Ch 27: Liver disease

Question 1

What are fat requirements for patient with liver disease?

Answer 1

Fat requirement should be 30-40% of non-protein energy

Question 2

True or false: Protein restriction is indicated in management of liver failure/cirrhosis

Answer 2

False; high protein intake may lead to better outcomes in patients with cirrhosis and liver failure–protein restriction is rarely indicated

Question 3

What are common CAM therapies in chronic liver disease?

Answer 3

Vit E, Combined antioxidants, Glutathione prodrugs, SAM/Betaine, Zinc, Milk Thistle, BCAA, Probiotics

Question 4

In Cirrhosis taste abnormalities have been associated w/ which deficiencies?

Answer 4

Zinc and Mg

Question 5

For liver disease patients, which weight should be used in nutrition assessment?

Answer 5

Dry weight; • Estimate 3-5 kg of ascitic weight added to euvolemic weight for mild ascites, 7-9 kg for moderate, and 14-15 kg for severe. Alternatively, lowest recent BW or IBW can be used

Question 6

What is the treatment for Wilson’s disease?

Answer 6

Use of chelating agents to remove tissue copper and allow copper excretion in the urine; trientine and penicillamine are most often used .FDA has approved zinc acetate administered at dose of 50 mg of elemental zinc daily for treatment of Wilson’s; concomitant intake of oral supps with additional zinc should also be considered

Question 7

What is hereditary hemochromatosis?

Answer 7

Genetic disorder of iron overload that classically occurs as autosomal recessive in individuals. Iron accumulation affects liver as well as heart, endocrine system, and musculoskeletal systems; results in cirrhosis in late stages but can be cured if caught before onset of cirrhosis

Question 8

What are the micronutrients of concern in cirrhosis

Answer 8

Vit E, zinc, D, A, thiamine, iron, and manganese

Question 9

What are estimated kcal/protien needs for patient’s with liver disease?

Answer 9

35-30 kcal/kg/d and protein at 1.0-1.5 g/kg/d; • Total energy can also be estimated using 1.2-1.4 REE (kcal/d)

Question 10

In the US, what is among the most frequent reasons for a liver transplant?

Answer 10

NASH related cirrhosis

Question 11

What is Wilson’s disease?

Answer 11

Autosomal recessive disease caused by mutations affecting biliary copper transporter ATP7B

Question 12

What is the treatment for hemochromatosis?

Answer 12

Therapeutic phlebotomy, patients must also limit dietary iron intake and ETOH consumption, they should also void excess vit C specific supplementation and supplements containing iron

Question 13

If HE persists despite max medical therapy and eval for other causes of changes in mentation, what can be used to help meet patient’s nitrogen needs?

Answer 13

a BCAA enriched supplemental formula; although positive results are seen in some studies, there is variability limits and definitive conclusions can not be drawn about the routine use of BCAA

Question 14

Chronic cholestatic disease may cause what to be malabsorbed?

Answer 14

Calcium and lipid soluble vitamins;vdeficiencies of ADEK and usually present and correlate with bilirubin levels; oral supplementation of ADEK may be necessary especially if steatorrhea is present

Question 15

Which sources of protein may be preferable compared to animal protein in liver disease?

Answer 15

Dairy and vegetable protein may be preferable compared to animal protein b/c the former is better tolerated and may more effectively help eliminate ammonia in case of PSE

Question 16

What is the most common blood borne infection in the US?

Answer 16

Hepatitis C; most commonly acquired via IV drug use, but also occurs in transfusion recipients, HD patients, Vietnam vets, and healthcare workers stuck with needles.

Question 17

Which nutrient deficiencies are common in alcoholic liver disease?

Answer 17

Vit B12, B1 (Thiamin), and B6 (pyridoxine)

Question 18

In which situation is PEG contraindicated in liver disease patient?

Answer 18

Ascites

Question 19

What has become most common cause of liver disease in US?

Answer 19

NAFLD (hepatic manifestation of metabolic syndrome/insulin resistance). This can progress to cirrhosis

Question 20

_____ may also play a role in pathogenesis of NAFLD,

Answer 20

Fructose. Evidence is also emerging that the type /ratio of dietary fats can contribute to NAFLD, an increased fat intake w/ excessive omega 6 FA has been implicated in promoting necroinflammation; conversely, a diet containing MCTS in the absence of LCTs has been reported as hepatoprotective

Question 21

In advanced liver disease, why do patients enter starvation state within a few hours of fasting?

Answer 21

Loss of glycogen stores; this leads to peripheral muscle breakdown to provide AA for gluconeogenesis thus contributing to protein malnutrition

Question 22

FDA has not approved any therapy from NAFLD; though trials have demonstrated a benefit with what?

Answer 22

vit E therapy of 800 IU/D

Question 23

What are some lifestyle modifications recommended to treat NASH?

Answer 23

Energy restriction, avoidance of simple sugars, moderate-vigorous exercise, weight loss

Question 24

What metabolic abnormalities are associated w/ chronic liver disease?

Answer 24

Decreased CHO use and storage capacity plus increase in fat and protein catabolism which leads to chronic catabolic state and depletion of protein/lipid reserves

Question 25

Wilson’s disease patients should be instructed to avoid which food?

Answer 25

Avoid foods high in copper including liver, chocolate, mushrooms, shellfish and nuts

Question 26

Which nutrient deficiency is common in patients with chronic hep C?

Answer 26

Vit D deficiency

Question 27

Protein-energy malnutrition is most common in which type liver disease?

Answer 27

Cirrhosis; Protein-energy malnutrition is prevalent in all forms of cirrhosis; severe muscle wasting may be clinically apparent.

Question 28

Hypoglycemia, requiring dextrose infusions to maintain euglycemia, is most likely to occur in which type of liver disease?

Answer 28

Fulminant hepatic failure

Hypoglycemia is commonly seen in patients with fulminant hepatic failure and may result from impaired glycogenolysis, glycogenesis, gluconeogenesis and hyperinsulinemia requiring aggressive glucose administration. Patients are usually in a hypercatabolic state with an increase in energy expenditure and can become rapidly malnourished.

Question 29

Hepatic encephalopathy is most likely to be improved by which trace element?

Answer 29

Zinc

Question 30

Appropriate treatment for ascites includes restriction of what?

Answer 30

Sodium and fluid