Manejo nutricional da cirrose hepática e suas complicações em pacientes hospitalizados / Nutritional management of liver cirrhosis and its complications in hospitalized patients

ABSTRACT BACKGROUND: Cirrhosis is a chronic and progressive liver disease that occurs from prolonged hepatocellular injury. Malnutrition causes complications in cirrhosis patients that worsen the condition to liver failure. Both are closely linked and increase the chances of morbidity and mortality. Regular nutritional screening and monitoring is prime concern for such patients including comprehensive dietary history, laboratory tests, and evaluation of muscle loss and strength capabilities to determine the degree of frailty. For efficient assessment of liver cirrhosis patients Subjective Global Assessment has been used worldwide. The nutritional objectives for such individuals should be to regain liver functions, to prevent complications associated, and to overcome nutritional deficiencies causing malnutrition. METHODS: We conducted a literature review using PubMed, Google Scholar and Science Direct for this purpose, a total of 130 articles were reviewed out of which 80 (from the past 5 years) including originally published research, review articles and abstracts were also included. Exclusion criteria of the selected studies was year of publication, irrelevancy and animal studies based on the purpose of current study. The aim of this study was to check nutritional management in patients having complications of liver cirrhosis. RESULTS: According to the guidelines, for the conservation of normal nutritional status of the malnourished patients', energy should be provided 35 kcal/kg/day while to prevent hypoalbuminemia and maintain the protein stores in the body, 1.5 g/kg/day protein has been recommended. Carbohydrates and fats for cirrhosis patients are recommended 50% to 60% and 10% to 20% of the total dietary intake respectively. CONCLUSION: Initial identification and prevention of malnutrition have the probability to lead to better health outcomes, prevention of complications of the disease, and improving quality of life.

RESUMO CONTEXTO: A cirrose hepática é uma doença crônica e progressiva que ocorre por lesão hepatocelular prolongada. A desnutrição causa complicações em pacientes com cirrose que pioram a condição para insuficiência hepática. A cirrose e a desnutrição estão intimamente ligadas e aumentam as chances de morbidade e mortalidade. O rastreamento e monitoramento nutricional regulares são as principais preocupações para esses pacientes, incluindo histórico alimentar abrangente, testes laboratoriais e avaliação de capacidades de perda muscular e força para determinar o grau de fragilidade. Para uma avaliação eficiente de pacientes com cirrose hepática, a Avaliação Global Subjetiva tem sido usada em todo o mundo. Os objetivos nutricionais desses indivíduos devem ser recuperar as funções hepáticas, prevenir complicações associadas e superar deficiências nutricionais que causam desnutrição. MÉTODOS: Realizada uma revisão de literatura usando PubMed, Google Scholar e Science Direct para este fim, e um total de 130 artigos foram revisados dos quais 80 (dos últimos 5 anos), incluindo pesquisas publicadas originalmente. Artigos de revisão e resumos também foram incluídos. Os critérios de exclusão dos estudos selecionados foram ano de publicação, irrelevância e estudos em animais com base na finalidade do estudo atual. O objetivo deste estudo foi verificar o manejo nutricional em pacientes com complicações da cirrose hepática. RESULTADOS: De acordo com as diretrizes, para a conservação do estado nutricional normal dos pacientes desnutridos, a energia deve ser fornecida 35 kcal/kg/dia, enquanto para prevenir hipoalbuminemia e manter os estoques de proteínas no corpo, 1,5 g/kg/dia de proteína foi recomendada. Carboidratos e gorduras para pacientes com cirrose são recomendados de 50% a 60% e 10% a 20% da ingestão alimentar total, respectivamente. CONCLUSÃO: A identificação inicial e a prevenção da desnutrição têm a probabilidade de levar a melhores desfechos de saúde, prevenção de complicações da doença e melhoria da qualidade de vida.

Prevalence of different sonographic stages among newly diagnosed cases of chronic hepatitis C

Objective: To find the prevalence of different sonographic stages among newly diagnosed cases of chronic hepatitis C

Study Design: Cross sectional study

Places and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi, from June 2014 to December 2015

Material and Methods: All freshly diagnosed patients of chronic hepatitis C [CHC] with a positive anti-HCV and a positive PCR for HCV were subjected to ultrasound abdomen. The sonographic stage of CHC was decided as per previously defined criteria. Prevalence of each sonographic stage at the time of initial diagnosis was determined. Study population was divided in two groups of 'Early stage CHC' [sonographic stage I, II] and 'Advanced stage CHC' [sonographic stage III, IV, V]. Student's t-test was applied to compare the means of the values for different sonographic parameters in the two groups

Results: The study included 178 patients with male to female ratio of 1.86:1. Mean age was 47.5 +/- 12.5 years. Prevalence of sonographic stages I, II, III, IV, Va and Vb in study population was 68% [n=121], 12% [n=21], 9% [n=16], 6% [n=11], 3% [n=5] and 2% [n=4] respectively. 'Early stage CHC' and 'advanced stage CHC' showed statistically significant [p-value <0.01] difference between average values of liver size, portal vein caliber, mean portal vein velocity and splenic size

Conclusion: The prevalence of advanced stage CLD [stage III-V] among newly diagnosed cases of chronic hepatitis C is as high as 20% despite the availability of diagnostic facilities