Disorders of the Liver

Question 1

What does the liver do?

Answer 1

produces bile: emulsifies fat

metabolize and store nutrients

detoxify drugs and waste products

*the liver does a lot so if something happens to the liver a lot will be effected

Question 2

What is a Fatty Liver?

Answer 2

accumulation of fat in liver tissue: liver enlargement (hepatomegaly)

asymptomatic: 20% or more people, reversible

Question 3

What are the causes of a Fatty Liver?

Answer 3

alcohol, too little protein, infection, cancer, drugs, obesity, diabetes

Question 4

What are the diet recommendations for a Fatty Liver?

Answer 4

depends on cause

Question 5

What is hepatomegaly?

Answer 5

liver enlargement

Question 6

What is Hepatitis ?

Answer 6

inflammation due to tissue damage

Question 7

What are the causes of Hepatitis?

Answer 7

viral infection (Hepatitis A, B, and C), alcohol, drugs, supplements (chaparral, senna, mistletoe, valerian root, jin bu huan, bee pollen, germander, skullcap, ma huang)

Question 8

What are the S/S of Hepatitis?

Answer 8

fatigue, muscle and joint pain, nausea, fever, pain in the liver area

jaundice

Question 9

What is jaundice?

Answer 9

bilirubin leaking into the blood stream

Question 10

What is the diet recommendation for hepatitis?

Answer 10

Depends of severity….

normal diet or high calorie diet, high protein

normally told to limit Fat intake b/c you don’t want a fatty liver on top of hepatitis

Question 11

What is Cirrhosis?

Answer 11

hardening of the liver with scar tissue

final stage of chronic liver disease, irreversible

impairs liver function, lead to liver failure

40% are Asymptomatic b/c liver disease progresses very slowly

Question 12

What are the causes of Cirrhosis?

Answer 12

alcohol, infection, bile duct disorders, congestive heart failure, drugs, supplements, genetic diseases

Question 13

How long after a Hepatitis infection does Cirrhosis begin?

Answer 13

between 10-20 years after a Hepatitis infection

Question 14

What are the complications of Cirrhosis?

Answer 14

Portal HTN
Esophageal Varices
Ascites
Poor fat absorption: malnutrition
Elevated blood ammonia levels
Hepatic Encephalopathy 
Decreased production of clotting factors (bruising and bleeding)

Question 15

What is Portal Hypertension?

Answer 15

high blood pressure in the portal vein

blood flow reduction to the liver: blood pressure increases

Question 16

What is Esophageal Varices?

Answer 16

diversion of blood to smaller blood vessels surrounding the liver (collaterals along the GI tract)

pressure build up creates dilation of collaterals

bulging vessels in the esophagus: varices

vulnerable to rupture b/c collaterals aren’t made to handle all the blood the liver is diverting to them.

if rupture occurs so will massive bleeding (lack of clotting factors with damaged liver)

Question 17

What are collaterals?

Answer 17

small blood vessels

Question 18

What is Ascites?

Answer 18

Fluid accumulation in the abdominal cavity

very last stage of liver damage

usually w/in 10 years of disease onset

indication that liver damage has reached critical stage: death within 2 years

Question 19

What are the 3 major factors that lead to fluid accumulation in the abdominal cavity (ascites)?

Answer 19

Portal HTN : causes fluid to leak from the blood vessels into the abdominal cavity

Reduced Albumin Synthesis : albumin retains water in the blood vessel, w/o it water will move out of the blood vessels into other tissue

Altered kidney function : Na and water retention

Question 20

What is Hepatic Encephalopathy?

Answer 20

abnormal neurological functioning (due to high ammonia levels)

Question 21

What is the diet therapy for liver problems/failure?

Answer 21

extra calories
high protein (depending on the severity b/c too much can give high ammonia levels with decreased liver functionality)
Vitamins and minerals
No alcohol and herbal supplements

Question 22

What does Ammonia (NH3) in the body come from?

Answer 22

protein breakdown and bacterial action

Question 23

How is urea made?

Answer 23

the liver binds CO2 with ammonia (from protein breakdown) to form urea…which is then excreted by the kidneys

Question 24

How does cirrhosis affect ammonia in the body?

Answer 24

with cirrhosis the liver cannot metabolize all the ammonia so the ammonia builds up and stays in the blood stream.

PROBLEM: if NH3 stays in blood stream it depresses the nervous system. eventually will give you disturbances and coma (HEPATIC COMA)

Question 25

Does all of the urea get excreted in normal conditions?

Answer 25

no, some of the urea may be reabsorbed in the kidney