Marty Hamilton, a 49-year-old carpenter, has just been diagnosed with cirrhosis, which is a consequence of his alcohol abuse over the past 25 years. Although he recognizes that he has an alcohol problem and recently entered an alcohol rehabilitation program, he is still drinking. At 5 feet 8 inches tall, Mr. Hamilton, who formerly weighed 160 pounds, now weighs 130 pounds. According to family members, he is showing signs of mental deterioration, such as forgetfulness and an inability to concentrate. He is jaundiced and appears thin, although his abdomen is distended with ascites. Laboratory findings indicate elevated serum concentrations of AST, ALT, and ammonia; reduced albumin levels; and hyperglycemia.

1. Do Mr. Hamilton’s laboratory values suggest liver disease? Compare the results of his laboratory tests with the values shown in Table 19-2.

2. From the limited information available, evaluate Mr. Hamilton’s nutrition status. What medical problem makes it difficult to interpret his present weight? Describe the development of that type of problem in liver disease, and explain how the diet is usually adjusted for such a patient.

3. Calculate Mr. Hamilton’s energy and protein needs. Describe the general diet you might recommend for him. What suggestions do you have for increasing his energy intake?

4. Explain the signify cance of Mr. Hamilton’s elevated blood ammonia levels. What are some signs that would indicate that he is undergoing mental decline?

5. Describe each of the following complications of liver disease: portal hypertension, jaundice, and gastro esophageal varices. What complication may result if the esophageal varices are not treated