Discuss the causes, symptoms and dietary management of cirrhosis of the liver.

1. 1 · Open in two lines. Cirrhosis is chronic, irreversible scarring of the liver. Malnutrition is present in most patients and worsens the outcome.
2. 2 · Causes. Alcohol, chronic hepatitis B and C, fatty liver, autoimmune and biliary disease, copper or iron overload.
3. 3 · Draw how complications arise. [Flow: scarring → high portal pressure → ascites and varices; liver failure → low albumin, jaundice, encephalopathy]
4. 4 · Symptoms and complications.
   • Fatigue, anorexia, muscle loss, jaundice, bruising.
   • Ascites, varices, hepatic encephalopathy.
5. 5 · Diet principles. Energy 35 kcal/kg, protein 1.2-1.5 g/kg, carbohydrate in small meals with a late-evening snack, moderate fat, sodium about 2 g in ascites, fluid limit only if sodium is very low, soft food for varices, vitamins and zinc, no alcohol.
6. 6 · Foods and menu. Include and avoid lists, then a salt-free one-day menu.
7. 7 · Close in one line. The liver cannot un-scar, but good nutrition slows decline and prevents complications.

Scoring tip: Show you know the change in protein advice: older books restrict it, current guidelines do not. Write both and say which is current.