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Chronic Liver Disease (CLD) (What is it? (The end stage of liver disease,…
Chronic Liver Disease (CLD)
What is it?
The end stage of liver disease
Completely damaged
Accumulation of scar tissue
Blockage of blood flow
All prevents normal function
Medical Treatment
Awaiting liver transplant
Conservative treatment
Nutritional Consequences
Correlation w severity of disease
Intermittent hepatic encephalopathy
Nutritional therapy
Complications of ascites
Malnutrition
Classifying the severity of LD
Child PUGH score
Grade B: 7-9 significant functional compromise
57-81% survival rate
Grade A: 5-6 Well compensated disease
80-100% survival rate in 2 yrs
Grade C: 10-15 decompensated disease
35-45% survival rate
MELD score
Uses creatinine, INR and bilirubin (strong indicators of 3mth survival
Ranges from 6-40 (higher = worse)
Used for prioritisation of organs for liver transplants
Prospectively developed and validated tool for assessing the severity of CLD and survival
Consequences
Ascites
Difficult to control w diet and diuretics
High mortality rate
Drainage is common
Malnutrition
How?
Insulin resistance
15-20% of pts are hypermetabolic
Inc macro metabolism
Inc gluconeogenesis (due to impaired storage, synthesis and breakdown of glucose
Inc pro & fat catabolism
Dec pro synthesis
Highly prevalent 50-90%
Hepatic encephalopathy