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% Document Info
\author{Michellephillips02}
\pdfinfo{
  /Title (liver-disease.pdf)
  /Creator (Cheatography)
  /Author (Michellephillips02)
  /Subject (Liver disease Cheat Sheet)
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\noindent
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Liver disease Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Michellephillips02} via \textcolor{DarkBackground}{\uline{cheatography.com/214485/cs/46721/}}}
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\noindent
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Michellephillips02 \\
  \uline{cheatography.com/michellephillips02} \\
  \end{tabulary}
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 11th July, 2025.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{What is it?}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{any condition that damages the liver and affects its ability to function}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Progression:}} Healthy liver → Fatty Liver → Inflammation (hepatitis) → fibrosis of liver → cirrhosis liver (irreversible)} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{AKA: Healthy liver → NAFLD → NASH → cirrhosis}}} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
Hep A \& C & autoimmune disease \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
liver cancer & toxins (alcohol, smoking) \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
metabolic conditions & obesity \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
DM & hyperinsulinemia \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.32733 cm} x{1.23579 cm} x{2.01388 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Biochem}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Marker}} & {\bf{Expected in LD}} & {\bf{Explanation}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
LFT (ALP, GGT \& bilirubin) & ↑ & Bile flow is blocked (biliary obstruction, intrahepatic extrahepatic). They can also rise with liver tumours or obesity \tn 
% Row Count 9 (+ 7)
% Row 2
\SetRowColor{LightBackground}
AST \& ALT & ↑ & ↑ ALT only = mild hepatic damage.  ↑ ALT and AST = hepatic damage.  Markers of recent (hours/days) liver injury (though AST can also rise with muscle damage. Damage to liver cells = release of AST and ALT (found in hepatocytes). \tn 
% Row Count 23 (+ 14)
% Row 3
\SetRowColor{white}
CRP & ↑ & Marker of inflammation \tn 
% Row Count 25 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Albumin \& prealbumin & ↓ & Indicate cirrhosis and end stage liver disease.  Albumin is synthesised in the liver.  Poor indicator of nutritional status in liver disease patients. Correlate with the progression and severity of LD. \tn 
% Row Count 37 (+ 12)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
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\begin{tabularx}{5.377cm}{x{1.32733 cm} x{1.23579 cm} x{2.01388 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Biochem (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
Vit A, D, E, K & ↓ & Fat malabsorption (↓ bile) \tn 
% Row Count 2 (+ 2)
% Row 6
\SetRowColor{white}
Zinc & ↓ & Develops from low intake, poor absorption (↓ bile, ↓ albumin), and diuretic (treat ascites) loss; linked to taste changes, glucose issues, encephalopathy, poor healing, and weakened immunity. \tn 
% Row Count 14 (+ 12)
% Row 7
\SetRowColor{LightBackground}
Thiamine & ↓ & Stores \& activates @ liver. ↓ hepatic reserves and alcohol intake preventing the conversion into its active form. \tn 
% Row Count 21 (+ 7)
% Row 8
\SetRowColor{white}
B12 & ↓ (tissue), ↑ (serum) & Reduced hepatic stores.  Liver cells release stored B12 when damages. \tn 
% Row Count 26 (+ 5)
% Row 9
\SetRowColor{LightBackground}
Folic Acid & ↓ & Liver stores \& metabolises folate into its active form.  Reduced hepatic reserves \tn 
% Row Count 31 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.32733 cm} x{1.23579 cm} x{2.01388 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Biochem (cont)}}  \tn
% Row 10
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Calcium & ↓ & Vitamin D deficiencies \tn 
% Row Count 2 (+ 2)
% Row 11
\SetRowColor{white}
Selenium & ↓ & ↓ absorption and intake \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\begin{tabularx}{5.377cm}{x{2.63781 cm} x{2.33919 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Functions of the liver}}  \tn
% Row 0
\SetRowColor{LightBackground}
P, CHO, F metabolism & Drug metabolism \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Stores: fat sol-vits, zinc, iron, copper and magnesium}} & {\bf{Secretes bile – fat absorption}} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
Synthesis: albumin, prealbumin, retinol-binding protein \& clotting factors & {\bf{Stores glycogen}} \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{+ many more!} \tn 
% Row Count 9 (+ 1)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Stages}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/michellephillips02_1751851613_stages-of-liver-disease-for-cirrhosis.png}}} \tn 
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Child Pugh Score}}  \tn
% Row 0
\SetRowColor{LightBackground}
5-6 points & {\bf{Grade A}} = 85-100\% survival rate. Well compensated. \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
7-9 points & {\bf{Grade B}} = Significant functional compromise. 60-80\% survival \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
10-15 points & {\bf{Grade C}} = decompensated disease. 35-45\% survival rate \tn 
% Row Count 7 (+ 2)
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} x{4.4793 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{NIS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Liver stores glycogen = {\bf{unable to regulate blood sugar.}} Needing small regular meals} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Maldigestion \& malabsorption:}} reduced bile (fat malabsorption), pancreatic insufficiency} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Altered taste, nausea} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Portal hypertension:}} in advanced liver disease. Vessels in liver blocked (eg scaring) = Blood merges into portal vein in liver = ↑ pressure = backflow of blood} \tn 
% Row Count 9 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & {\bf{Oesophageal varices}} - dilated Abnormal veins – may bleed = reduced oral intake, dysphagia, text-mod \tn 
% Row Count 12 (+ 3)
% Row 5
\SetRowColor{white}
 & {\bf{Ascites}} - Abdominal swelling caused by accumulation of fluid. Malnutrition ↑s risk. Can't use a PEG. early satiety, fluid \& NA restrictions \tn 
% Row Count 17 (+ 5)
% Row 6
\SetRowColor{LightBackground}
 & {\bf{Encephalopathy (HE)}}– alters brain function. Confusion, memory, shaky, trouble talk/walk. inability to self-feed, dysphagia, tiredness, malaise (general feeling unwell). Stage 0 (no abnormalities)-4 (coma) \tn 
% Row Count 23 (+ 6)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{Jaundice:}} liver cirrhosis or liver cancer. Serum bilirubin \textgreater{}2.5-3 mg/dL. Loss of liver function to metabolise bilirubin (damaged hepatocytes) = bilirubin builds up} \tn 
% Row Count 27 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Nut Reqs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{USE DRY WEIGHT}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Compensated liver disease: 100-145kJ/kg/day (CQHHS)} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{NASH, cirrhosis, transplantation, hepatic encephalopathy: 145 – 165 kJ/kg/day (CQHHS), ESPN = 30-35kcal/kg} \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Protein: 1.2 -1.5 g/P/kg/d (CQHHS). 1.5 for cirrhosis} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Fat: Restrict if: signs of fat malabsorption. Don't remove as it's a source of fat-sol V \& concentrated energy} \tn 
% Row Count 11 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Na: 2g/day (CQHHS)} \tn 
% Row Count 12 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Risk of deficiency (alcoholic liver disease): folate, Vit C, B group} \tn 
% Row Count 14 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Prevent toxicity: Copper \& magnesium} \tn 
% Row Count 15 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Thiamine: 100mg OD-TDS} \tn 
% Row Count 16 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Vitamin D: 400-800IU/day} \tn 
% Row Count 17 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Vitamin K: 10mg every 4 weeks K: 10mg every 4 weeks} \tn 
% Row Count 19 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Calcium: 1200-1500mg/day} \tn 
% Row Count 20 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Zinc: multivitamin can be used} \tn 
% Row Count 21 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Intervention}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{NAFLD:}} Weight loss – similar to T2DM – {\bf{intensive lifestyle.}} & ↓ weight, lifestyle behaviours, euglycemia/normal lipids/normal BP = reduce portal hypertension \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{CLD (NASH, Cirrhosis):}} HPHE. {\bf{Malnutrition}} strategies. Maintain muscle mass.} \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Screen malnutrition (RFH-NPT) and Sarcopenia (SARC-F) - Prevent sarcopenia, severe fatty liver, infections, LOS, mortality, HE \tn 
% Row Count 14 (+ 7)
% Row 3
\SetRowColor{white}
 & Varices: softer foods without sharp edges to avoid bleeds \tn 
% Row Count 17 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & Ascites – Na 60 mmol/day (ESPEN) \tn 
% Row Count 19 (+ 2)
% Row 5
\SetRowColor{white}
 & {\bf{EN}} (NGT) – intake is \textless{}70-80\% of reqs (CQHHS) eg oesophageal varies. 1.5-2 kcal feed. \tn 
% Row Count 24 (+ 5)
% Row 6
\SetRowColor{LightBackground}
 & {\bf{PN}} – liver failure - 2-in-1 bag (no fat) \tn 
% Row Count 27 (+ 3)
% Row 7
\SetRowColor{white}
 & Thiamine supplementation before PN to prevent Wernicke-Korsakoff syndrome \tn 
% Row Count 31 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Intervention (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
 & Minimise fasting \tn 
% Row Count 1 (+ 1)
% Row 9
\SetRowColor{white}
 & BCAA Supps (12-14g/day delivered in the evening before sleep) \tn 
% Row Count 5 (+ 4)
% Row 10
\SetRowColor{LightBackground}
For alcoholic liver disease (not w/ cirrhosis): initial remove alcohol \& treatment withdrawal S/S. Correct deficiencies. & V\&M affected by alcohol: ↓ folic acid, thiamine, B6, niacin, Vit K, Vit C, Vit D, Vit A, iron, K, Mg \tn 
% Row Count 11 (+ 6)
% Row 11
\SetRowColor{white}
Refer & EP. Speechie \tn 
% Row Count 12 (+ 1)
% Row 12
\SetRowColor{LightBackground}
{\bf{Consider}} & DO THEY HAVE ASCITIES? Swallowing function, ability to self-feed, texture-mod, refeeding risk \tn 
% Row Count 17 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Strategies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Malnutrition strategies}} - ONS, EN/PN} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{6-8 meals/day. Max. 6-7 hours without any intake (CQHHS)} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Monitoring}}  \tn
% Row 0
\SetRowColor{LightBackground}
tolerance to feeds & wt \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
N/V/D & nut deficiencies \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
re-asses reqs & restriction changes \tn 
% Row Count 3 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Example PESS}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{NAFLD: Excessive oral intake, Food and nutrition knowledge deficit} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{NASH/Severe CLD: malnutrition, Inadequate protein-energy intake, Inadequate oral intake} \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Guidelines \& References}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{ESPEN guideline on clinical nutrition in liver disease (2019)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{ESPEN practical guideline: clinical nutrition in liver disease (2020)} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{FEEDS Gastroenterology and liver disease} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Central Queensland Nutrition guidelines for liver disease management 2019} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}