liver cirrhosis knh 411 morgan deihs lydia dysart
TRANSCRIPT
Liver Cirrhosis
KNH 411Morgan DeihsLydia Dysart
Objectives
Define Cirrhosis
Understand what MELD means
Name 3 SYMPTOMS of Cirrhosis
Name 3 Methods of TREATMENT for Cirrhosis
BackgroundTeresa (Terri) Wilcox:
Female, 26 y/o
Marital Status: Single- lives with roommate who is a law student
Number of Children: 0
Years education: Postgraduate- architecture
Language: English Only
Occupation: Doctoral graduate student in architecture
Hours of work: Teaches late morning and late afternoon; takes classes and conducts research during most evenings
Ethnicity: European American
Religious affiliation: Unitarian
Medical History Onset of disease:
Dx 3yrs ago with Hepatitis C- previously treated with alpha-interferon an ribavirin; seasonal allergies treated with antihistamines
Medical history: fatigue, anorexia, nausea,
vomiting, weakness; has lost 10lbs since last visit (6mo. Ago); bruising (not R/T injury)
Surgical History: No surgeries
Alcohol use: Yes
Family History: Mother: HTN, diverticulitis,
cholecystitis, carpal tunnel syndrome
Father: diabetes, peptic ulcer disease
Paternal Grandmother: cholecystitis, bilateral breast cancer
Maternal Grandmother: leukemia
Paternal Grandfather- cirrhosis
Paternal Grandmother- amyotrophic lateral sclerosis
Vital Signs
Temp: 96.9
Pulse: 72
Resp Rate: 19
BP: 102/65
Height: 5’8”
Weight 125 lb
BMI: 19kg/m2
Throat: Enlarged esophageal veins
Skin: bruising on lower arms & legs; telangiectasias on chest
Abdomen: mild distention, heptomegaly; non ascites
Urine: Amber, Cloudy
MELD ( Model For End-Stage Liver Disease) score: 23
What is Cirrhosis?Definition:
A condition when the liver deteriorates and loses function due to chronic injury. Scar tissue replaces the healthy liver and blocks the flow of blood through the liver.
Common Causes:
Alcohol Abuse
Hepatitis B
Hepatitis C
Nonalcholoic Fatty Liver Disease (NFLD)
Genetic diseases: Hemochromatosis CF Wilson’s disease
EtiologyCirrhosis Factors:
Alterations in serum biologic mediators: Tumor necrosis factor α, leptin, adiponectin
Hepatitis C (diagnosed 3 years ago) viral infection transmitted through blood contact
that causes inflammation, swelling, and damage to the liver.
Alcohol ConsumptionMay attribute to symptoms and onset of disease
AssessmentWt= 125lb Ht= 5’8”
BMI= 19kg/ m2
Current Wt= 125lb
Ideal Wt= 140lb
Rec. Cal Intake: 35-40kcal/kg 1,988-2,272kcal
Rec. PRO Intake: Up to 1.6g/kg 90.88 g of protein
Dietary IntakeGeneral Intake
Breakfast: Calcium- fortified Orange juice
Lunch: soup and crackers w/ Diet Coke
Dinner: Chinese or Italian Carryout
Usual Dietary Intake
Sips of water, juice, and Diet Coke only.
Has not eaten the past 2 days.
Lab ResultsReference Range 12/19 1012
ALT (U/L) 4-36 62
Alakine phosphatase (U/L)
30-120 275
AST 0-35 230
Albumin 3.5-5 2.1
PT 12.4-14.4 18.5
Bilirubin <0.3 3.7
Serum Ammonia (umol/L)
9-33 3
Hemoglobin (g/dL) 12-15 10.9
Hematocrit (%) 37-47 35/9
PESP- low energy intake
E- RT lack of appetite
S- AEB dietary recall, and recent weight loss ( 10 lbs in 6mo.), and low range of BMI
P- Low intake of protein
E- RT Low calorie intake
S- AEB lab values:
Total Protein 5.4 (6-8)
hemoglobin 10.9 (12-15)
Hematocrit 35.9 (ref 37-47)
TreatmentCurrent diet order: soft, 4 g. sodium, high- kcal
Our recommendation: TPN (2-5 days) to increase kcal and PRO intake
After TPN: Rec. Soft diet Fruits and vegetables Plant- based diet Lean PRO (legumes, poultry, or fish) Avoid Raw Seafood
Vitamin/ mineral intake: Continue taking Vit E, Calcium w/ Vit D, MVI, chicory &
ginger. Milk thistle not needed
Questions:What is Cirrhosis?
What does MELD stand for?
What are 3 SYMPTOMS?
What are 3 TREATMENTS?
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Sutter Health. (2013). MELD and the Waiting Listfor Liver Transplanthttp://www.cpmc.org/advanced/liver/patients/topics/MELD.html
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Viral Hepatitis. (2010, January 1). Retrieved September 23, 2014, from http://www.hepatitis.va.gov/provider/reviews/treatment-side-effects.asp