- What is cirrhosis?
Cirrhosis is the final stage of chronic hepatitis. Normal liver parenchyma is replaced by fibrotic tissue, scars and nodules, leading to impaired liver function (liver failure).
Cause of cirrhosis?
- Infection with hepatitis B and C viruses.
Research shows that if you drink 1 shot of wine (250 ml) or half a liter of beer every day, within 10 years it can lead to cirrhosis. With people with hepatitis B and C viruses or people with existing liver diseases, cirrhosis progresses faster.
- Liver disease: fatty liver, long-term biliary tract disease, autoimmune hepatitis, liver cancer, …
- The liver accumulates metals such as iron (Haemochromatosis), copper (Wilson’s disease).
- Other causes: parasitic infection (Liver flukes), drugs (Methotrexate, Amiodarone), hepatic veno-occlusive disease (Budd-Chiari Syndrome), right heart failure, congenital…
How to detect (diagnose) cirrhosis?
There are often no, or unclear symptoms and the disease progresses silently. Initial manifestations may be:
- Feeling of indigestion.
- Loss of appetite and weight loss.
- Nausea, vomiting, stomachache.
- Or on the skin, there are blood vessel marks shaped like “little red spiders” (vascular asterisks).
When liver function is seriously impaired (late stage), there will be symptoms such as:
- Swollen legs or ascites
- Dark and yellow skin, yellow eyes
- Palmar erythema
- Vascular stars
- Bleeds easily (teeth, nose, stomach, intestines)
- Neuropsychiatric disorders
- In men: decreased sexual desire, enlarged breasts
Diagnosis is based on:
- Take history (such as drinking alcohol, using liver-damaging drugs, hepatitis, blood transfusion, family members with liver disease).
- Symptoms of the etiology or clear manifestations of late-stage disease.
- Blood test, ultrasound, endoscopy or CT scan or liver biopsy, in which liver biopsy is the “gold” standard for definitive diagnosis of cirrhosis.
How to treat cirrhosis?
If the disease is detected early, treatment can slow the progression to severe cirrhosis.
Treatment will depend on the cause of the disease such as:
- Alcoholism treatment program for alcoholics because alcoholics cannot be forced to stop drinking immediately.
- Or treat with medication for people infected with viruses B and C to prevent further liver damage.
- Or other treatment methods depending on the cause of cirrhosis. When the disease has complications (severe stages of the disease), treatment at that time is mainly to treat complications such as severe ascites, gastrointestinal bleeding, infection or treatment of hepatic coma.
- Liver transplant is the final solution for people with end-stage cirrhosis
- What is the impact of the disease on nutritional status?
The liver is considered a “factory” for processing and synthesizing (metabolizing), storing nutrients and detoxifying, to maintain all vital activities of the body. Nutrients (sugar, protein, fat, minerals or vitamins) from food, after being digested and absorbed into the blood, will be transferred to the liver to be “processed” (metabolized), stored and eliminated. Besides, the liver also has the function of metabolizing and eliminating alcohol.
Because the liver plays an important role in metabolizing such nutrients, once cirrhosis or liver failure will lead to indigestion, a feeling of being full quickly, loss of appetite, or a feeling of nausea… causing the patient to become malnourished. The frequency of malnutrition ranges from 20 – 60%. The more severe the liver failure, the more frequent and severe the malnutrition becomes. Severe malnutrition occurs in almost 100% of cirrhotic patients waiting for liver transplantation.
Malnutrition has the following symptoms:
- Anorexia or poor appetite (less than 50% compared to normal).
- Unintentional weight loss (in cirrhosis with no edema, with no ascites).
- Atrophy of skeletal muscle mass, loss of subcutaneous fat.
- Weak walking and fatigue.
Note: Rapid weight gain in a short period of time can be a sign of leg swelling or ascites.
- Instructions for choosing nutritional supplements for people with cirrhosis
If the patients are tired, eat little or are malnourished, they can supplement nutritional products with the following characteristics:
- Full of nutrients and balance between nutrients.
- Energy provided: After preparing 100mL for about 100kcal.
- Rich in BCAA (branched amino acids) (accounting for about 45-50% of total protein).
- Good fats: low in saturated fat, low in cholesterol, high in unsaturated fatty acids.
- Providing adequate minerals and vitamins according to Recommended Dietary Allowances (RDA).
- Manufactured by a highly reputable company.
- The product has been proven effective in clinical research.
References:
Instructions for nutritional care in cirrhosis (2023), Luu Ngan Tam MD. PhD., President of the Viet Nam Society for Parenteral Enteral Nutrition (VietSPEN), President of the Ho Chi Minh Society for Parenteral Enteral Nutrition.