressure

Red blood cell production: The kidneys

play a role in the production of red blood
cells

Metabolic blood acid-base balance: The

kidneys maintain a healthy balance of blood
acid-base
URINE FORMATION PROCESS
ACUTE RENAL FAILURE
Acute kidney injury (AKI), previously called acute
renal failure (ARF), denotes a sudden and often
reversible reduction in kidney function, as measured
by glomerular filtration rate (GFR).

Acute kidney failure occurs when your kidneys

suddenly become unable to filter waste products
from your blood.

AKI causes a build-up of waste products in your

blood and makes it hard for your kidneys to keep the
right balance of fluid in your body
 ETIOLOGY SYMPTOMS
Oliguria - Decreased urine output and
Organ failure (e.g., heart, liver)
Anuria
Overuse of pain medicines called “NSAIDs”,
Swelling in legs, ankles, and around the
which are used to reduce swelling or relieve
eyes
pain from headaches, colds, flu, and other
Fatigue or tiredness
ailments.
Shortness of breath
Severe allergic reactions
Confusion
Burns
Nausea
Injury
Seizures or coma in severe cases
Major surgery
Chest pain or pressure
 COMPLICATIONS OF AKI.
Fluid and Electrolyte Imbalance

Cardiovascular Complications

Impaired Immune Fuction

Chronic Kidney Disease

Neurological Complications
GFR by COCKCROFT
FORMULA

DATE GFR

14.11.23 48.5 ml/min

15.11.23 72 ml/min

17.11.23 92.1 m/min

 HEART
Heart is a primary organ of our circulatory
system.
Heart contains four main sections
(chambers) made of muscle and
powered by electrical impulses.

LOCATION- Heart is located between the lungs in the

middle of chest,
behind and slightly to the left of breastbone
(sternum).
Heart is the main organ of our cardiovascular
system, a network of blood vessels that pumps
blood throughout our body
FUNCTIONING OF HUMAN
HEART
Blood enters right atrium from superior and inferior vena cava.

2. Blood in right atrium flows through right AV valve (tricuspid)

into right ventricle.

3. Contraction of right ventricle forces pulmonary valve open.

4.Blood is distributed by right and left pulmonary arteries to the

lungs, where it oxygenates blood.

6. Blood returns from lungs from pulmonary veins to left atrium.

7. Blood in left atrium flows through left AV valve (mitral) into left
ventricle.

8. Contraction of left ventricle forces aortic semilunar valve

open.

10. Blood in aorta is distributed to every organ in the body.

HYPERTENSION
HYPERTENSION IS ELEVATED BLOOD
PRESSURE, WHO DEFINES HYPERTENSION
AS A CONDITION IN WHICH SYSTOLIC
PRESSURE EXCEEDS 140 MMHG AND
DIASTOLIC PRESSURE EXCEEDS 90
MMHG .
HIGH BLOOD PRESSURE IS NOT A
DISEASE BUT ONLY A SYPMTOM
INDICATING THAT SOME UNDERLYING
DISEASE MAY BE PROGRESSING.

WITH DIASTOLIC PRESSURES OF 100 OR

ABOVE, THERAPY SHOULD BE INITIATED
WITH DRUGS AS WELL AS DIET.
PANCREAS
PANCREAS IS AN ABDOMINAL GLANDULAR
ORGAN WITH BOTH DIGESTIVE (EXOCRINE)
AND HORMONAL ( ENDOCRINE)
FUNCTIONS.

IT IS LOCATED IN THE ABDOMEN BEHIND

THE STOMACH AND FUNCTIONS AS A
GLAND.

STRUCTURE - RIGHT SIDE OF THE

PANCREAS IS CALLED THE HEAD, IS THE
WIDEST PART OF THE ORGAN AND LIES IN
THE CURVEOF THE ABDOMEN. TAPERED LEFT
SIDE IS CALLED THE BODY OF PANCREAS ,
ENDS NEAR THE SPLEEN, CALLED THE TAIL.
FUNCTIONS OF PANCREAS
 DIABETES MELLITUS
Diabetes mellitus Type-2, also known as Adult-onset Diabetes, is a chronic
metablic disorder characterized by decreased ability or complete inability of
body to take up glucoseresulting in highbloodsugar levels
It is usually caused due to impaired insulin senstivity.
Symptoms include- Increased thirst, Decreased blood clotting, Blurred vision,
etc.
CLINICAL EXAMINATION
Breathing Difficulty

PHYSICAL EXAMINATION
Conscious
Dyspnec
Ambulatory
VITALS
PULSE B.P TEMPERATURE RESP.

NORMAL RANGES 72 /min 120/80 mmHg 98.4°F 24/min

14/11/23 94/min 130/80 mmHg 97°F 20/min

15/11/23 84/min 120/70 mmHg 97.2°F 22/min

16/11/23 84/min 130/80 mmHg 97.4°F 20/min

17/11/23 90/min 140/70 mmHg 98°F 20/min

BIOCHEMICAL PARAMETERS
Hb
TLC PLT UREA/CREAT SODIUM POTASSIUM CHLORIDE
g/dl

4000-
NORMAL 13-15 1.5-4.5 135-145 3.5-5.2 96-106
11000 0.7-1.2
RANGES g/dl microlitre
Lakhs mEq/L mEq/L mEq/L

14.11.23 12.1 6900 1.05L 90/1.9 123 4.0 107

15.11.23 13.2 5400 1.03L 72/1.2 125 4.2 102

17.11.23 12.5 7000 1.22L 55/1.0 133.7 4.5 105

 LIVER FUNCTION TEST
TOTAL
Albumin Bilirubin Bilirubin
PROTEIN AST (SGOT) ALT (SGPT)
Serum TOTAL DIRECT
g/dl

6.60-8.70 3.40-5.20 0.00- 1.40 4.0-40.0 4.0-41.0

NORMAL RANGES 0.10-0.30 mg/dl
g/dl g/dl mg/dl U/L U/L

14.11.23 7.08 4.30 1.74 0.65 79.60 47.50

 BLOOD SUGAR AND INSULIN
CHART
PRE- Post- Pre-
DRUGS FBS Insulin Insulin Insulin Insulin
LUNCH BS Lunch BS Dinner BS

NORMAL 70-100 80-130 80-130 80-130

RANGES mg/dl mg/dl mg/dl mg/dl

14/11 199 mg/dl - - - - - 142 mg/dl -

15/11 167 mg/dl - 312 mg/dl 8 units - - 316 mg/dl Tab.

16/11 235 mg/dl 4 units - - - - - -

17/11 194 mg/dl Tab. - - - - - -

DRUG THERAPY
 DRUGS DOSE ROUTE FUNCTIONS SIDE-EFFFECTS

Inj. Piperacillin +
4.5 gm IV Anti-biotic Headache, fever
Tazobactum

Nausea, Stomach
Tab. Metinex 2.5 mg BD Anti-Diabetic
[pain

Inj. Pantoprazole 40 mg IV Antacid Nausea, Vomiting

Vitmain-B1
Inj. Thiamine 100 mg IV Itching, weakness
Supplement

Headaches,
Inj. Lantus 12U SC Insulin
Allergic reactions

Tab. Rifaximine 550 mg PO Anti-biotic Bloating, Fever

Tab. Aspirin 75 mg PO NSAID Constipation

Anti- Constipation,
Tab. Rosuvastatin 5 mg PO
Cholestrolemic Dizziness
DIET THERAPY
FOODS TO BE FOODS TO BE
INCLUDED AVOIDED
Legumes like Beans, lentils, Chickpeas etc. Highly processed foods- fast food, canned soups,
Whole Grains and cereals packaged snacks.
Vegetable soup Unhealthy fats- Margarine, Vegetable shortenings
Eggs-egg white, cheese and other dairy and fried foods
products Salty snacks- Chips
Nuts and seeds Bakery products- cake, pastries and biscuits
Green Leafy vegetables
Raw or undercooked foods
Alcohol
NUTRITION CARE
PLAN
FOOD HABITS- Ova- Vegetarian
FOOD ALLERGIES/INTOLERANCES- None
FAMILY TYPE- Joint
SOCIAL HISTORY - History of Alcoholism since 25 years
FOOD ITEMS PREFERRED
CEREALS - ALL
PULSES - ALL
MILK & MILK PRODUCTS - ALL
GREEN LEAFY VEG. - ALL
NON VEGETARIAN - ONLY EGG
ROOTS & TUBERS - ALL
OTHER VEGETABLES - ALL
FRUITS - FEW
FRIED FOODS - NO
COOKING OIL USED - MUSTARD OIL
SWEETS - NO
NUTS - FEW
SOFT DRINKS/ALCOHOL - BOTH
SEASONINGS - FEW
EATING OUT - RARELY
DIET
IMPLEMENTATION
DIET STARTED- 13/11/23
DIET IMPLEMENTED- 60 G PROTEIN, LOW SALT,
DIABETIC LIGHT
 HOME DIET
MEAL MENU SERVING

TEA 1 SERVING
BREAKFAST
BISCUITS 1 SERVING

CHAPATI 2.5
DAL 1/2 SERVING
LUNCH
VEGETABLE 1/2 SERVING
CURD 1 SERVING

TEA 1 SERVING
EVENING TEA
BISCUITS 1 SERVING

CHAPATI 1.5
DINNER
VEGETABLE 1 SERVING

ALCOHOL ALCOHOL 400 ml

 HOSPITAL DIET
MEAL MENU SERVING

SUJI KHEER/DALIA 1 SERVING

BREAKFAST TEA 1 SERVING
BOILED EGG 1

MID - MORNING VEGETABLE SOUP 1 SERVING

KHICHDI 1 SERVING
VEGETABLE 1 SERVING
LUNCH
DAL 1 SERVING
CURD 1 SERVING

TEA 1 SERVING
EVENING TEA MARIE BISCUITS 1 SERVING
BOILED EGG 1

KHICHDI
1 SERVING
DINNER VEGETABLE
1 SERVING
DAL
 ACTUAL DIET
MEAL MENU SERVING

SUJI KHEER/DALIA 1 SERVING

BREAKFAST TEA 1 SERVING
BOILED EGG 1

MID - MORNING VEGETABLE SOUP 1 SERVING

KHICHDI 1 SERVING
VEGETABLE 1 SERVING
LUNCH
DAL 1 SERVING
CURD 1 SERVING

TEA 1 SERVING
EVENING TEA MARIE BISCUITS 1 SERVING
BOILED EGG 1

KHICHDI
1 SERVING
DINNER VEGETABLE
1 SERVING
DAL
DIET
CALCULATIONS
ENERGY (Kcal) PROTEIN (g) CARBOHYDRATES (g) FAT (g)

RDA 2320 54 130 25

MDA 1600 60 276 36

HOME DIET 3926 56 319 28

HOSPITAL DIET 1490 58 228 35

ACTUAL DIET 1490 58 228 35

 ENERGY DISTRIBUTION (Kcal)
4000

3000

2000

1000

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
 PROTEIN DISTRIBUTION (g)
60

50

40

30

20

10

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
CARBOHYDRATE DISTRIBUTION (g)
350

300

250

200

150

100

50

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
 FAT DISTRIBUTION (g)
40

30

20

10

0
RDA MDA HOME DIET HOSPITAL DIET ACTUAL DIET
 FAT
ENERGY DISTRIBUTION FAT
PROTEIN
6.9% 10.9% PROTEIN
13.9%
18.1%

CARBOHYDRATE CARBOHYDRATE
79.2% 71%

HOME DIET HOSPITAL DIET

MY LEARNINGS FROM THIS
CASE STUDY
Effective Communication’
Report Reading
Stages of Kidney Diseases
Patient Consultation
 BIBLIOGRAPHY
Srilakshmi B., “Food Science”, New Age International (P) Ltd, Publishers, Pune, (1997)
Mudambi, S. R., Fundamentals of foods, nutrition and diet therapy. New Age International.(2007)
https://clevelandurology.net/posts/kidney-health/20-healthful-foods-for-fighting-kidney-disease/
https://columbiasurgery.org/liver/liver-and-its-functions/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-function
https://www.texasheart.org/heart-health/heart-information-center/topics/heart-anatomy/
Thank You