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clinical nutrition > chapter 19 book notes > Flashcards

chapter 19 book notes Flashcards

1
Q

What is the most metabolically active organ in the body? & why

A

-liver
-plays central role in processing & storing the nutrients provided by the foods we eat.

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2
Q

What proteins does the liver produce?

A

-most of the proteins that circulate in plasma,
including albumin, blood-clotting proteins, and transport proteins

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3
Q

What else does the liver produce?

A

-bile

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4
Q

the liver ??? drugs and alcohol and processes excess ?? so that it can be safely excreted as urea.

A

-detoxifies
-nitrogen

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5
Q

primary symptom of liver disease:

A

-fatigue, which often goes unnoticed

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6
Q

two most common disorders of the liver:

A

-fatty liver
-hepatitis

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7
Q

fatty liver:

A

-an accumulation of fat in liver tissue;
-an imbalance between the amount of fat produced in the liver and the amount the liver uses or exports to the blood via very-low-density lipoproteins

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8
Q

what causes a fatty liver?

A

-defects in metabolism
-excessive alcohol ingestion
-exposure to various drugs and toxins

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9
Q

nonalcoholic fatty liver disease

A

-unrelated to alcohol
-insulin resistance is the primary risk factor

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10
Q

what can accompany in a nonalcoholic fatty liver?

A

-type 2 diabetes mellitus, metabolic syndrome, and obesity

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11
Q

Additional causes of a fatty liver:

A

-protein-energy malnutrition
-long-term total parenteral nutrition

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12
Q

Fatty liver is estimated to affect as many as ??? of adults in Westernized countries
and nearly ?? percent of heavy drinkers.

A

-1/3
-90%

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13
Q

In many individuals, fatty liver is ??? and
causes no harm.

A

-asymptomatic `

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14
Q

In other cases, it may be associated with ???? , AND ?? and ?? (SYMPTOMS)

A

-inflammation (steatohepatitis)
-liver enlargement (hepatomegaly)
-fatigue

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15
Q

If inflammation and scarring develop, fatty liver may progress to…

A

-cirrhosis
-liver failure
-liver cancer

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16
Q

What is the most common cause of abnormal liver enzymes levels in the blood?

A

-fatty liver

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17
Q

Laboratory findings typically include elevated concentrations of what liver enzymes ?

A

-alanine aminotransferase (ALT) and aspartate aminotransferase (AST),
as well as triglycerides, cholesterol and glucose

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18
Q

What is the usual treatment for a fatty liver?

A

-eliminate the factors that cause it
-For example, if fatty liver is due to excessive alcohol use or a drug treatment, it may improve after the patient discontinues use of the substance

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19
Q

An appropriate treatment for patients with obesity or diabetes with a fatty liver is:

A

-weight reduction
-increased physical activity
-medications that improve insulin sensitivity

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20
Q

Dietary suggestions for a fatty liver:

A

-reduction in added sugars (especially fructose) and replacement of saturated with unsaturated fats.
-Mediterranean dietary pattern

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21
Q

hepatitis:

A

-infection of liver tissue with specific viruses that causes inflammation and damage
-A, B, C, D, and E

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22
Q

other causes of hepatitis:

A
  • excessive alcohol intake,
  • exposure to some drugs
  • fatty liver disease,
    -autoimmune disease.
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23
Q

long term hepatitis can lead to:

A

-cirrhosis and liver cancer

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24
Q

acute hepatitis is most often caused by infection
with what hepatitis viruses

A
  • A, B, or C
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25
Q

Hepatitis A virus (HAV):

A

-primarily spread via fecal–oral transmission,
- involves the ingestion of foods or beverages that have been contaminated
with fecal material

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26
Q

Outbreaks of HAV infection are often associated with :

A

-floods and other natural disasters,
-when sewage contaminates water supplies.

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27
Q

Vaccinations against HAV are recommended for high-risk individuals, such
as (5)

A

-international travelers,
-children living in communities with high disease rates,
-people experiencing homelessness,
-people who inject illicit drugs,
-persons with unsafe sexual behaviors

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28
Q

, routine vaccination is recommended for all
children at ?? year of age.

A

-1

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29
Q

HAV infection usually resolves within a few ?? and
does not cause chronic infection or permanent liver damage.

A

-months

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30
Q

Hepatitis B virus (HBV) is transmitted by infected

A

-blood or needles,
- by sexual contact with an infected person,
-from mother to infant during childbirth.

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31
Q

A major global health concern, HBV has infected as much as ?? of the world
population
chronic illness develops
in fewer than ?? percent of cases.

A

-half
-10%

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32
Q

Hepatitis C virus (HCV) is spread via infected ?? or ?? but is not readily
spread by ?? or ??

A

-blood or needles
-sexual contact or childbirth

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33
Q

HCV infection is currently the most
common bloodborne infection in the United States and is a leading cause of ???

A

-chronic liver disease

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34
Q

is there a vaccine for HVC?

A

-no

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35
Q

symptoms and signs of hepatitis:

A

-jaundice
-enlarged liver
-fatigue
-anorexia
-muscle weakness

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36
Q

Treatment of hepatitis:

A

-bed rest
-appropriate diet
-avoid substances that irritate the liver such as alcohol, drugs, and certain dietary substnaces

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37
Q

Does hepatitis A need medication to be resolved? what about B and C?

A

-NO
-YES

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38
Q

antiviral agents that can treat HBV AND HBC

A

-lamivudine and ribavirin,
-block viral replication, and interferon alfa, which both inhibits viral replication
and enhances immune responses

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39
Q

Nonviral forms of hepatitis may be treated with
??? and ??

A

-anti-inflammatory and immunosuppressant drugs

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40
Q

is hospitalization required for hepatitis?

A

-NO
-unless other medical conditions or complications hamper recovery

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41
Q

cirrhosis:

A

-an advanced stage of liver disease
-extensive scarring replaces healthy liver tissue

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42
Q

physical description of a cirrhotic liver

A

-shrunken, irregular, nodular appearance

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43
Q

Together, chronic liver disease and cirrhosis rank as the ?? leading
cause of death in the United States.

A

-11th

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44
Q

The chief causes of cirrhosis in the United States are

A

-HBC
-alcoholic liver disease,
-nonalcoholic fatty liver
-HBV

45
Q

Many patients with liver disease remain ?? for years.

A

-asymptomatic

46
Q

Initial symptoms are usually nonspecific and may include

A

-fatigue,
-malaise,
-anorexia,
-weight loss

47
Q

the decline in liver function can lead to metabolic disturbances: patients
may develop ?? , ?? easily, and be more susceptible to ??.

A

-anemia
-bruise
-infection

48
Q

If bile obstruction occurs, ?? , ?? , and ??
(itchy skin) are likely

A

-jaundice
-fat malabsorption
-pruritus

49
Q

The physical changes in liver tissue may interfere
with ?? flow, causing fluid to accumulate in blood vessels and body
tissues.

A

-blood

50
Q

Advanced cirrhosis can disrupt function of which organs?

A

-kidney, liver and brain

51
Q

?? liver enzyme levels are elevated in liver disease
because the injured liver tissue releases the ?? into the bloodstream

A

-serum
-enzymes

52
Q

Serum levels of ?? may be elevated if the liver is too damaged to
process the ?? or if bile ducts are blocked and prevent its excretion.

A

-bilirubin

53
Q

The impaired synthesis of plasma proteins in the liver reduces ??
levels and ??
blood-clotting time

A

-albumin-
-extends

54
Q

Liver damage also impairs the connversion of

A

-ammonia to urea, causing ammonia levels in the blood to rise

55
Q

A large volume of ? normally flows through the liver.

A

-blood

56
Q

The hepatic portal vein and hepatic artery together supply approximately ?? milliliters

A

-1500
-1.5 quarts each minute

57
Q

The scarred tissue of a cirrhotic liver ?? the flow of blood, ?? of which
is supplied by the portal vein

A

-impairs
-3/4

58
Q

The restricted blood flow within the liver stimulates
the release of ?? (and therefore, increased blood flow) in nearby arterioles leading to a greater volume of blood

A

-vasodilators

59
Q

portal hypertension:

A

-elevated blood pressure in the hepatic portal vein
-due to obstructed blood flow through the liver and a greater inflow of portal blood

60
Q

collateral vessels:

A

-blood vessels that enlarge or newly form to allow an alternative pathway for diverted blood, usually in GI tract and abdominal wall
-happens when blood is forced backward into the veins that normally supply the portal vein

61
Q

varices:

A

-abnormally dilated blood vessels

62
Q

what varices vulnerable to rupture because they have thin walls
and often bulge into the lumen

A

-esophageal varices
-gastric varices

63
Q

Within 10 years of disease onset, about ?? percent of patients with cirrhosis
develop ??

A

-50%
-ascites

64
Q

ascites:

A

-an abnormal accumulation of fluid in the abdominal cavity

65
Q

The development of ascites indicates that liver damage has reached
a ?? stage, as up to half of patients with ascites die within ?? years.

A

-critical
-5

66
Q

Ascites happens due to…..

A

-portal hypertension and sodium retention in the kidneys

67
Q

The elevated pressure within the liver’s small blood vessels (?? )
causes fluid to leak into ?? vessels and, ultimately, the abdominal cavity.

A

-sinusoids
-lymphatic

68
Q

The movement of water into the abdomen may be exacerbated by low levels of
serum ??

A

-albumin
-this protein helps retain fluid in blood vessels

69
Q

hepatic encephalopathy:

A
  • a neurological complication of advanced liver disease
    changes in personality, mood, behavior, mental ability, and motor functions.
70
Q

At worst what can also develop due to hepatic encephalopathy:

A

-amnesia,
-unresponsiveness
-hepatic coma

71
Q

Although hepatic encephalopathy is ??? with medical treatment, its presence suggests a ?? prognosis for the patient with liver disease, especially when the
neurological changes are more pronounced.

A

-reversible
-poor

72
Q

What is the exact cause of hepatic encephalopthay?

A

-unknown

73
Q

what elevated blood level is believed to contribute to some impairment of haptic encephalopathy?

A

-ammonia

74
Q

Normally, the liver extracts this ammonia from portal ?? and converts it to ?? , which is then excreted by the ?? . In advanced liver disease, the liver is unable to process the ammonia sufficiently.

A

-blood
-urea
-kidneys

75
Q

Most patients with advanced cirrhosis develop ?? and experience some degree of ??

A

-PEM
-wasting

76
Q

A liver transplant may be necessary for patients with advanced ??

A

-cirrhosis

77
Q

THE FOLOWING MEDICATIONS HELP TREAT CIRRHOSIS

A
78
Q

Individuals with portal hypertension and varices may be given ?? such as

A

–betablockers
-propranolol (Inderal) and nadolol (Corgard)
-REDUCES PORTAL BLOOD PRESSURE AND BLEEDING RISK

79
Q

Diuretics help to control portal hypertension and ascites; common examples
include

A

-spironolactone (Aldactone) and furosemide (Lasix).

80
Q

what treats hepatic encephalopathy by reducing ammonia production and
absorption in the colon?

A

-lactulose, a nonabsorbable disaccharide

81
Q

To stimulate the appetite and promote
weight gain, what can be prescribed?

A

-megestrol acetate (Megace) or dronabinol (Marinol)

82
Q

nutrition diet for cirrhosis

A

-high protein, high kcaloric

83
Q

Estimates of energy needs generally range from ?? to ?? kcalories per kilogram
of body weight per day

A

-30 to 40

84
Q

protein needs range from ?? to ?? grams of protein per kilogram
of body weight per day based on dry weight or an appropriate weight for height

A

-1.2 to 1.5

85
Q

In patients with hepatic encephalopathy, the
protein intake should be ?? ?? the day so that only modest amounts are consumed at each meal.

A

-soread throughout

86
Q

Protein restriction is rarely recommended because an
inadequate protein intake can worsen ?? and ??.

A

-malnutrition
-wasting

87
Q

what oral supplementation may improve neurological functioning in patients with hepatic encephalopathy?

A

-branched chain amino acids

88
Q

The muscle tissue in these patients typically sacrifices its own BCAAs
to assist with ?? detoxification; hence, BCAA supplementation may help to
prevent this damaging ?? breakdown and also reduce tissue ammonia levels.

A

-ammonia
-muscle

89
Q

In patients with fat malabsorption, fat intake may be restricted to less than
?? percent of total kcalories or as necessary to control steatorrhea

A

-30%

90
Q

Patients with ascites are generally advised to restrict
their ?? intake

A

-sodium

91
Q

treatment for ascities

A

-sodium restriction (no more than 2000mg per day)
-diuretic therapy to promote fluid loss

92
Q

Note that fluid restrictions are occasionally implemented
when ascites is accompanied by severe

A

-hyponatremia
-abnormally low sodium levels in the blood, a possible result of fluid overload

93
Q

Many patients find low-sodium diets??? , so some health practitioners may
allow a more liberal sodium intake and depend on diuretics to remove excess fluid.

A

-unpalatable

94
Q

If patients do not respond to sodium restriction and diuretic therapy, excess fluid may be removed from the abdomen by surgical puncture called ??

A

-paracentesis

95
Q

To prevent recurrent ascites what can be performed?

A

-transjugular intrahepatic portosystemic shunt:
-a passage within the liver that connects a portion of the portal vein to the
hepatic vein using a stent; access to the liver is gained via the jugular vein in the neck.

96
Q

If steatorrhea is present, fat-soluble nutrients can
be provided in

A
  • water-soluble forms.
97
Q

Patients with esophageal varices may find it easier
to ingest supplements in ?? form

A

-liquid

98
Q

In hospitalized patients who are unable
to consume enough food, ?? feedings may be infused overnight as a supplement
to oral intakes or may replace oral feedings entirely

A

-tube

99
Q

In patients with esophageal
varices, the feeding tube should be as ?? and ?? as possible to prevent
rupture and bleeding.

A

-narrow and flexible

100
Q

To avoid excessive fluid delivery, patients with ascites
typically require concentrated ?? solutions, which are infused into ??
veins

A

-parenteral
-central

101
Q

The most common illness that precedes liver
transplants is ?? liver disease, which accounts for about ?? percent of liver
transplant cases

A

-alcoholic
-23%

102
Q

Five-year survival rates among transplant recipients may be as high as
?? percent, depending on the cause of illness.

A

-80%

103
Q

Complications such as ?? and ???? worsen the prognosis for liver transplants

A

-ascites and haptic encephalopathy

104
Q

Correcting malnutrition ?? transplant surgery can
help to speed recovery after the surgery

A

-before

105
Q

The main concerns immediately following a transplant are

A

-organ rejection and infection

106
Q

what drugs reduce the immune responses that cause rejection of liver transplant but also raise risk for infection:

A

-immunosuppressive drugs
-prednisone, cyclosporine, tacrolimus

107
Q

Infections are a potential cause of
Death following a liver transplant; therefore, ?? and ?? medications are
prescribed to reduce infection risk.

A

-antiviral and antibiotics

108
Q

Immunosuppressive drugs can affect nutrition status in numerous ways by causing side effects that..

A

-affect the gastrointestinal
-nausea, vomiting, diarrhea, mouth sores

109
Q

The stress associated with transplant surgery increases ?? and ??
requirements.

A

-protein and energy
-so a high calorie, high protein diet will help meet the postsurgical needs of a transplant patient.

clinical nutrition (26 decks)

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