Liver cirrhosis is the final stage of liver injury and
degeneration. It involves inflammation and death of liver cells and is characterized
by abnormal structure and function of the liver. Active tissues of the liver
are replaced by inactive tissues and are filled by fibrous tissue and fat and nodules
are formed leading to obstruction and liver failure.
Various causes of this condition, such as, Neglected acute/chronic
hepatitis, alcoholism associated with malnutrition, virus and toxins, metabolic
disorders and altered immune response.
The symptoms of liver cirrhosis are GI disturbances like anorexia,
nausea, vomiting, abdominal pain and distension; electrolyte and fluid
imbalance; weight loss and muscle wasting; fatty
infiltration of the liver; severe jaundice; bleeding tendency; ascitis; osteoporosis;
high drug sensitivity; chronic inflammation of the liver; fibrosis and fatty
infiltration of the liver; and necrosis (death of cells).
Liver cirrhosis progresses in stages – the first stage being fatty liver or hepatic steatosis in
which there is fat infiltration in the liver cells which affects normal
functioning of the liver. This stage is reversible by just abstinence from
alcohol abuse. The second stage is Alcoholic
Hepatitis in which the liver is enlarged and there is abdominal pain,
anorexia, nausea, vomiting, weakness, diarrhoea, weight loss and fever. This
stage too is reversible. The third stage is Alcoholic Cirrhosis in which complications such as ascitis,
gastrointestinal bleeding, Portal hypertension, Hepatic coma etc. are seen.
The dietary management is aimed at maintaining adequate nutrition, preventing
breakdown of body tissue, controlling oedema and ascitis and preventing
symptoms of encephalopathy. A diet high in
Carbohydrate, moderate in Protein and low in fat is advised. The diet
should be given in several feedings (6-8
feedings per day) and vitamin and
mineral supplementation is very important. The diet needs to progress from liquid to soft to normal depending on
the acute stage and recovery. High calorie and protein beverages can be given
between meals. Fat has to be low and then gradually increased as per the
subject improves. Individualized diets are found to be very helpful.
The role of different nutrients in managing liver cirrhosis
is given below:
Nutrients
|
Notes
|
Kilocalories
|
The
energy requirements are increased due to a high catabolic state. Hence, a 2000-3000KCal
diet is recommended. Calories are required to maintain weight.
|
Carbohydrates
|
Carbohydrates
are kept adequate so that it has a protein sparing action and promotes the
storage of glycogen. It protects and supports liver function. Hence, 300-400
g of Carbohydrates is recommended in a diet.
|
Protein
|
Proteins
should be high enough to maintain positive nitrogen balance and low enough to
prevent hepatic coma. Usually it is 1g/kg/dry body weight and may be
increased to 1.2-1.5g/kg daily. In cases of Sepsis, infection, GI bleeding,
severe ascitis, atleast 1.5g of protein/kg/day may be needed.
|
Fat (g)
|
Moderate
fat intake is recommended as steatorrhea may be seen or malabsorption of fat
occurs. Medium Chain Triglyceride fats are prescribed. About 25% of
total Calories should come from fats.
|
Vitamins and
minerals
|
Vitamin
B and C, Folic acid, calcium, magnesium and zinc have to be supplemented, Iron
has to be given to prevent anemia. Serum levels of calcium, magnesium and
zinc are low and hence have to be supplemented.
|
Sodium
|
Restricted
if oedema or ascitis is present. Restriction is upto 500mg/day and maybe
increased to 2g/day with diuretics. Serum sodium and potassium levels have to
be monitored. Emphasis is on low sodium foods and avoidance of table salt and
salt in food preparation
|
Fluids
|
May be
restricted to correct oedema and ascitis. Fluids upto 1500ml/day is
recommended.
|
Fibre
|
Restricted
to prevent haemorrhage from varices.
|
Post by Faiz Lahori
Liver Disease in Alpha-1 Antitrypsin Deficiency
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