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MNT > Exam 2 - Liver > Flashcards

Exam 2 - Liver Flashcards

1
Q

What are lab tests that can be done for liver disease?

A
  • hepatic excretion - bilirubin
  • cholestasis tests - serum alkaline phosphatase
  • hepatic enzymes - ALT, AST, serum lactic dehydrogenase
  • serum proteins
  • markers of speific liver diseases - hepatitis antibodies
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2
Q

What are the inherited liver diseases?

A
  • hemochromatosis
  • wilsons disease
  • a1-antitrypsin deficiency
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3
Q

Hemochromatosis

A
  • Inherited disease of iron overload (20-40g iron stored, high)
  • Absorb excessive iron from gut and store excessive amounts
  • one of the more common genetic liver diseases
  • treatment: regular blood draws
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4
Q

Wilson’s disease

A

Autosomal recessive disorder associated with impaired biliary copper excretion

Treatment = copper kelators

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5
Q

α1-antitrypsin deficiency

A
  • Causes cholestasis or cirrhosis and can lead to liver and lung disease
  • Only treatment is liver transplant
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6
Q

Acute hepatitis

A
  • Inflammation of the liver caused by virus, bacteria, toxins, obstruction, parasites or drugs
  • contains specific antibodies to run labs for
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7
Q

Chronic hepatitis

A
  • Defined: At least 6-month course of hepatitis or biochemical and clinical evidence of liver disease with confirmatory biopsy findings of unresolving hepatic inflammation
  • Most common causes: HBV, HCV, autoimmune hepatitis
  • labs: elevated bilirubin, alkaline phosphatase, serum AST
  • Symptoms: jaundice, dark colores urine, anorexia, fatigue, headache, nasuea, vomiting, fever
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8
Q

Alcoholic liver disease

A
  • Stages of Progression:
    Fatty liver (hepatic steatosis) - reversible
    Alcoholic hepatitis
    Cirrhosis (scarring): GI bleed, Encephalopathy, Portal hypertension, Ascites
  • Ethanol rapidly and completely absorbed even with malabsorption
  • Chronic consumption of >80 g of ethanol/day
  • pathways produce acetaldehyde which is highly toxic to liver
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9
Q

alcoholic related malnutrition

A
  • Replaces food in the diet
  • Pancreatic insufficiency, functional alterations of the intestinal mucosa
    Impairs amino acid uptake and protein synthesis
    Increases catabolism in the gut
  • Use of lipids and carbs is compromised
  • Widespread vitamin and mineral deficiencies
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10
Q

Fatty liver disease

A
  • Lipid accumulation > 5% liver weight = “Steatosis”
  • Increased availability and decreased degradation of fatty acids
  • must treat cause of fatty liver
  • present in 90% of chronic alcohol abusers
  • virtually asymptomatic - hepatomegaly most common clinical sign, severe symptoms include dark urine or light stools
  • slightly elevated AST & ALT - usually decrease within days of hospitalization
  • fatty liver is reversible
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11
Q

What is MASLD?

A

Matabolic associated steatotic liver disease

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12
Q

What is the spectrum or progression of liver disease?

A

accumulation of fat in hepatocytes leads to fibrosis, cirrhosis and possible carcinoma

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13
Q

What is the treatment for MASLD?

A
  • weight loss
  • insulin sensitizing drugs
  • 800 IU/day vitamin E
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14
Q

What are the risk factors for MASLD?

A
  • drugs
  • metabolic disorders (diabetes, obesity, dyslipidemia, metabolic syndrome)
  • family history
  • hispanic or asian
  • age 40-50’s
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15
Q

What is cirrhosis?

A

Chronic liver disease
- healthy tissue is replaced by scar tissue
- blood flow is blocked
- loss of liver function occurs
- most common causes are chronic alcoholism and HCV (hep c)

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16
Q

What are the clinical manifestations for Cirrhosis?

A
  • hepatomegaly
  • vitamin deficiences may lead to depressed Hgb and Hct (anemia)
  • symptoms: fatigue, weakness, nausea, poor appetite, malaise
  • jaundice, dark urine, light stools, steatorrhea, itching, abdominal pain, bloating
  • Wernicke-Korsakoff syndome
  • peripheral neuropathy
17
Q

What is wernicke-korsakoff syndome?

A

Thiamin deficiency
- eventually will have brain involvement
- mentation - encephalopathy
- vision - nystagmus
- ataxia - gait, involuntary movements

18
Q

What deficiencies can occur with liver cirrhosis?

A

B6, B12, thiamin, & folate

19
Q

End Stage Liver Disease (ESLD) complications?

A
  • malnutrition
  • portal hypertension with varices
  • ascites
  • hepatic encephalopathy
  • glucose alterations - leads to elevated glucose levels
  • fat malabsorption
  • osteopenia
20
Q

What is portal hypertension?

A
  • elevated blood pressure in portal vein caused by obstruction of blood flow through the liver
  • primary symptoms and complications include: ascites, GI bleeding from varices (enlarged blood vessels), encephalopathy
  • Parenteral nutrition may be needed during acute bleeds
21
Q

What is ascites and what causes it?

A
  • accumulation of fluid, serum protein, electrolytes in peritoneal cavity
  • caused by increased pressure from portal HTN and decreased production of albumin (maintains osmotic pressure)
22
Q

What is the recommended MNT for ascites?

A
  • encourage oral proteins/supplements
  • restrict salt to 2 g/d
  • restrict fluid to 1.5 L/day
  • diuretics
  • adequate kcal (small frequent meals due to satiety from pressure on abdomen)
  • vit/min supplements
23
Q

What is hepatic encephalopathy?

A
  • syndome of impaired mental status and abnormal neuromuscular function
  • inability of liver to metabolize toxic substances
24
Q

What is the recommended MNT for encephalopathy?

A
  • 95% of patients can tolerate up to 1.5 g/kg protein
  • no improvements shown with additional BCAA’s
  • probiotics may help by reducing ammonia levels
25
Q

What is the recommended MNT for Cirrhosis and ESLD?

A
  • 25-40 kcals/kg
  • up to 1.5 g/kg IBW protein
  • fat restriction less than 30% if steatorrhea present
  • 2 grams Na/day with ascites
  • mechanical soft diet with espophageal varices
  • water and fat soluble vitamin supplements, iron, zinc, and mg supplements
  • EN is preferred
26
Q

Liver transplant

A
  • considered in cases where effects of disease have higher potential mortality than transplant
  • patients w/ alcoholism must be abstinent 6 months
  • requires psychological and nutritional evaluations
  • long term preventative nutrition to optimaize health and to avoid or minimize: excessive weight gain, hyperlipidemia, hyperglycemia, hypertension, osteopenia
27
Q

Recommended MNT for pre liver transplant?

A
  • 20-50% above basal for kacals
  • protein 1-1.5 g/kg
  • 2 gm/day Na
  • 2.5 L fluid/day
  • normalize macro and micronutrients
  • normalize blood sugar, nitrogen balance, relevant labs
28
Q

Recommended MNT for post liver transplant?

A
  • 20-30% above basal for kcals
  • 1.2-1.75 g/kg protein
  • 2 g/day Na
  • fluid as needed
  • other nutrients individualized based on immunosuppressant drug regimen - could cause hyperglycemia, Na & K retention
  • provide DRI for vitamins

MNT (16 decks)

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