Application of exercise in the clinical setting

Question 1

what 5 main functions does the liver have

Answer 1

• carb, lipid, aa, vitamin and mineral metabolism
• synthesis
• secretion
• detoxification - eg. ammonia into urea
• storage- glycogen

Question 2

how many deaths does chronic liver disease cause per year

Answer 2

2 million (and is increasing)

Question 3

normal process if the liver becomes inflamed or fibrosis occurs

Answer 3

• if you stop the things causing it then it is reversible and heals

Question 4

what is the problem with cirrhosis of the liver has been reached
- what can it then lead to likelihood of

Answer 4

only treatment is liver transplant as its irreversible
- liver failure, portal hypertension and cancer = death

Question 5

ways chronic liver disease causes frailty

Answer 5

• uses energy from muscles so reduces muscle mass, potentially reducing physical function and causing disability
• reduces aerobic capacity
• infection
• liver transplant and admission to hospital can be detrimental

Question 6

hyperammonia
- what is it

Answer 6

raised levels of ammonia (dangerous and needs to be treated)

Question 7

impact of malnutrition on metabolism

Answer 7

• reduced intake alters carb metabolism (glycogen synthesis) and reduces insulin sensitivity therefore reducing glycogen stores and causes starvation
• reduced fat intake reducing gluconeogenesis and energy fuel

Question 8

impact of Physical inactivity on human

Answer 8

• Fatigue, fluid overload, anaemia, pain, altered metabolism, mental health disturbances, muscle atrophy, increased adipose tissue

Question 9

impact of prehabilitation pre-liver transplant
- what is it

Answer 9

places patient in much better position to cope and recover dependency
- improving functional ability of patient prior surgery to allow better recovery

Question 10

measurements of frailty in CLD
- 4 for muscle mass
- 4 for physical function
- 1 for physical disability
- 2 for aerobic capacity

Answer 10

• CT, MRI, DEXA, ultrasound
• LFI (liver frailty index), gait speed, SPPB, 6MWT
• karnofsky scale
• CPET, DASI

Question 11

what is the LFI

Answer 11

liver frailty index
hand grip, balance test, 5 chair stands timed. Scores then give you a final index. Shown to predict mortality after transplant

Question 12

what is the DASI

Answer 12

Duke Activity Status Index
questionnaire which predicts VO2 peak and correlates with CPET

Question 13

physical frailty in sarcopenia
- what is sarcopenia
- what is causing the muscle protein breakdown
- what allows muscle protein synthesis

Answer 13

• loss of skeletal muscle mass and strength
• Physical inactivity, Malnutrition, Hyperammonia, Increased myokines
• medications, nutrition, exercise