CASE STUDY 4

LIVER DISEASE

INTRODUCTION TO LIVER DISEASE

There is little evidence that the liver ages and it can function well into old age if disease free. It
is also able to naturally regenerate lost tissue. Chronic liver disease is characterised by scarring
and destruction of the liver tissue. Early changes, such as 'fatty liver' (a build up of fat in the
liver cells) can progress via inflammation (hepatitis) and scarring (fibrosis) to irreversible
damage (cirrhosis). At this point, the liver will not be able to regenerate itself though further
damage can be averted. Most chronic liver disease is symptomless ('silent') and when symptoms
do develop, they are often vague such as tiredness, weakness, loss of appetite and nausea.

CAUSES

A variety of illnesses can affect the liver, for example,certain drugs like excessive amounts of
acetaminophen,and acetaminophen combination medications like Vicodin, Norco, and stains.

•cirrhosis

• alcohol abuse

• hepatitisA, B, C, D, and E,

• Epstein Barr virus (infectious mononucleosis),

• non-alcoholic fatty liver disease.

• Iron overload (hemochromatosis)

SYMPTOMS

• weakness and fatigue.

• weight loss

•nausea

•vomiting and yellow discoloration of the skin(jaundice)

PRINCIPLE OF THE DIET

-A high calorie , high protein , high carbohydrate, moderate or restricted fat high vitamin diet
helps in regeneration of liver and helps to prevent the formation of ascites .

GENERAL INFORMATION

Name :Mr.Raghavan

Age : 58 Years

Gender : Male

Hospital Number : 16033245

Ward Number : III A

Room Number : 310

Date of Admission : 6-12-2017

Date of Discharge : 13-12-2017

Occupation : coolie
Activity : Moderate

Approximate Income : Nil

Family History : Nil

MEDICAL HISTORY

Past Medical History : Nil

Present Complaints : Liver cirrhosis, Hypertension

Personal History : Nil

Diagnosis : Chronic liver disease.

NUTRITIONAL STATUS EVALUATION

ANTHROPOMETRIC ASSESSMENT

Weight(cm) = 76 kg

Height (kg) = 180cm

Body Mass Index (BMI) = Weight (kg)/ Height (m2) = 76/1.82 = 23

Ideal Body Weight (IBM)= Height -100 = 180-100 = 80kg

 BIOCHEMICAL ASSSESSMENT

PARAMETERS 6/12/17 REFERENCE VALUE

Hemoglobin 8.6 g/dl 13.5-17.0g/dl

PCV 36.9% 40-50%

Red cell count 3.29 m/cu mm 4.6-6.0m/cu mm

Platelets 1.31 L/µl 1.5-4L/µl

Neutrophils 64.6% 40-65%

Lymphocytes 20% 30-50%

E.S.R 75mm 5-15mm

Urea 50m g/dl 15-40mg/dl

Sercreatinine 1.5 g/dl 0.6-1.2mg/dl

SGOT 36 IU/L 5-40IU/L

SGPT 21 IU/L 5-40IU/L

Albumin 2.7 g/dl 3.5-5g/dl

Globulin 3.0 g/dl 2-3.5g/dl

Uric acid 0.6 mg/dl 0.5-7.0mg/dl

Ser potassium 5.2 mEq/L 3.8-5.0 mEq/L

Ser sodium 138 mEq/L 136-145mEq/L

Blood pressure 100/60 mmHg 120/80mmHg

BIOPHYSICALPARAMETERS

PARAMETERS VALUES REFERENCE VALUE

Blood pressure 126/90 120/80 mmHg

Body temperature 102 °F 98.7⁰F

Pulse rate 67/mnt 72/mnt

Respiration rate 23/mnt 12-16/mnt

CLINICAL ASSESSMENT

ORGANS OBSERVATION

Hair Dry

Nails Normal

Skin Normal

Eyes Normal

Mouth Normal

Neck Normal

DIETARY ASSESSMENT

TYPE OF DIET : Non vegetarian

FOOD FREQUENCY RECORD :

Sl. FOOD ITEM DAILY WEEKLY MONTHLY OCCASIONALLY

NO

1 Cereals 

2 Pulses 
3 Green leafy 
vegetables

4 Milk and milk 

products

5 Fish 

6 Meat 

7 Egg 

8 Fruits 

9 Nuts 

10 Fat and oil 

11 Sugar 

PAST DIETARY INTAKE PATTERN

TIMING FOOD ITEM QUANTITY

Early morning Tea 100 ml

Breakfast Uppuma 200 g

Coconut chatni 1/2cup

Mid-morning Apple juic 1 glass

Lunch Rice 300g

Bitter guard 1/2 cup

Amaranth 1/2 cup

Evening Tea 300 ml

Bread 2 no

Dinner Dosa 3 no

Coconut chatni 1/2 cup

APPOROXIMATE NUTRIENT INTAKE

Energy 188.2(kcal)

Protein 44.49 (g)

Carbohydrate 332.65(g)

Fat 33.96(g)

NUTRITIONAL STATUS OF THE PATIENT

According to the nutritional assessement of the patient Mr.Raghavan,56 years

old male was suffering from Chronic liver disease. The weight of the patient was 76kg and the
height of the patient was 180 cm. According to the body mass index, the patient was normal
(23kg/m2). The ideal body weight was 80kg. In biochemical analysis, shows that the values were
normal excep ESR,urea, serum creatinine,serum protein which was high. In clinical assessment,
hair was dry and all the other characteristics was normal .

TREATMENT

The patient was taking prescribed in the hospital

DRUGS
 Inj. Kephazon 1gm

Inj. Deriphyllin 1 lamp

Inj. Pantocid 40mg

Inj. Lasix 40mg

Tab. Udiliv 300mg

Tab. Becozuls 2mg

Levolinnebu 30mg

NUTRITIONAL CARE PLAN

GOALS OF NUTRITIONAL CARE PLAN

To increase the blood heamoglobin level through diet

To maintain body weight

To maintain biophysical biochemical parameters

To maintain blood pressure level

DIET ORDER/ DIET PRESCRIPTION

NUMBER OF DIET TYPE OF DIET

Day 1 Normal diet

Day 2 Normal diet

Day 3 Normal diet

DIET PRESCRIBED BY THE HOSPITAL

DAY 1
 MEAL TIME MENU QUANTITY

6.00am6.00am Tea 200ml

8.00am Dosa 180g

Onion chutney 60g

10.00am Oats 50g

12.30pm Rice 100g

Sambar 190g

Cabbage thoran 30g

Boiled sardine 100g

3.00pm Boiled Tapioca 70g

Pears 100g

8.00pm Chappathi 40g

Vegetable curry 180g

Sugar 25g

APROXIMATE NUTRIENT INTAKE

TIME FOOD INGREDIENT QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

ITEM
Early Tea Skimmed milk 200 58 9.2 5 0.2
morning Sugar 25 99.5 24.85 0.025 ---
Breakfast Dosa Rice 150 519 118.5 9.6 0.6
Black gram dal 30 104.1 7.2 17.88 0.4

Onion Onion 60 30 6.66 0.72 0.06

chatney
Mid Oats Oats 50 187 31.4 6.8 3.8
morning
Lunch Rice Rice 150 519 118.5 9.6 0.6

Sambar Red gram dal 35 117.25 20.6 7.805 0.595

Chilly 5 2.9 0.3 0.29 0.06
Brinjal 30 7.2 1.2 0.42 0.009
Ladiesfinger 60 21 3.84 1.14 1.2
Drumstick 30 7.8 1.11 0.75 0.03
Yam 30 33.3 7.8 0.4 0.05

Cabbage Cabbage 30 13.5 2.3 0.9 0.05

thoran

Boiled Sardine 100 101 -- 21 1.9

Sardine
Evening Boiled Tapioca 40 109.9 26.67 0.450 0.14
Tapioca

Pears Pears 100 52 11.9 0.6 0.2

Dinner Chappathi Wheat 40 136.4 28.48 4.84 0.68
Veg curry
Green garm dal 50 174 0.9 12.25 0.6
Mint 20 9.6 1.16 0.96 0.12
Curry leaves 20 21.6 3.74 1.2 0.2
Carrot 60 25.8 6.36 0.54 0.06
Coconut 20 88.8 2.6 0.9 8.32
Oil 10 90 ---- ----- 10

TOTAL 2009.65 325.7 94.5 29.274

PERCENTAGE 64 18 13.1

DAY 2

MEAL TIME MENU QUANTITY

6.00am Tea 200ml

8.00am Chapathi 40g

 Egg curry

30g

10.00am Tapioca 70g

Pears 100g

1.00pm Rice 150g

Vegetable curry 150g

Chutney 60g

Cabbage thoran 50g

Boiled sardine curry 100g

3.00pm Ragi porridge 50g

8.00pm Dosa 50g

Sambar 200g

Sugar 25g

APROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENT QUANTITY ENERGY CARBOHYDRATE PROTEIN FAT

Early Tea Skimmed milk 200 58 9.2 5 0.2

morning Sugar 25 99.5 24.85 0.025 ---
Breakfast Idli Rice 150 519 118.5 9.6 0.6

Sambar Black gram dal 30 104.1 7.2 17.88 0.4

MEAL TIME Red gram dal MENU QUANTITY
Chilli 35 117.25 20.6 7.805 0.595
6.00am Brinjal Tea 5 2.9 200ml0.3 0.29 0.06
Drumstick 30 7.2 1.2 0.42 0.09
8.00am Lady’s finger Idly 30 7.8 80g 1.11 0.7 0.03
Carrot 30 21 2.84 1.14 1.2S
Yam Sambar 30 12.9 180g3.18 0.27 0.03
20 33.3 7.8 0.4 0.05
10.00am Boiled tapioca 70g
Mid Boiled Tapioca Tapioca 70 109.9 26.67 0.49 0.14
morning 1.00pm Rice 100g
Lunch Rice Rice 150 519 118.5 9.6 0.6
Vegetable curry 150g
Veg curry Green gram dhal 50 17.4 9.9 12.25 0.6
Onion
Cabbage
20 thoran 40g
Curry leaves 10 2.22 0.24 0.02
Coccount 20 21.6 3.74 1.2 0.2
Mint Butter
30milk 133.2 3.9 100g 1.35 12.48
20 9.6 1.16 0.96 0.12
3.00pm Oats 50g
Oil
Cabbage thoran Cabbage 10 90 ---- ---- 10
30 13.5 2.3 0.9 0.05
Butter milk
Butter
8.00pmmilk 100
Chappathi 15 0.5 50g 0.8 1.1
Evening Oats Oats 50 187 31.4 6.8 3.8
Egg curry 120g
Dinner Chappathi Wheat 40 136.4 28.48 4.84 0.68
Sugar 25g
Egg Curry Egg 60 31.2 0.42 6.6 0.12

Onion 30 15 3.33 0.36 0.03

Tomato 30 6.9 1.08 0.57 0.3

TOTAL 2043 489.4 79.53 52.274

PERCENTAGE 62.03 15.5 23.02

DAY3
 APPROXIMATE NUTRIENT INTAKE

TIME FOOD ITEM INGREDIENT QUANTITY ENERGY CARBOHPROTEIN FAT

YDRATE
Early Tea Skimmed milk 200 58 9.2 5 0.2
morning Sugar 25 99.5 24.85 0.025 ---
Breakfast Chappathi Wheat 40 136.4 28.48 4.84 0.68

Egg Curry Egg 60 31.2 0.42 6.6 0.12

Onion 30 15 3.33 0.36 0.03

Tomato 30 6.9 1.08 0.57 0.3

Mid morning Boiled Thapioca Thapioca 70 109.9 26.67 0.49 0.14

Pears Pears 100 5.2 11.9 0.6 0.2

Lunch Rice Rice 150 519 118.5 9.6 0.6

Veg curry Green garm dal 50 17.4 9.9 12.25 0.6

Onion 20 10 2.22 0.24 0.02
Curry leaves 20 21.6 3.74 1.2 0.2
Coconut 30 133.2 3.9 1.35 12.48
Mint 20 9.6 1.16 0.96 0.12
Oil 10 90 ---- ---- 10

Cabbage thoran Cabbage 30 13.5 2.3 0.9 0.05

Chutney Onion 60 30 6.66 0.72 0.06

Boiled Sardine Sardine 100 101 ---- 21 1.9

Evingin Ragi porridge Ragi 50 164 36 3.65 0.65
Dinner Idli Rice 150 519 118.5 9.6 0.6

Sambar Black gram dal 30 104.1 7.2 17.88 0.4

Red gram dal 35 117.25 20.6 7.805 0.595

Chilli 5 2.9 0.3 0.29 0.06
Brinjal 30 7.2 1.2 0.42 0.09
Drumstick 30 7.8 1.11 0.7 0.03
Lady’s finger 30 21 2.84 1.14 1.2
Carrot 30 12.9 3.18 0.27 0.03
Yam 30 33.3 7.8 0.4 0.05

TOTAL 2124 368 97 18

PERCENTAGE 69 18 7.6

PROGRESS OF THE PATIENT

Problems oriented record: The patients come with bronchial effusion

Dietary problems: No dietary problems

Weight changes: No weight change

Biochemical parameters: Patient have low haemoglobin level and low PCV

CONCLUSION

Mr. Raghavan 58 year old man admitted in the hospital due to liver cirrhosis, hypertension .Heis
a known case of choronary liver disease. It was found from his anthropometric profile that his
BMI was 23 kg/m². Which shows that he is normal weight. On accessing the dietary habit it was
noticed that the calorie in take was high on the basis of diagnosis and nutritional assessment.
The diet counseling was given. The diet prescribed for the patient is high calorie , high protein,
high carbohydrate diet with liberal vitamins and minerals. At the time of discharge he will be
given conseling regarding to the importance of diet.