Hepatobiliary Flashcards
Average alcohol content of beer
3.8%. 12oz. in serving
Average alcohol content of unfortified wine
12-14%. 5oz.
Average alcohol content of fortified wine?
Brandy, sherry, port 20%. 1.5 oz. in a serving
Average alcohol content of distilled liquor
80 proof is 40%. 1 proof = .5%
Conversion factor for mL to oz.
30mL = 1 oz.
How to determine the grams of alcohol in a drink
X oz. × 30mL/oz. = YmL × Z% alcohol content = grams of alcohol
Functions of the liver
CHO, lipid, protein, enzyme, vitamin, and bile acid metabolism. Heme metabolism. Storage.
Liver function in carbohydrate metabolism
Glycogenesis, gluconeogenesis, oxidation via TCA cycle, glycogenolysis, glycolysis
direct bilirubin
aka. conjugated bilirubin. 0.1-0.3mg. Indicates biliary tree obstruction
hemolytic jaundice
Pre-hepatic. Increased destruction of RBCs with rapid release of bilirubin into the blood. Urine is dark, but the stool is normal in color because there is nothing wrong with the liver.
hepatic jaundice
Decreased uptake of bilirubin &/or decreased liver function. Caused by damaged hepatocytes.
post-hepatic jaundice
aka. obstruction jaundice. Obstruction of the bile ducts, which prevents excretion of bilirubin into the GI. Urine is dark, stools will be pale because bile is not reaching the GI tract.
indirect bilirubin
aka unconjugated bilirubin. 0.1-0.5mg. Indicates RBC hemolysis or liver damage
What lab values will be elevated in liver disease
Serum & urine bilirubin. Prothrombin time. ALT. AST. Alkaline phosphatase
Prodromal period of hepatitis
Before jaundice occurs.
Symptoms of the prodromal stage
Anorexia, fatigue, N/V
Acute fulminant hepatitis
↓ gluconeognesis. Fluid & electrolyte imbalance. Prolonged PTT. Bilirubin > 20 mg/dL
Medical treatment of Hepatitis
Bedrest. Corticosteroids. 3-MU Interferon α-2B. Rebetol.
3-MU Interferon α-2b
parenteral antiviral - blocks translate of viral DNA
Rebetol
RNA.e analog that inhibits replicate of Hepatitis C
What are the nutritional implication of hepatitis?
Weight loss and nutritional deficiency
What nutrients are needed for liver regeneration
High calorie, high CHO, 1.5-2g protein. Restrict fat if it causes N. Vitamins and minerals 2xRDA. No alcohol.
Hepatic steatosis
fatty liver, stage 1 of alcoholic liver disease. AST and ALT elevated. Benign and reversible. Increase in mobilization of fatty acids. ↓ in fatty acid oxidation; ↑ i triglyceride production; triglycerides are trapped in liver.
Alcoholic hepatitis
May be caused by a binge
Alcohol metabolism
EthOH is absorbed throughout GI tract. Ethanol →Acetaldehyde →Acetate
What are the two major enzyme systems that process alcohol?
Alcohol dehydrogenase. Microsomal ethanol oxidizing system (MEOS).
Effect of alcohol on folic acid nutriture?
Consume folate deficient diets. Absorption is impaired - reduced carrier. Binds folate in the hepatocyte & decreases enterohepatic circulation of folate.
Effect of alcohol on Thiamin status?
Thiamin deficient diet. Decreased uptake of thiamine from the GI. Impaired thiamin utilization. Activity level of 3-transketolase enzymes are ↓ - thiamin cannot be converted to TPP.
MNT for Alcoholic hepatitis
Treat withdrawal symptoms. Correct deficiencies. Multivitamin and mineral.
What micronutrients should be supplemented in Alcoholic hepatitis?
Thiamin 50-100mg/day - 14 day. Folic acid - 1mg. Vit C - 175-500mg. D 200-500IU. Selenium 5-50mcg. Mg - 100-400mg. All other RDA.
What factors contribute to increased ammonia?
Normal: 19-60 µg/dL. AA form ammonia after deamination. Urine output is decreased & BUN (10-20mg/dL) is retained. ↓ hepatic function causes decreased urea production. ↓ urea synthesis leads to ↑ ammonia
MNT for cirrhosis
Diruetic. Soft diet - varices. Moderate Na. 1-1.5g protein. 35-40kcal/kg. CHO spread out through day. Multi 2x RDA.
Serum lipase
0-110 U/L. Usually rises 24-48 hours after onset of pancreatitis, remain elevated for 5-7 days. Preferred lab for diagnosis.
Serum amylase
25-125 U/L. Highly sensitive but low specificity. Return to normal within 48-72 hours after acute insult - may remain normal in some pt.
Medical treatment for pancreatitis
Aggressive hydration. H2-receptor antagonists. Somatostatin - inhibits release of pancreatic secretions.
MNT for mild pancreatitis
Oral feeding of low-fat diet.
MNT for sever acute pancreatitis
Early EN - 24-48 hours - assists with prevention of infectious complications. Continuous associated w/ less stimulation of pancreas. Small peptides, fat-fee chemically defined formula
Should immune nutrition be used in pancreatitis?
No evidence to support its use. However, glutamine is indicated if PN used.
