16. Prognosis of Cirrhosis Child-Pugh and MELD Score Both used to determine prognosis of Cirrhosis (mortality and survival) Determine Need For Transplantation Used in studies to determine effect of treatment on liver function
26. Stages of Hepatic Encephalophay Stage Symptoms I Mild Confusion, agitation, irritability, sleep disturbance, decreased attention II Lethargy, disorientation, inappropriate behavior, drowsiness III Somnolent but arousable, slurred speech, confused, aggressive IV Coma
27.
28.
29.
30. Abnormal plasma amino acids: chronic liver disease Val 400 350 300 250 150 200 100 50 Thr Leu Ileu Lys Try Meth Phe Tau Asp Glu Ser Pro Gly Ala Tyr Orn His Arg Essential Non-Essential % of Normal Cerra, et al; JPEN, 1985 J. Y. Pang
31.
32.
33.
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35.
36.
37.
38.
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42.
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50. * Significantly different from both lactoalbumin and maltodextrin. 1 Some individuals were removed based on more than 1 criterion. 2 Cases with HCC were censored at the time of HCC diagnosis. 3 The number of withdrawn patients who died or progressed to exclusion criteria within 12 mo from entry into the study is reported in parentheses. 4 Including the patient lost to follow-up. Study Profile of BCAA Trial BCAA Lactoalbumin Maltodextrin Total number 59 56 59 Lost to follow-up 1 — — Intention-to-treat analysis 58 56 59 Events (death, any cause, or progression of liver failure to exclusion criteria) 9 (15.5%) * 18 (32.1%) 16 (27.1%) Removed from systematic follow-up 1 7 4 4 Development of HCC 2 1 1 2 Noncompliance to treatment 3 5 (1) 2 (1) 0 Side effects 3 4 4 (1) 2 (1) 2 Treatment-unrelated diseases — 1 — Regular 3-mo follow-up 42 (71.2%) * 34 (60.7%) 39 (66.1%) Admission to hospital 15 (35.7%) * 27 (79.4%) 28 (71.8) Admission rate (patients/y) 0.6 ± 0.2 * 2.1 ± 0.5 1.9 ± 0.4 Total no. d in hospital 195 * 327 520
63. Not significant Combining survival data regardless of window of f/u showed no significant Difference in survival between BCAA and controls
64.
65.
66.
67. TABLE 1 Randomized controlled trials of BCAA treatment in cirrhosis 1 1 bw, body weight; co, crossover study; pg, parallel group design. 2 Dietary BCAA not included. Data are in g/d except as noted. 3 Positive, BCAA significantly different; negative, BCAA not significantly different.
CHO metabolism : glycogenesis, glycogenolysis, gluconeogenesis Protein metabolism: deamination and transamination, synthesis of serum protein, blood clotting protein, lipoprotein Fat: converts fatty acids from diet and adipose tissue Acetyl-CoA, also synthesis of cholesterol and phospholipids Storage: fat soluble vitamins, B12, and other minerals Conversion of Vit. D to active form, carotenes to vit. A, vit. K to prothrombin