Ch. 25 Liver Diseases Flashcards
The portal vein carries blood from ____ to ____.
Digestive tract; liver
About how much blood is estimated to pass through the liver?
70-80%
What are important functions of the liver?
Produce bile (emulsifier of fats; stored in gallbladder)
Detox
Heme metabolism
Storage (glycogen, fat, fatty acids, fat-soluble vitamins)
Synthesis of fat and proteins
What is a fatty liver?
An accumulation of fat in the liver tissue
What can contribute to a fatty liver?
Alcoholic liver disease Exposure to drugs and toxic metals Obesity, diabetes mellitus, kwashiorkor and marasmus After GI bypass surgery Long-term TPN
Can fatty liver be seen in kids?
Yes
Are there different progressions to a fatty liver?
Yes
2013: Of liver disease deaths (aged ≥ 12 years), what percentage involved ETOH?
46.4%
What is cirrhosis?
Advanced stage of liver disease
Scar tissue replaces healthy liver tissue –> liver cells lose their function
Scarring becomes extensive as disease progresses
Leads to liver failure –> death
Can you get Cirrhosis from other factors besides ETOH?
Yes
Does the liver have the capacity to regenerate cells?
Yes
What color does a liver with Cirrhosis appear?
Orange
What are causes of Cirrhosis?
Chronic ETOH use
Chronic Hepatitis C infection
Fatty liver disease
Chronic Hepatitis B infection
Is Cirrhosis a systemic infection/disease?
Yes; infects whole body
Cirrhosis: Consequences
- Portal Hypertension
- Collaterals and Gastroesophageal Varices
- Ascites
- Jaundice
- Hepatic Encephalopathy
- Malnutrition and Wasting
Portal Hypertension
consequence of cirrhosis
Elevated blood pressure in the portal vein caused by obstructed blood flow through the liver
–scar tissue is what actually obstructs the blood flow
Collaterals and Gastroesophageal Varices
consequence of cirrhosis
Develop through gastrointestinal tract - become enlarged and engorged - may rupture - sometimes fatal
Ascites
consequence of cirrhosis
Abnormal accumulation of fluid in the abdominal cavity (“beer gut”)
Caused by portal hypertension
Water retention due to altered kidney function
Reduced albumin synthesis by the diseased liver
–albumin helps to hold fluid in the blood
Abdominal discomfort and early satiety –> leads to malnutrition
About how many patients with ascites die within a couple of years?
About half
Jaundice
consequence of cirrhosis
Yellow discoloration of tissues (sclera)
“yellowing of eyes”
Due to increase of bilirubin
Hepatic Encephalopathy
consequence of cirrhosis
Condition in advanced liver disease characterized by abnormal neurological functioning.
May result in:
- -changes in personality, reduced mental abilities
- -amnesia
- -seizures
- -hepatic coma
- -elevated ammonia levels
What’s the problem with increased ammonia levels and Hepatic Encephalopathy?
AA breakdown –> get ammonia –> liver extracts ammonia from the portal blood and converts it to urea
Much of the urea gets excreted by the kidneys
Advanced liver disease: ammonia can reach the brain –> get altered neurological symptoms
What macronutrient do we associate with ammonia?
Protein
Malnutrition and Wasting
consequence of cirrhosis
Risk of developing protein-energy malnutrition (PEM)
–they’re sick. They don’t feel like eating
Consume less food due to reduced appetite, fatigue, or gastrointestinal symptoms (ascites - early satiety)
Diet has lack of taste - limited sodium
Fat malabsorption - steatorrhea
Figure 25-1: Functions of the liver?
Receives nutrients from the digestive tract and processes them for distribution throughout the body
Figure 25-1: Functions of the Biliary System?
Includes the gallbladder, which stores and secretes bile, and the bile ducts, which conduct bile from the liver to the gallbladder and from the gallbladder to the intestine.
Figure 25-1: Function of the Hepatic Vein?
Returns blood from the liver to the heart
Figure 25-1: Function of the Hepatic Artery?
Supplies oxygen-rich blood from the heart to the liver
Figure 25-1: Function of the Portal Vein?
Carries nutrient-rich blood from the digestive tract to the liver
Figure 25-1: Function of the GI Tract Veins?
Transport absorbed nutrients to the portal vein
Cirrhosis Dietary Intervention if Malnourished
Increase kcal
Protein 0.8-1.2g/kg/d (dry weight)
–we don’t restrict protein as much as we used to
–reasonable balancing act when it comes to protein
Frequent small meals
Cirrhosis Dietary Intervention if Ascites
Sodium restriction (ex: less than 2,000 mg/d [2 g/d]) Fluid restriction (ex: 1,200-1,500 cc/d) Potassium
Cirrhosis Dietary Intervention if Esophageal Varices
Small, frequent meals, avoid irritants such as spicy foods
Cirrhosis Dietary Intervention if Fat Malabsorption
Restrict total calories from fat
Should you give alcohol to someone with cirrhosis?
NO
Can vitamin and mineral supplementation be a part of dietary intervention for those with cirrhosis?
Yes
