GI 3 Flashcards
liver cirrhosis definition
__ stage of progressive liver disease in which there is distortion of __ architecture
liver cirrhosis definition
late stage of progressive liver disease in which there is distortion of hepatic architecture
liver cirrhosis definition
__ formation of regenerative nodules that lack __ organization
liver cirrhosis definition
diffuse formation of regenerative nodules that lack normal organization
liver cirrhosis definition
nodules are surrounded by __
liver cirrhosis definition
nodules are surrounded by fibrous bands
development of cirrhosis steps
- liver cell injury
- activation of heaptic stellate cells (HSC)
- expansion of myofibroblasts
- fibrosis
- cirrhosis
3 mediators of activation of stellate cells and expansion of myofibroblasts
ROS
NO
TGF-beta
expansion of myofibroblasts causes increased
collagen
glycoproteins
proteoglycans
4 causes of liver cell injury
- HBV, HCV infection
- drugs and toxin
- autoimmune attack
- other causes
liver importance to nutrition (3)
- glucose homeostasis
- protein synthesis
- drug/toxin metabolism
impacts of malnutrition in liver disease
- increasingly recognized complications of ESLD
- very common (20-50% of patients with cirrhosis)
5 observed changes of liver disease and cirrhosis
- malnutrition
- direct complication of cirrhosis
- complications due to other organ systems
- physical inactivity
- environmental/organizational factors
malnutrition in liver disease and cirrhosis due to
- reduced oral intake
- malabsorption
- increased catabolic state/hypermetabolism
3 direct complications of cirrhosis
- altered catabolic state
- altered protein metabolism
- increased ammonia concentration (myotoxic)
altered catabolic state leads to
imbalance between energy needs and intake
altered protein metabolism causes
accelerated muscle breakdown
increased ammonia concentration (myotoxic) causes
destruction of skeletal muscle
3 complication due to other organ systems
- high circulating levels of inflammatory markers
- low levels of testosterone and changes in growth hormone secretion/sensitivity
- obesity
high circulating inflammatory markers leads to
reduced muscle protein synthesis and increased degradation
obesity leads to (3)
- metabolic dysregulation
- visceral fat accumulation
- insulin resistance
physical inactivity in cirrhosis
common in patients
environmental/organizational factors
- social determinants of health (health literacy, food insecurity, financial strain (including that on caregivers))
- lack of time during clinical visits to dedicate to nutrition
what is alcohol-associated liver disease
__ entity characterized by __ and __
what is alcohol-associated liver disease
distinct entity characterized by jaundice and liver function
prevalence of alcohol-associated liver disease in US
2%
morbidity and mortality and alcohol use:
incidence of alcohol-associated liver disease:
morbidity and mortality and alcohol use: increasing worldwide
incidence of alcohol-associated liver disease: increasing since pandemic
severe acute alcohol-associated hepatitis has mortality of up to __% at one month
severe acute alcohol-associated hepatitis has mortality of up to 25-40% at one month
alcohol is high in
calories
calories from alcohol __ other claories and cause reduced __ which leads to __
calories from alcohol displaces other claories and cause reduced intake from more nutritious sources which leads to nutritional deficiences
effects of alcohol on GI tract
1. shortening of __ in sm. intestine –> __
2. alteration of __
3. reduction in gut metabolism of __ –> impaired absorption of
effects of alcohol on GI tract
1. shortening of villi in sm. intestine –> impaired digestion and absorption
2. alteration of gut microbiome
3. reduction in gut metabolism of bile acids –> impaired absorption of fat and fat-soluble vitamins
alcoholism + coexisting chronic __ –> __ insufficiency –> impaired digestion of __
alcoholism + coexisting chronic pancreatitis –> exocrine insufficiency –> impaired digestion of macronutrients
alcohol-associated liver disease deficiencies
folic acid
thiamine
vit D
vit A
Mg
Zn
alcohol-associated liver disease
folic acid deficiency can promote __
folic acid deficiency may worsen __
alcohol-associated liver disease
folic acid deficiency can promote oxidative stress
folic acid deficiency may worsen alcohol-related liver injury
__% hospitalized patients with alcohol use disorder have folic acid deficiency
__% of patients with alcohol use disorder have thiamine deficiency
__% of patients with cirrhosis and __% with liver disease have vit D deficiency
__% of patients with cirrhosis have zinc deficiency
80% hospitalized patients with alcohol use disorder have folic acid deficiency
80% of patients with alcohol use disorder have thiamine deficiency
85% of patients with cirrhosis and 50% with liver disease have vit D deficiency
> 80% of patients with cirrhosis have zinc deficiency
why does thiamine deficiency occur in alcohol use disorder and what can it lead to
occurs bc inadequate dietary intake
impaired absorption
increased release/decreased uptake in liver
can lead to Wernicke’s encephalopathy or Korsakoff psychosis
vit D deficiency exaggerates alcohol-related __ and __
vit D deficiency exaggerates alcohol-related oxidative stress and liver injury
increased severity of liver disease = increased deficiency of __
increased severity of liver disease = increased deficiency of vitamin A
vit deficiency can cause
night blindness
hypogonadism
hypogeusia
insomnia
which vitamin deficiency should not be supplemented? why?
vit A bc it can be hepatotoxic
Mg deficiency occurs bc of
malabsorption and high renal excretion
Mg deficiency can increase
oxidative stress
Mg deficiency is associated with
poor cognition
reduced muscle strength
symptoms of zinc deficiency
muscle craps
taste alteration
encephalopathy
increased infections
how to treat zinc deficiency
some evidence for supplementation
(especially with severe encephalopathy)
timing of meals for liver disease
benefits on muscle mass
early morning breakfast
late evening snack
small, frequent meals and snacks every 3-4 hours while awake
protein guidelines
adults with cirrhosis:
critically ill adults with cirrhosis:
children with chronic liver disease:
protein guidelines
adults with cirrhosis: 1.2-1.5 g/kg ideal body weight
critically ill adults with cirrhosis: 1-2 g/kg ideal body weight
children with chronic liver disease: up to 4g/kg ideal body weight
protein guidelines focus on
diversity of protein sources
nutritional supplementation options for liver disease
- oral nutrition supplementation (NG tube feeds if patient still has issues)
- enteral nutrition
- parenteral nutrition (only for decomponsated (advanced) cirrhotic patients)
