CH. 20 Liver Flashcards
What are the functions of the liver?? (many)
- Central in processing, storing and redistributing nutrients.
1. Regenerative tissue
2. produces bile
3. detoxifies body
4. converts protein to ATP
5. Stores glycogen & fat sol. vitamins
6. Produces some blood clotting factor
7. Fructose and galactose converted to glucose
8. major gluconeogenesis site
9. Can store fat
10. Production of TG’s from fatty acids
11. Make cholesterol, transport via LDL’s to tissue.
12. synthesizes non-essential amino acids
13. Site for break down of dead red blood cells. Heme converted to bile acids and is excreted.
14. Hormone secretion and regulation
What is the spectrum of liver disorders?
Fatty liver—-Liver fibrosis—-cirrhosis—-liver transplant
Role of alcohol in fatty liver?
- Enhances lipolysis
- inhibits fatty acid oxidation in the liver
- inhibits release of VLDL into blood
- up regulates fatty acid transport proteins(moves from fat to liver cells)
Those @ risk for fatty liver?
- alcoholic liver disease
- exposure to drugs/toxic metals
- diabetes
- Metabolic syndrom
- obesity
- malnutrition: kwashiorkor(swollen belly from low protein)
- Long term TPN
- Obese children
NAFLD more common if?
- increased age
- increased BMI
- mexican american
- male
Symptoms of fatty liver?
- asymptomatic
- hepatomegaly(enlarged liver)
- inflammation
- fatigue
Elevated blood values for fatty liver?
- AST
- ALT
- TG’s
- Cholesterol
- Glucose
Treatment of fatty liver?
Goal is to eliminate causal factors:
- Alcohol abuse
- lower blood lipid levels
- weight reduction
- increase physical activity
What is hepatitis?
Liver inflammation
What causes hepatitis?
Any factor causing damage to liver tissue
- Usually from infection w/ virus
- Dont have to have fatty liver to get this. Can jump right ot this stage.
Other causes of Hepatits?
- Alcohol abuse
- Fatty liver disease
- Autoimmune disease
- exposure to drugs, herbs, toxic chemicals
Symptoms of Hepatitis?
-Slightly enlarge and tender liver
-Jaundice: From bilirubin
-Fatigue
-N/V
-Anorexia(low appetite)
-Pain in liver area and joints
-Fever
-Muscle weakness
-Skin rashes
-Elevated liver enzymes in blood: Raised: AST, ALT, Alk Phos, Bili
Lowered: Albumin
How is Hep A,B,C each contracted?
A: Fecal oral transmission
B: Infected blood, needles, sexual contact, mother to baby
C: Infected blood or needles
Which Hep has vaccinations?
A and B
How fast does Hep A resolve?
3-6 months
How much of the world infected with Hep B?
1/3
Prevelance of chronic illness in Heb B?
Less than 10 percent
Heb B contributes to 780,000 deaths per year world wide
.
Is Hep C spread by sexual contact?
Not usually
Hep C. almost always progresses to chronic illness and most common cause of liver disease in U.S.
.
Medical treatment for hepatitis?
- Bed rest
- Avoidance of alcohol, drugs, supplements that lead to liver damage
- Antiviral drugs
Dietary treatment for Hep?
- No standard treatment. You just address the general symptoms.
- Anorexia
- Malnutrition
- Low fat diet if steatorrhea(Give med. chain TRG’s)
- Fluid and Elec. replacement if vomiting
What is Cirrhosis?
- Final phase of chronic liver disease
- Extensive scarring (fibrosis)
- Smaller liver, irregular nodular appearance
- Eventually leads to liver failure
Causes of Cirrhosis?
- Alcohol
- Chronic Hep B,C
- Fatty liver
- Genetics
- Bile Duct blockages: Possibly caused by cystic fibrosis
Mild symptoms of Cirrhosis?
- Fatigue, weakness, anorexia, weight loss(from fat malabsorption)
- Anemia and easy bruising
- Poor circulation
- Jaundice & fat malabsorption(if bile obstruction)
Advanced symptoms of Cirrhosis?
- Portal hypertension
- Collaterals & gastroesophageal varices
- Ascites
- Hepatic encephalopathy
- Malnutrition & Wasting
What is portal hypertension?
The portal vein supplies blood to the liver. Scarring in the liver prevents blood flow which increases pressure in the portal vein.
What are collaterals?
newly established vessels that bypass the liver and put the blood right back into the portal vein
What are gastroesophageal varices?
Engorged blood vessels that are vulnerable to rupture
-May cause massive bleeding
What is Ascites?
Accumulation of fluid in abdominal cavity
Facts about Ascites….
- Result of sever liver damage
- 50% of cirrhosis patients get ascites
- Half with ascites die within 2 years
Mechanism for ascites?
- Damaged tissue causes portal HyperT…….2. Blood accumulates in abdominal cavity…….3. Decrease in arterial blood volume…….4. Vasoconstricters released……….5. Na & H2O retained by kidneys………6. Accumulation of body fluid….
OR
Low serum albumin (leakage of fluid)
What is hepatic encephalopathy?
altered neurological function
-If severe: amnesia, seizures, hepatic coma
cause of hepatic encephalopathy?
Exact cause unclear but it is thought to be caused by in increased levels of ammonia in the blood from not being converted to urea in the liver.
-Limit protein intake to avoid excess nitrogen
Treatment goals for cirrhosis?
- correct underlying cause of illness
2. monitor and manage complications
Medical treatment for cirrhosis?
- Depends on cause… Can include:
- Antivirals, antihypertensives, diuretics, antibiotics, appetite stimulants, ammonia reducing, antihyperglycemics
- Screening for gastroesophageal varices and liver cancer
Nutrition therapy goals for cirrhosis?
- Customized
- Treat complications like PEM, muscle wasting, ascites
- Avoid alcohol, herbal supplements, high doses of Vit’s/Min’s which may damage liver further.
Energy recommendations for cirrhosis?
- 20-40% above RMR
- No activity factor necessary if patient is sedentary
- If weight gain desired.. Add 500 kcal/day
Protein recommendation for cirrhosis?
- 0.8-1.2 grams/kg per day
- If hepatic encephalopathy- 0.8 g spread throughout the day
Fat recommendation for cirrhosis?
- If fat malabsorption exists, restrict to less than 30% of total calories
- MCT’s
- IF SEVERE: supplement fat soluble vitamins, calcium, magnesium, zinc at less than 100% RDA
Carb recommendation for cirrhosis?
- Watch for insulin resistance
- If IR, monitor carb intake and blood glucose levels
Vitamins and minerals recommendation for cirrhosis?
- Multi vitamin often necessary
- If esophageal varices, try liquid supplements
Fluid and sodium recommendations for cirrhosis?
-If ascites, restrict sodium to less than 2 g/day
Medical treatment for liver transplant?
Organ rejection: immunosuppressive drugs:
- GI side effects
- Hyperglycemia
- Electrolyte and fluid imbalances
- Hypertension
- Elevated blood lipids
- Protein catabolism
Infection
Nutrition therapy for liver transplant?
- Meet needs of symptoms
- High calorie and protein diet
- Enteral supplements
- Vit and Min’s
- Vigilant food safety!
