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Nut. Mgt in CLD - Assessment (Biochem (Nutritional Pathology (fat soluble…
Nut. Mgt in CLD - Assessment
The Difficulties
Traditional indices are altered independent of nut status
Prothrombin time
Body wt
Albumin, pre-albumin
Body composition
Combination of tools and measures are recommended
Anthro
Mid arm muscle circumference
Skin folds
SGA
Hand grip strength
Ht, wt, BMI
Do not add oedema in wt
DO add ascites in wt
Body Composition
DEXA
BIA
Biochem
Renal markers
Electrolytes
Liver function tests:
Albumin - determinant of liver func
Ammoni - elevation indicates liver dysfunc
Bilirubin
Viral serology
ALP - elevation suggestion blocking in bile flow
Prothrombin time - effectiveness of blood clotting proteins
AST - elevated w ALT = LD
Partial Thromboplastin Time (PTT) - blood clotting proteins
ALT - elevated in LD, damage from hep, or other
Ammonia
Haemoglobin (Hgb)
Markers of infection - WBC, leukocytes
Markers of inflammation -CrP
Nutritional Pathology
fat soluble vitamins
trace elements
Client Hx
Previous encephalopathy
Comorbidities
Renal Impairment
T2DM
Cognitive and functional status
Medications
MVI, thiamin
Vit K
Diuretics
Laxatives
PPI
Abx
Aetiology and severity of LD
Fluid status
Do not add oedema in wt
DO add ascites in wt
Diet
Prior restriction no longer relevant ( E&P restriction
Use of CAM, MVI
Establish barriers to dietary intake (NIS, psychosocial factors
Food preferences - cultural, personal
Alcohol intake
Adequacy/frequency of intake
NFPF
Steatorrhea
Early satiety
Diarrhoea/constipation
Anorexia
N & V
Dysguesia