Abstract. NAVARRO-CASTILLO, Pablo. Handling decompensated cirrhosis. Acta méd. costarric [online]. , vol, suppl.3, pp. ISSN Un pobre estado nutricional se asocia con un peor pronóstico de supervivencia, lo que se ha demostrado en pacientes con cirrosis descompensada y en. Política de cookies. Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante.
Liver cirrhosis and encephalopathy: Servicio de Medicina Intensiva. El tratamiento nutricional reporta beneficios en los diferentes estadios de la enfermedad.
Cirrhosis represents the final stage of many chronic liver diseases and is associated to more or less pronounced hyponutrition, independently of the etiology, particularly at advanced stages.
Its origin is descompensaa, with three factors contributing to it: A poor nutritional status is associated with a poor survival prognosis. Whether caloric-protein malnourishment CPM is an independent predictor of mortality or only a marker of the severity of liver failure is subject to controversy.
There is no consensus on which are the best diagnostic criteria for CPM in cirrhosis. Assessment of hyponutrition is extremely difficult since both the disease itself and the triggering or etiologic factors affect many of the parameters used. Metabolic impairments mimic a hypercatabolic state.
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These patients have decreased carbohydrate utilization and storage capacity and increased protein and fat catabolism leading to depletion of protein and lipid reserves. These abnormalities together with decreased nutrients intake and absorption are the bases for CPM. The most important metabolic impairment in patients with advanced liver disease is the change in amino acids metabolism.
The plasma levels of branched amino acids BAA are decreased and of aromatic amino acids AAA are increased, which has therapeutic implications. Among the consequences of the structural impairments taking place in cirrhosis, we may highlight hepatic encephalopathy, defined as impaired central nervous system functioning that manifests as a series of neuropsychiatric, neuromuscular, and behavioral symptoms. These are due to the inability of the diseased liver to metabolize neurotoxins that accumulate in the brain affecting neurotransmitters and are attributed to the toxic effect of ammonium on the brain tissue.
Cirrosis y encefalopatía hepáticas: consecuencias clínico-metabólicas y soporte nutricional
Nutritional therapy brings benefits in the different stages of the disease. In the short term, it improves nitrogen balance, decreases the hospital stay, and improves liver function. In the long term, it decreases the incidence and severity of encephalopathy and improves quality of life. Supplementation with enteral nutrition may improve protein intake, decrease the frequency of hospitalization, and improve the nutritional status, the immune function and the disease severity. Protein restriction is not indicated in compensated cirrhosis.
In acute encephalopathy temporary protein restriction may be needed, which should not last longer than 48 h and be minimized since even in patients with liver disease better outcomes are obtained without obtaining severe protein restriction. Oral supplementation with BAA slows the progression of liver disease and improves survival and quality of life.
Pero la linfopenia y la respuesta inmune alterada son comunes en la cirrosis, incluso en el paciente bien nutrido. Estudios del metabolismo de los carbohidratos en la cirrosis han demostrado que la prevalencia de intolerancia a la glucosa es elevada Las alteraciones estructurales en la cirrosis tienen dos importantes efectos: Como hemos visto, su origen es multifactorial fig.
La hipoglucemia no es demasiado frecuente en la cirrosis, salvo en estadios muy avanzados de la enfermedad. El manejo general de la EH, con independencia del soporte nutricional, incluye 20, Deterioro agudo de la enfermedad de base cirrosis.
Control de los potenciales factores precipitantes. Se utilizan mayoritariamente dos clasificaciones para los pacientes con EH: Ausencia de cambios detectables en la personalidad o en la conducta.
Un resumen del tratamiento nutricional en las diferentes fases de la cirrosis se expone en la tabla II. El tratamiento nutricional reporta beneficios en los estadios avanzados de la enfermedad.
Los pacientes con cirrosis avanzadas deben recibir los alimentos convenientemente cocinados, dada la frecuencia de complicaciones infecciosas gastrointestinales que aumentan considerablemente la mortalidad Malnutrition in alcoholic and virus-related cirrosis. Am J Clin Nutr ; Current nutrition in liver disease.
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J Hepatol ; Relationship of protein calorie malnutrition to alcoholic liver disease: Alcohol Clin Exp Res ; Short and long term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: Clin Nutr ; Infectious complications of cirrhosis. Curr Gastroenterol Rep ; 4: Malnutrition in liver disease. Liver Transplant ; 6 Supl.
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J Parent Enteral Nutr ; Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: Effects of oral branched chain amino acid granules on eventfree survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol ; 3: Parenteral nutrition with branched chain amino acids in hepatic encephalopathy.
Vegetable versus animal protein diet in cirrhotic patients with chronic encephalopathy.
EASL – Clinical Practice Guidelines
A dewcompensada cross-over comparison. J Intern Med ; Effects of extra carbohydrate supplementation in the late evening on energy expenditure and substrate oxidation in patients with liver cirrhosis. Nutr Hosp ; Zinc supplementation and amino acid nitrogen matabolism in patients with advanced cirrhosis. Serrano Servicio de Medicina Intensiva. ABSTRACT Cirrhosis represents the final stage of many chronic liver diseases and is associated to more or less pronounced hyponutrition, independently of the etiology, particularly at advanced stages.
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