CASE STUDY

Liver cirrhosis

Presenter’s Name: Rameesha Sheikh

BS Nutrition (Semester VIII)
School of Public Health
Dow University of Health Sciences
 Patient’s Background
• Age: Sarah 26 y/o
• Gender: Female
• Occupation: Assistant professor.
• Present complain: Esophageal varices .
• Medical history: Liver Cirrhosis secondary to chronic hepatitis C infection.
 Anthropometric Measurements:

• Height: 5ft 9”

• Weight: 49 kg on admit.
*Her weight was 53 kg and lost 3 kgs in past 6 months

• BMI: 18.5 kg/m2 (Normal)

• IBW: 65 kg
 Biochemical Tests
• LFTs :

S.no Test Result Value Reference Value

1. alanine transaminase (ALT): 50 IU/ml 5-40 IU/ml

2. Aspartate amino 40 IU/ml 4-36 IU/ml

transferase
 Clinical Examination
• Appearance:
 Tired

• Extremities:
 Normal muscular tone, no edema

• Skin:
 Dry, bruising noted on lower arms and legs; telangiectasia's noted on chest

• Chest/Lungs:
 Respirations normal; no crackles, rhonchi, wheezes

• Abdomen:
 Mild distension, hepatomegaly; no ascites
 Dietary Assessment
Usual intake:

• Breakfast: Oat meal

• Lunch: Soup and bread & diet coke

• Dinner: Home or Chinese or fast food take-out

• Usual take sips of water, juice and diet coke

• Drinks Alcohol: 1-2 glasses

• *Currently having poor appetite since 15 days

 Nutrition Diagnosis

S.no Problem Etiology Sign and symptoms

1. Inadequate oral intake poor appetite Wt.loss in 6 months

2. Underweight Inadequate nutrient intake BMI of 18.5 kg/m2

3. Poor appetite esophageal varices Weight loss
 Nutrition Intervention
Nutrition Prescription:

• Soft diet (Blenderized)

• Adequate protein low sodium diet
• Sodium restriction:

• BMR: 1700 kcal

Macronutrient requirement:

• CHO: 50% i.e. 212 gm

• PTN: 30% i.e. 127 gm.
• FAT: 20% i.e. 37gm.
 Interventions and Goals
• Intervention#01: Sodium restricted to 1000 mg
• Goal#01: To prevent future fluid retention

• Intervention#02: Soft texture

• Goal#02: To prevent from more rupture of esophagus

• Intervention#03: High protein diet

• Goal#03: To gain BW, muscle building and regenerating tissue
 Implementation
S.no

1. Breakfast: ½ c Daalya with minced chicken

1 boiled egg

2. Mid-Morning 1 or 2 Seasonal ripe fruit

3. Lunch ½ cup lentils with boiled rice

½ cup yogurt (without fat)

4. Mid-Evening 1 mashed potato

smoothie Or lassi with 1 scoop bene ptn

5. Dinner ½ c kichri mix with mined qeema

½ custard

6. Bedtime 1 cup milk with 1 scoop bene ptn

 Monitoring
After one month follow up:

• Appetite becomes Fair

• Weight gain

• Tired to fresh energetic

 Goal Progress

After two months follow up:

• Gained 2 kg weight

• Blenderized to soft diet