Exam 2 - Liver Flashcards
What are lab tests that can be done for liver disease?
- hepatic excretion - bilirubin
- cholestasis tests - serum alkaline phosphatase
- hepatic enzymes - ALT, AST, serum lactic dehydrogenase
- serum proteins
- markers of speific liver diseases - hepatitis antibodies
What are the inherited liver diseases?
- hemochromatosis
- wilsons disease
- a1-antitrypsin deficiency
Hemochromatosis
- 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
Wilson’s disease
Autosomal recessive disorder associated with impaired biliary copper excretion
Treatment = copper kelators
α1-antitrypsin deficiency
- Causes cholestasis or cirrhosis and can lead to liver and lung disease
- Only treatment is liver transplant
Acute hepatitis
- Inflammation of the liver caused by virus, bacteria, toxins, obstruction, parasites or drugs
- contains specific antibodies to run labs for
Chronic hepatitis
- 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
Alcoholic liver disease
- 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
alcoholic related malnutrition
- 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
Fatty liver disease
- 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
What is MASLD?
Matabolic associated steatotic liver disease
What is the spectrum or progression of liver disease?
accumulation of fat in hepatocytes leads to fibrosis, cirrhosis and possible carcinoma
What is the treatment for MASLD?
- weight loss
- insulin sensitizing drugs
- 800 IU/day vitamin E
What are the risk factors for MASLD?
- drugs
- metabolic disorders (diabetes, obesity, dyslipidemia, metabolic syndrome)
- family history
- hispanic or asian
- age 40-50’s
What is cirrhosis?
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)
What are the clinical manifestations for Cirrhosis?
- 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
What is wernicke-korsakoff syndome?
Thiamin deficiency
- eventually will have brain involvement
- mentation - encephalopathy
- vision - nystagmus
- ataxia - gait, involuntary movements
What deficiencies can occur with liver cirrhosis?
B6, B12, thiamin, & folate
End Stage Liver Disease (ESLD) complications?
- malnutrition
- portal hypertension with varices
- ascites
- hepatic encephalopathy
- glucose alterations - leads to elevated glucose levels
- fat malabsorption
- osteopenia
What is portal hypertension?
- 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
What is ascites and what causes it?
- accumulation of fluid, serum protein, electrolytes in peritoneal cavity
- caused by increased pressure from portal HTN and decreased production of albumin (maintains osmotic pressure)
What is the recommended MNT for ascites?
- 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
What is hepatic encephalopathy?
- syndome of impaired mental status and abnormal neuromuscular function
- inability of liver to metabolize toxic substances
What is the recommended MNT for encephalopathy?
- 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
What is the recommended MNT for Cirrhosis and ESLD?
- 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
Liver transplant
- 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
Recommended MNT for pre liver transplant?
- 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
Recommended MNT for post liver transplant?
- 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
