Nutrition and Liver Disease
Terms
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- Liver Disease
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12th leading cause of death in the US
Malnutrition common in liver disease - Primary Cause of Severe Liver Disease in Adults
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Hepatisis C
Alcoholism- Affects both nutritional status and liver function. - Five functions of the Liver
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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
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1. Fatty Liver
- Alcoholic
- NAFLD
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
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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
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Liver enlargement
Inflammation
Fatigue
Liver Damage/failure
Abnormal liver enzymes/lipids - Fatty Liver Treatment
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Elimination of causing factors
- Alcohol abuse
- Drug therapies
Weight loss
BG control
Reduction in blood lipid levels - Hepatitis
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Inflammation of the liver
Due to viral infection (Hep C most common)
Hep C will progress to cirrhosis and liver failure
DIETARY TREATMENT
Eliminate EtOH
Vitamin/mineral supplementation - Cirrhosis
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Destruction of livers cells leading to impaired liver function
Scarring becomes extensive as the disease progresses
Eventually leads to liver failure - Complications of Cirrhosis
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Jaundice
Fatigue
Bruising and bleeding
Low bone mass
Increased blood NH3
Decrease albumin synthesis
Increase aldosterone
Malnutrition and wasting - Portal Hypertension
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Decrease blood flow through protal vein
- Increased BP in portal vein
- Enlarged veins (varices)
ASCITES
Decreased Alb and aldosterone - Ascites Defintion and Causes
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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
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Mood swings
Flapping tremors
Memory Loss
Coma - Hepatic Encephalopathy Causes
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DISTURBED NITROGEN BALANCE METABOLISM
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
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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 -
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
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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
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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.