Questions for Medical Nutrition Therapy: A Case Study Approach 4th ed.
Title: Case 12 – Cirrhosis of the Liver
Questions:
1. The liver is an extremely complex organ that has a particularly important role in nutrient metabolism. Identify three functions of the liver related to each of the following:
a. Carbohydrate metabolism Galactose and fructose are products of carbohydrate digestion and are converted to glucose in the hepatocyte or liver cell.1 The liver then stores glucose as glycogen by undergoing glycogenesis and then returns it to the blood when glucose levels become low by undergoing glycogenolysis.1 The liver also produces “new” glucose from gluconeogenesis from precursors such as lactic acid, glycogenic amino acids, and intermediates
…show more content…
As a result, there is an elevation in chemical lab values. The signs and symptoms that result in these physiological changes are jaundice, ascites, hypernatremia, hepatic encephalopathy, glucose alterations, fat malabsorption, hepatorenal syndrome, and osteopenia.1 Gi bleeding also sometimes occurs with cirrhosis
5. List the most common signs and symptoms of cirrhosis, and relate each of these to the physiological changes discussed in question #4.
The signs and symptoms that result in these physiological changes are pruritus, jaundice, ascites, portal hypertension, esophageal varices, easy bruising from internal bleeding, hypernatremia, hepatic encephalopathy, glucose alterations, hepatorenal syndrome, and osteopenia. Skin conditions such as pruritus and jaundice along with osteopenia can be due to the lack of nutrient flow throughout the body. Ascites and edema are due to the fluid build-up in the system. Esophageal varices is due to bleeding within the GI tract.
6. After reading this patient’s history and physical, identify her signs and symptoms consistent with her
1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to
The inflammation of the liver is detected by the blood tests taken and can be reduced by drinking lots and lots of fluids, to flush out the toxins. A patient can detect liver inflammation by nausea, vomiting, reduced appetite and jaundice. It is also possible to obtain rash-like symptoms, similar to those of measles or scarlet fever. They can appear all over the body and are very itchy, much like hives. A cortisone cream applied in small amounts to the small bumps can reduce the itch and swelling. Severe scratching of the bumps can leave scars.
In the presented case scenario, we have Mr. Gil Martin who is a 55-year-old Hispanic male. He comes in to the clinic today with complaints of weakness, fatigue, and loss of appetite. A student nurse will be precepting your assessment of Mr. Martin and when collecting subjective and objective data it is important to pay close detail to all findings. Ultimately this patient was diagnosis with cirrhosis, which is an abnormal liver condition that leads to irreversible scarring of the liver (National Institute of Health [NIH], 2017), so during assessment we should pay attention to details leading to this diagnosis.
As cirrhosis progresses, the hardened tissues being formed stop the liver from functioning properly. The buildup of scar tissue prevents blood flow through the liver and slows down toxin and nutrient processing. The production of substances made by the liver is also delayed (WebMD, 2014). As stated in WebMD, 2014, symptoms of cirrhosis include: loss of appetite, lack of energy (fatigue), weight loss or weight gain, bruises, yellowing of skin or the whites of eyes (jaundice), itchy skin, fluid retention (edema) and swelling, a brownish or orange tint to the urine, light colored stools, confusion, disorientation, personality changes, blood in the stool, and
• Signs of elevated blood sugar level like increased thirst, blurred vision, frequent urination weight loss or fatigue
The individual may also experience chills, vomiting, diarrhea, muscle aches and weakness, bright red coloring of the eyes, throat, and vagina, a rash that resembles sunburn. These symptoms can rapidly progress to severe hypotension and can even lead to multisystem dysfunction such as kidney and other organ failure (Clinic Staff, 2014).
Hyponatremia and Hyperkalemia are also associated with Addison’s disease, patients usually complain of gastrointestinal upset as well as anorexia, nausea, vomiting, diarrhea, and a salt craving. These symptoms can be more severe if an accident involving the patient occurs, for example lower pain in the back, abdomen, and legs, as well as extreme vomiting and diarrhea followed by dehydration, low blood pressure, and a loss of
This condition is diagnosed with a medical history and physical exam. You may also have tests, including:
One of these symptoms is jaundice, which is characterized by yellowish skin and eyes because of an inability of the liver to remove bilirubin from the blood. Patient with cirrhosis also suffering from itching, due to deposited bile's products in the skin. This patient also suffers from accumulation of fluid in legs that is called edema. As a result of the blockage of blood flow via the liver, fluid accumulation in abdomen which is worsen by the decrease in protein production. Other symptoms include fatigue, weakness, loss of appetite, weight loss and nausea. As the disease progress, complications may develop ,such as varices that happens with cirrhosis patient when the blood flow through the liver slows, so the blood from intestine go back to the vessels of the stomach and esophagus, these vessels are not meant to carry this much of blood so they dilate (varices), with increasing
Kidney failure is the most common one. The kidney would be overburdened on its function of reducing the toxicity of the body. Reduction in oxygen supply in blood is another complication that leads to a reduction in the rate of body metabolism (Rehm, 444). If liver cells are damaged, there would be too much sugar in the blood. The secretion of enzymes diabetes mellitus and Diabetes Insipidus would be impended so there would be a higher sugar level in the blood causing diabetes. There would also be a change in blood count. The number of platelets would be reduced thus abnormalities would occur in blood clotting process. Poor blood clotting process increases the risk of infections. Besides, it also leads to excessive bleeding thus causing anemia. Men suffering from cirrhosis are at a risk of breast enlargement and loss of body muscles (Schuppan, 841). Women are at a danger of reaching menopause prematurely. The complications can be treated by the change of lifestyle, but if it becomes ineffective, then liver transplant would be
The liver is the body's second largest organ. The liver perfoms many essential functions making the liver a vital organ. The six major functions of the liver are: digestion, metabolism, detoxification, storage, production, and immunity. The liver produces bile that is used in digestion of fats. The liver metabolizes carbohydrates, lipids and proteins. The hepatocytes of the liver detoxify substances such as drugs and alcohol. The liver stores many vitamins, minerals, and nutrients gathered from blood that passes throught the hepatic portal system. The liver also produces several vital protein components of blood plasma inculding prothrobin, fibrinoge, and albumins. The liver functions as part of the immune system with the use of Kupffer
There are many different signs and symptoms of pernicious anemia. As mentioned before, the classic sign is the feeling of being tired and weak at all times. Other signs and symptoms can include having a bright red, smooth tongue, tingling and numbness in the hands and feet, shortness of breath (Mary J. Shomon, n.d.) There is also changes in a persons nervous system. Such changes are seen in the patients vision, taste, and smell. The patient may also have an unsteady gait, become depressed, confused, have a loss of memory and develop psychosis. Problems can even occur in the digestive system. This would include bleeding gums, mouth sores, nausea and vomiting. Gas, heartburn, change in bowel movements (constipation or diarrhea), and weight change are some other symptoms. Evan hepatomegaly can be part of the disease process. Left untreated pernicious anemia can lead to heart failure/heart attacks and strokes. The disease also
This keeps up for a few days and you begin to feel a loss of appetite as well as nausea. A low grade fever between 100 °f - 102 °f is present. A pain and discomfort in the abdomen above the liver is also common, due to enlargement of the liver. After a few days of torture, a person’s urine becomes darker than usual and then jaundice, (a yellowish discoloration of the skin) appears. Jaundice and the dark urine indicate that liver is not functioning properly in removing a reddish-yellow pigment called bilirubin from the blood.
The site of the primary infection is in the alimentary tract, a short prodromal or pre-icteric phase, varying from two to seven days, usually precedes the onset of jaundice. The most prominent symptoms in this phase are fever, headache, muscular and abdominal pain, anorexia, nausea, vomiting and sometimes arthralgia. Hepatomegaly and leukopenia are often present during this period. In typical cases the urine becomes dark, and the stools pale before appearance of yellow discoloration of the mucous membranes and appearance of jaundice about ten days after onset of the general symptoms. Fever and most of the general symptoms usually subside within a few days of jaundice, but in severe cases both general and abdominal symptoms may become further aggravated at this phase. Jaundice is often accompanied by itching and sometimes by urticarial or papular rashes. Liver is usually enlarged and liver function tests are abnormal with highly elevated levels of serum alanine aminotransaminase (ALT) and serum aspartate aminotransaminase (AST).
It is a very important organ for many functions. It helps your body to digest food, store energy and remove toxins. It is located in the super right part of the body (3). The liver weight in the human body is about 3 pounds. Liver divided into two large lobes, called the right lobe and the left lobe. The pancreas, intestines and liver work together to absorb and process food. The liver's main function is to filter the blood that coming from the digestive system, before passing it to the whole body. The liver also makes proteins important for blood clotting