Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications

Bémeur, Chantal; Butterworth, Roger F.

doi:10.1016/j.jceh.2015.02.004

Cited by 18 publications

(19 citation statements)

References 126 publications

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“…Gentle exercise is recommended for cirrhotic patients to maintain musculoskeletal system and avoid sarcopenia and ameliorate osteopenia [72] Nutrition: Optimizing nutrition requirements is based on metabolic comorbidities, and degree of liver dysfunction to promote liver regeneration and remolding, and to prevent the development of protein and energy malnutrition and to maintain healthy musculoskeletal system [73] Supplements: Including vitamins, minerals, amino acids and herbs, should be accurately assessed, monitored and supplemented, if needed, under supervision of the treating physician [74] Social habits:…”

Section: Lifestyle Changesmentioning

confidence: 99%

Management of the patient with SVR

Terrault

Hassanein

2016

Journal of Hepatology

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In the current era of therapy with direct-acting antiviral (DAAs) drugs, achievement of a sustained virological response (SVR) is achievable in ⩾90% of hepatitis C-infected patients. SVR benefits are well-recognized with reductions in rates of liver complications, hepatocellular carcinoma and mortality. Additional benefits include reduced morbidity related to extrahepatic and systemic manifestations of hepatitis C such as renal, dermatologic, and metabolic complications. However, not all patients will derive all of these benefits and monitoring for progression is necessary, especially in those with more advanced fibrosis. To maximize the health benefits of SVR, counseling patients on best means to maintain good liver health and prevent reinfection are also important.

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Section: Lifestyle Changesmentioning

confidence: 99%

Management of the patient with SVR

Terrault

Hassanein

2016

Journal of Hepatology

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“…Determination of nutritional status in patients with cirrhosis can be difficult and is often inaccurate . Some of the common tools used to assess nutritional status such as whole body weight, unintentional weight loss, body mass index, and serum proteins are poor indicators of nutritional status and muscle wasting in patients with decompensated cirrhosis . The degree of malnutrition using these parameters is frequently masked by the presence of ascites, peripheral edema, and hepatic hydrothorax.…”

Section: Introductionmentioning

confidence: 99%

“…The degree of malnutrition using these parameters is frequently masked by the presence of ascites, peripheral edema, and hepatic hydrothorax. Standard nutritional assessment of the patient with cirrhosis thus includes subjective global assessment (SGA) of nutritional status and hand grip strength in addition to adequacy of oral intake, frequency of meals or snacks, changes in appetite, taste sensation, early satiety, and nausea …”

Section: Introductionmentioning

confidence: 99%

“…Alterations in carbohydrate metabolism, fuel utilization, and reduced glycogen storage in particular contribute to the development of malnutrition in patients with chronic liver disease (CLD) . It has been established that both the macro‐ and micronutrient requirements of patients with decompensated cirrhosis are altered as a result of the disease process . In 2006, the European Society for Enteral and Parenteral Nutrition published evidence‐based guidelines for the nutritional management of patients with cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

“…6 Some of the common tools used to assess nutritional status such as whole body weight, unintentional weight loss, body mass index, and serum proteins 7 are poor indicators of nutritional status and muscle wasting in patients with decompensated cirrhosis. 8 The degree of malnutrition using these parameters is frequently masked by the presence of ascites, peripheral edema, and hepatic hydrothorax. Standard nutritional assessment of the patient with cirrhosis thus includes subjective global assessment (SGA) of nutritional status 9 and hand grip strength 10 in addition to adequacy of oral intake, frequency of meals or snacks, changes in appetite, taste sensation, early satiety, and nausea.…”

Section: Introductionmentioning

confidence: 99%

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Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites

et al. 2017

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Background and AimAlterations in nutrient metabolism, nutritional requirements, and reduced dietary intakes are common in chronic liver disease (CLD). These result in malnutrition, sarcopenia, and exacerbate progression to decompensation and ascites. We aimed to investigate the effects of continuous tube feeding (TF) on nutritional status and levels of ascites in malnourished individuals with decompensated cirrhosis.MethodsFourteen malnourished patients with decompensated cirrhosis and ascites who failed to respond to standard oral nutritional interventions received supplementary continuous nasogastric TF for 7 ± 1 weeks. Liver disease severity was assessed by model for end‐stage liver disease (MELD) and Child–Turcotte–Pugh (CTP) scores.ResultsContinuous TF occurred at home for 7 weeks (1.5–12 weeks). Prior to feeding, 12 patients had severe ascites, 10 required paracentesis, and 13 were severely malnourished. At completion of TF, five patients did not have ascites, four had mild ascites, four had moderate ascites, and only one had severe ascites and 10 no longer required paracentesis (P < 0.001). Median patient survival was 26 ± 7 months. Five survived to transplantation and three remained transplant‐free at 8, 1.9, and 1.7 years. Seven patients were moderately malnourished at completion of TF with an overall improvement in hand grip strength from 51% to 65% of predicted (P = 0.02).ConclusionSupplementary continuous TF may help to reduce ascites and paracentesis requirements and improve nutritional status. Supplementary continuous TF should be considered as a treatment for malnourished patients with decompensated cirrhosis and refractory ascites.

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Treatment of AECHB and Severe Hepatitis (Liver Failure)

Wang

Dou

et al. 2019

Acute Exacerbation of Chronic Hepatitis B

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This chapter describes the general treatment and immune principles and internal management for AECHB and HBV ACLF, including ICU monitoring, general supportive medications/nutrition/nursing, immune therapy, artificial liver supportive systems, hepatocyte/stem cell, and liver transplant, management for special populations, frequently clinical complications and the utilization of Chinese traditional medicines. Early clinical indicators of severe hepatitis B include acratia, gastrointestinal symptoms, a daily increase in serum bilirubin >1 mg/dL, toxic intestinal paralysis, bleeding tendency and mild mind anomaly or character change, and the presence of other diseases inducing severe hepatitis. Laboratory indicators include T-Bil, PTA, cholinesterase, pre-albumin and albumin. The roles of immune indicators (such as IL-6, TNF-α, and fgl2), gene polymorphisms, HBV genotypes, and gene mutations as early clinical indicators. Intensive Care Unit monitor patients with severe hepatitis include intracranial pressure, infection, blood dynamics, respiratory function, renal function, blood coagulation function, nutritional status and blood purification process. Nursing care should not only include routine care, but psychological and special care (complications). Nutrition support and nursing care should be maintained throughout treatment for severe hepatitis. Common methods of evaluating nutritional status include direct human body measurement, creatinine height index (CHI) and subject global assessment of nutrition (SGA). Malnourished patients should receive enteral or parenteral nutrition support. Immune therapies for severe hepatitis include promoting hepatocyte regeneration (e.g. with glucagon, hepatocyte growth factor and prostaglandin E1), glucocorticoid suppressive therapy, and targeting molecular blocking. Corticosteroid treatment should be early and sufficient, and adverse drug reactions monitored. Treatments currently being investigated are those targeting Toll-like receptors, NK cell/NK cell receptors, macrophage/immune coagulation system, CTLA-4/PD-1 and stem cell transplantation. In addition to conventional drugs and radioiodine, corticosteroids and artificial liver treatment can also be considered for severe hepatitis patients with hyperthyreosis. Patients with gestational severe hepatitis require preventive therapy for fetal growth restriction, and it is necessary to choose the timing and method of fetal delivery. For patients with both diabetes and severe hepatitis, insulin is preferred to oral antidiabetic agents to control blood glucose concentration. Liver toxicity of corticosteroids and immune suppressors should be monitored during treatment for severe hepatitis in patients with connective tissue diseases including SLE, RA and sicca syndrome. Patient with connective tissue diseases should preferably be started after the antiviral treatment with nucleos(t)ide analogues. An artificial liver can...

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Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications

Cited by 18 publications

References 126 publications

Management of the patient with SVR

Management of the patient with SVR

Aggressive nutrition intervention reduces ascites and frequency of paracentesis in malnourished patients with cirrhosis and ascites

Treatment of AECHB and Severe Hepatitis (Liver Failure)

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