Liver Cirrhosis PDF

Liver Cirrhosis  Definition It is a condition in which hepatocytes are destroyed and replaced by fibroblasts, resulting in a small number of healthy cells remaining. Thus, the liver's ability to get rid of various nitrogenous toxins, especially ammonia, decreases. We cannot diagnose cases...

Liver Cirrhosis  Definition It is a condition in which hepatocytes are destroyed and replaced by fibroblasts, resulting in a small number of healthy cells remaining. Thus, the liver's ability to get rid of various nitrogenous toxins, especially ammonia, decreases. We cannot diagnose cases of cirrhosis in its early stages except with a liver sample The fibrous tissue surrounds the healthy cells, causing the tissue to become like knots ‫ عقد‬., these nodular tissues can block the flow of blood from the intestine to the liver, which increases the pressure in the veins that connect to this area and supply it with blood, especially the portal vein area. This causes water to accumulate in the body and cause bloody bleeding from the swollen veins in the gastrointestinal tract.  Symptoms Severe fatigue. Loss of appetite, nausea, vomiting and weight loss. Liver enlargement and gallstones. Yellowing of the whites of the eyes. Swollen feet, ascites in the abdomen (Water and fluid retention and low osmotic pressure in the plasma due to the severe decrease in the level of albumin in the blood) Esophageal varices ‫دوالي المريء‬ the proportion of ammonia in the blood rises the palm of the hand becomes red due to the expansion ‫تمدد‬ ‫ الشعيرات الدموية‬of the capillaries and blood pools under the skin  The causes of cirrhosis of the liver are many, and it may be due to several Unknown reasons and cirrhosis may take for 20 years to appear.  Ascites might be treated by Reducing salt (Na) and taking diuretics, or following paracentesis ‫ عملية البزل‬with a special needle to filter water from the abdominal cavity in case the diuretics does not respond. Or the food is free of salt, with antibiotic injections in the event of a bacterial infection in the peritoneum of the abdomen.  Cirrhosis stages First degree of cirrhosis (20%): We do not find any pathological manifestations. But by examination, we are surprised by cirrhosis, so that liver enzymes may be normal in about 50% of cases and may be elevated in some cases. Second degree of cirrhosis (40%): We notice an increase in the proportion of bile in the blood to a small degree. We note that the proportion of albumin in the blood is less than normal. The third degree of fibrosis (80%): we may find in addition to this the presence of ascites in the abdomen and swelling of the feet. The development of cirrhosis of the first to third degree may take many years, depending on: The virus type, its activity, and the degree of hepatitis ranging from mild to moderate or severe. drugs harmful to the liver, environmental pollution, food preservatives, herbs harmful to the liver, medicines that have not been studied on liver, and then not paying attention to food rich in antioxidants that protect public health and liver health). When advanced cases of cirrhosis of the liver appear, we may expect complications of cirrhosis of the liver.  RDA 1- Energy : 35 -40 cal/kg BW ( depending on dietary carb and fats) 2- Proteins : 1 – 1.5 gram/kg BW It is preferable to eat easily digestible protein (egg white, boiled chicken breast) Some patients develop sensitivity against protein (the inability to represent protein), which leads to high ammonia in the blood. High ammonia in the blood leads to damage to brain cells and impairment of its functions, which results in hepatic coma To reduce the level of ammonia in the blood: protein is determined (0.3-0.8 g/kg of ideal body weight) + protein is from milk, egg white as they give the least ammonia output+ Plus some antibiotics and drugs that decrease The level of ammonia In the case of hepatic coma: Protein is completely prevented + tube feeding is provided (glucose / fat), then the amount of protein increases with the improvement of the condition and starts with 10 g protein / day until we are sure that the body can tolerate it. The patient should be given vitamins and mineral drugs (vitamin B complex + iron). 3- Fat : 20% (vegetable source) and in the case of low bile secretion, fat is limited to (30-40 g/day). 4- Carbohydrates: 55-60% (it is preferable to eat bee honey, as it stimulates the liver to work 5- Meals are small and frequent 6- Fluids and salts:* In the absence of ascites Na = 1000 - 2000 mg, In case of ascites (abdominal) or edema of the legs: Na (200-500 mg/day) should be determined. The amount of fluid is determined based on the amount of urine excreted If there is renal failure + hepatic failure (determine potassium)  Home work Design a full day diet for Ahmed that suffer from liver cirrhosis, with age 60 year, his body weight around 90 kg and height 170 cm with light activity