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Nutrition and Liver Disease


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Liver Disease
12th leading cause of death in the US
Malnutrition common in liver disease
Primary Cause of Severe Liver Disease in Adults
Hepatisis C
Alcoholism- Affects both nutritional status and liver function.
Five functions of the Liver
1. Carb, protein, and lipid metabolism
2. Detoxification of endo-exogenous substances
3. Vitamin storage
4. Synthesis of plasma proteins
- Albumin
- Prealbumin
- Clotting proteins
Bile and cholesterol synthesis
Four Signs of Liver Dysfunction
1. Fatty Liver
- Alcoholic
2. Jaundice: bilirubin increases in the blood
3. Decreased plasma proteins
- Albumin, clotting factors
4. Elavated Serum Enzymes
- ALT- Alanine transaminase
- AST- Aspartine transaminase
Fatty Liver Cause
Alcoholic liver disease
Exposure to drugs and toxic metals
Obesity, DM, kwashiorkor and marasmus
Post Gastrointestinal Surgery
Long-term parenteral nutrition
Fatty Liver Consequences 5
Liver enlargement
Liver Damage/failure
Abnormal liver enzymes/lipids
Fatty Liver Treatment
Elimination of causing factors
- Alcohol abuse
- Drug therapies
Weight loss
BG control
Reduction in blood lipid levels
Inflammation of the liver
Due to viral infection (Hep C most common)
Hep C will progress to cirrhosis and liver failure

Eliminate EtOH
Vitamin/mineral supplementation
Destruction of livers cells leading to impaired liver function
Scarring becomes extensive as the disease progresses
Eventually leads to liver failure
Complications of Cirrhosis
Bruising and bleeding
Low bone mass
Increased blood NH3
Decrease albumin synthesis
Increase aldosterone
Malnutrition and wasting
Portal Hypertension
Decrease blood flow through protal vein
- Increased BP in portal vein
- Enlarged veins (varices)
Decreased Alb and aldosterone
Ascites Defintion and Causes
Accumulation of fluid in abdominal cavity
1. Portal HTN
2. Water retention due to altered kidney function
3. Decreased alb sysnthesis by the liver

Treatment: Sodium restrictions and diuretics (if Na lower retrict fluids 1-1.5L)
Hepatic Encephalopathy (Hepatic Coma)
Neuropsycological disorder due to severe liver disease
Hepatic Coma Symptoms
Mood swings
Flapping tremors
Memory Loss
Hepatic Encephalopathy Causes
Hyperammononemia due to inability to remove NH3 from the blood
- Action of bacteria on unabsorbed protein in the colon
- Amino acid catabolism
Decreased branched chain amino acids
Altered uptake leads to decrease NT production in the brain
Hepatic Encephalopathy Treatment
Lactulose or anti-biotics
Protein restrictions if needed (40-60g/day) may increase to 1.2-1/5g/kg as tolerated.
Give Branch chain amino acids
Malnutrition and Wasting
PEM: protein-energy malnutrition
Consume less food due to reduced appetite, fatigue, or gastrointestinal symptoms
Fat Malabsorption
Unable to meet high energy needs
Cirrhosis Medical Nutritional Therapy
Energy: May range from 20-75% above basal energy expenditure depending
Based on desirable weight or dry weight (weight without ascites)
Protein 1-1.5g/kg
Treatment of Cirrhosis
Vitamin and mineral supplementation
If steatorrhea occurs use fat soluable vitamins in a water soluable form.
CAUTION: Vit A toxicity can occur at lower intake levels in liver disease and alcoholism. Large doses of niacin can cause liver damage
Liver Transplants
Post-transplantation Concerns
Immunosupressive drugs are given to prevent rejections which can lead to infection
- Antibiotics and antivirals often prescribed
- Food saftey measures used
Liver Transplant
Side Effects of Immunosuppressives
N & V
Hyperglycemia and DM
Electrolyte and fluid imbalance
Alteration in taste
HTN, Hyperlipidemia, osteoporosis, and protein catabolism
High kcal, high protein, enteral supplementation if nessecary.

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