Chapter 25 - Liver Disease and Gallstones PDF

Understanding Normal and Clinical Nutrition Eleventh Edition Chapter 25 Liver Disease and Gallstones Copyright© 2016 Cengage Learning. All Ri...

Understanding Normal and Clinical Nutrition Eleventh Edition Chapter 25 Liver Disease and Gallstones Copyright© 2016 Cengage Learning. All Rights Reserved.  Introduction 1. The liver is the most metabolically active organ. 2. The liver plays a central role in processing, storing, and redistributing the nutrients provided by the foods we eat 3. The liver produces most of the proteins circulating in plasma. 4. Bile is produced in the liver emulsify fat during digestion. Between meals, this is stored in the gallbladder. 5. The liver detoxifies drugs and alcohol and processes excess nitrogen so that it can be safely excreted as urea Copyright © 2016 Cengage Learning. All Rights Reserved. Copyright © 2016 Cengage Learning. All Rights Reserved.  Disorders of the Liver Fatty Liver Hepatitis Copyright © 2016 Cengage Learning. All Rights Reserved.  Fatty Liver 1. Fatty liver is an accumulation of fat in the liver caused by An imbalance between the amount of fat produced in the liver and exported/used by the liver. Excess fat is packaged into VLDLs and exported to the bloodstream 2. Defects in metabolism, excess alcohol, or drug exposure are often the cause. 3. In non-alcoholic fatty liver disease, insulin resistance is the primary risk factor. Other causes of fatty liver include PEM and long-term TPN. 4. For some people, fatty liver disease is asymptomatic For others inflammation, liver enlargement and fatigue occur. 5. The two liver enzymes that are usually elevated in laboratory tests for fatty liver are ALT & AST Copyright © 2016 Cengage Learning. All Rights Reserved.  Fatty Liver Treatment of fatty liver – Eliminate factors that cause it – Example: If due to alcohol & drugs---discontinue use – Lowering blood lipid levels, weight loss, increase activity, medication to improve insulin sensitivity – Rapid weight loss discouraged Copyright © 2016 Cengage Learning. All Rights Reserved.  Hepatitis Hepatitis – Liver inflammation – Results from damage to liver tissue – Caused by infection with specific viruses ▪ Designated by A, B, C, D, and E – Other causes: excessive alcohol intake, exposure to some drugs and toxic chemicals, fatty liver disease, and autoimmune disease – Long-term hepatitis can lead to cirrhosis & liver cancer. Copyright © 2016 Cengage Learning. All Rights Reserved.  Hepatitis Viral hepatitis – Hepatitis A (HAV) ▪ Spread via fecal-oral transmission – Hepatitis B (HBV) ▪ Spread by infected blood or needles ▪ By sexual contact with infected person ▪ From mother to infant during childbirth – Hepatitis C (HCV) ▪ Spread by infected blood or needles ▪ Most progress to chronic illness; no vaccine Copyright © 2016 Cengage Learning. All Rights Reserved.  Hepatitis Copyright © 2016 Cengage Learning. All Rights Reserved.  Hepatitis Symptoms and signs – Depend on cause and severity of hepatitis – Mild or chronic---asymptomatic – Acute : fatigue, N/V, anorexia, pain in liver area, jaundice, fever, muscle weakness, skin rashes, joint pain Treatment of hepatitis – Supportive care (bed rest) and diet (avoid alcohol, drugs, supplements Nutrition therapy for hepatitis – Most people require no dietary changes Copyright © 2016 Cengage Learning. All Rights Reserved.  Jaundice Jaundice results when liver dysfunction impairs the metabolism of bilirubin, a breakdown product of hemoglobin that is normally excreted in bile and urine. Accumulation of bilirubin in the bloodstream leads to yellow discoloration of tissues Copyright © 2016 Cengage Learning. All Rights Reserved.  Cirrhosis Late stage of chronic liver disease Long term liver disease destroys liver tissue leading to scarring (fibrosis) Impaired liver function and may eventually result in liver failure Copyright © 2016 Cengage Learning. All Rights Reserved.  Cirrhosis Match these With these a) Fibrosis a) Late stage of chronic liver disease b) Cirrhosis b) Shrunken, irregular, nodular c) Scarring of the liver d) Impaired function, often resulting in failure Answer: A→C B→A,B,D Copyright © 2016 Cengage Learning. All Rights Reserved. Copyright © 2016 Cengage Learning. All Rights Reserved.  Cirrhosis Consequences of cirrhosis – Slowly progressing liver damage ▪ Symptoms: -Asymptomatic -fatigue, anorexia, weight loss -Later: anemia, bruise easily, more susceptible to infection -If bile obstruction: jaundice, fat malabsorption, pruritus ▪ The physical changes in liver tissue may interfere with blood flow, causing fluid to accumulate in blood vessels and body tissues. ▪ Advanced cirrhosis can disrupt kidney, lung, and brain function, and is usually associated with malnutrition. ▪ Laboratory tests for assessment of liver Copyright © 2016 Cengage Learning. All Rights Reserved. Copyright © 2016 Cengage Learning. All Rights Reserved.  Consequences of Cirrhosis – Portal hypertension The scarred tissue of a cirrhotic liver impedes the flow of blood. The restricted blood flow within the liver stimulates the release of vasodilators (and therefore, increased blood flow) in nearby arterioles, leading to a greater volume of portal blood. The increased portal blood coupled with resistance to blood flow within the liver causes a rise in blood pressure within the hepatic portal vein. Copyright © 2016 Cengage Learning. All Rights Reserved.  Consequences of Cirrhosis – Collateral vessels and gastroesophageal varices 1. blood flow through the hepatic portal vein obstructed 2. blood diverted to the systemic circulation via collateral vessel 3. these become enlarged and engorged with blood 4. These can rupture and cause bleeding Copyright © 2016 Cengage Learning. All Rights Reserved.  Consequences of Cirrhosis – Ascites ▪ Accumulation of fluid in abdominal cavity ▪ Indicates that liver damage is at critical ▪ A consequence of portal hypertension ▪ Causes discomfort, early satiety & malnutrition Copyright © 2016 Cengage Learning. All Rights Reserved.  Consequences of Cirrhosis Hepatic encephalopathy: abnormal neurological functioning Elevated blood ammonia levels Normally, the liver extracts this ammonia from portal blood and converts it to urea Malnutrition and wasting Copyright © 2016 Cengage Learning. All Rights Reserved. Copyright © 2016 Cengage Learning. All Rights Reserved. Stages of Hepatic Encephalopathy Copyright © 2016 Cengage Learning. All Rights Reserved.  Treatment of Cirrhosis Correct underlying cause of disease and prevent or treat complications Abstinence from alcohol Liver transplantation Medications (example diuretics, beta blockers) Copyright © 2016 Cengage Learning. All Rights Reserved.  Nutrition Therapy for Cirrhosis Protein-energy malnutrition and muscle wasting are common Energy – 25-40 kcalories per kg of dry body weight Protein – 1-1.5 grams per kg of dry body weight Carbohydrate and fat – Similar to general population – Insulin resistance (diabetes diet) – Steatorrhea (restrict fat to less tan 30%, mainly from MCT) Copyright © 2016 Cengage Learning. All Rights Reserved.  Nutrition Therapy for Cirrhosis Sodium – Sodium Intake restricted with ascites (2000mg/day) – Potassium intake to be monitored – Surgical puncture to remove excess fluid Vitamins and minerals- supplements Enteral and parenteral nutrition support Copyright © 2016 Cengage Learning. All Rights Reserved.  Nutrition Therapy for Cirrhosis Match these With these a) Protein-energy a) 25 to 40 malnutrition and wasting b) Spread throughout the day c) Common, and require b) Calories (kcal/kg) sufficient calories and c) Dietary substances to protein to maintain nitrogen avoid balance and body weight d) Alcohol, some herbal d) Protein (g/kg) supplements, vitamin/mineral megadoses Answer: e) 4 to 6 smaller meals and oral supplements A→C f) 1 to 1.5 B→A,E C→D D→B,F Copyright © 2016 Cengage Learning. All Rights Reserved.  Nutrition Therapy for Cirrhosis Match these With these a) Carbohydrate a) Recommendation is similar to b) Sodium those of general population c) Fat b) Fluid loss d) Fluid restriction c) Taken consistently throughout the e) Diuretic day to manage insulin resistance d) May be restricted due to ascites Answer: e) May be restricted to