Cirrhosis -- or scarring of the liver -- is a serious disease that can block the blood and bile flow from your liver; in severe cases, a liver transplant is needed. Cirrhosis is often accompanied by malnutrition due to nausea and loss of appetite, as well as changes in the way your body absorbs nutrients. Although there is no cure for the condition, prompt, proper treatment of cirrhosis and associated malnutrition can slow the progression.
Cirrhosis Features
The liver plays a vital role in detoxifying harmful substances, purifying blood and producing vital nutrients. Mild cirrhosis allows the liver to continue to function; with more advanced scarring, function becomes impossible. Symptoms include fatigue, bleeding or bruising easily, fluid accumulation in the abdomen, swollen legs, nausea, loss of appetite and resultant weight loss. You may also experience yellowing of the skin or eyes, mental confusion and itching. Chronic alcohol abuse and hepatitis B and C are the main causes of cirrhosis in the United States. It can also be caused by cystic fibrosis, Wilson's disease, nonalcoholic fatty liver disease and hemachromatosis, or iron buildup in the body. If you have symptoms of cirrhosis, see your doctor.
Diagnosing Cirrhosis and Malnutrition
Although cirrhosis of the liver can be determined by blood test, CT, ultrasound, MRI and liver biopsy, malnutrition is not as easily diagnosed, especially in its early stages. In a 2002 article in the Journal of Gastroenterology and Hepatology, author Anthony Donaghy noted that ascites -- or swelling of the belly due to fluid retention -- can disguise malnutrition and interfere with a diagnosis; a technique called upper limb anthropometry, which measures skin fold thickness, is valuable in identifying malnutrition. Donaghy adds that assessing muscle strength is also an effective way of determining nutritional status.
Treating Cirrhosis
Cirrhosis is treated with a variety of medications including antibiotics, beta blockers -- which help lower the pressure in the vein bringing blood from the liver to the intestine -- and diuretics to reduce edema. A surgical drainage of fluid resulting from ascites and edema may be performed. If the liver fails, it must be replaced with a transplant, in which the liver is removed and replaced with a complete liver from a deceased donor or a partial liver from a live donor. Nutritional status deeply affects the outcome of liver transplants in adults.
Treating Malnutrition in Cirrhosis
Cirrhosis patients have higher protein and energy requirements and need more than 50 g of protein -- or 1 to 1.5 g per kg of body weight -- a day, ideally from fish, poultry and legumes. Your doctor may advise late evening feedings or overnight nasogastric feeding, as the cirrhotic liver can only provide glucose for six to eight hours of fasting, compared to the 36- to 48-hour span of healthy people. Cirrhosis also causes resistance to insulin and growth hormone; growth hormone supplements may be required to avoid breakdown of lean muscle mass, loss of muscle strength and impaired immune system. A low-sodium diet to ease edema is also recommended, as well as adequate amounts of fresh fruits and vegetables. Many cirrhosis patients develop osteoporosis as a result of not absorbing vitamin D properly. The use of biphosphonates for osteoporosis in cirrhosis patients is currently being studied.
