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Dietetics written exam > Hepatobiliary Disease > Flashcards

Hepatobiliary Disease Flashcards

1
Q

Biliary system

A

Main = liver

Other - pancreas, stomach, gallbladder, common bile duct…

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2
Q

Liver functions (4)

A

Synthesis - proteins, cytokines, TAG, haem, bile salt
Storage - folate, glycogen, Vit A,D,E,K, B12
Metabolism - fat, CHO
Degradation - detoxification, inactivation of hormones, destruction of RBC

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3
Q

Chronic liver disease (3)

A

Compensated liver disease
Decompensated liver disease
Cirrhosis

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4
Q

Chronic liver disease:

A

Complications reflect degree of damage

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5
Q

Chronic liver disease:

Compensated

A

Asymptomatic

Can occur with up to 80% of liver damage

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6
Q

Chronic liver disease:

Decompensated liver disease

A

Syptomatic
Child-pugh classification system

Symptoms - ascites, jaundice, variceal bleeding, encephalopathy

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7
Q

Chronic liver disease:

Cirrhosis

A

Irreversible damage to liver
Hepatocyte replaced by fibrosis
Changes flow of blood through liver => portal hypertension -> ascites or varices
Metabolic changes - glucose intolerance, malnutrition

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8
Q

Types of liver disease

A 
Infections
Toxic
Cholestatic
Metabolic 
Vascular
Other (CF related)
Acute or chronic
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9
Q

Non-alcoholic fatty liver disease

A

May progress to CLD

Occurrence linked with - genetics, low P.A, high energy intake, overweight/obesity, insulin resistance

Symptoms - generally those considered harmless, e.g. fatigue, weight loss, weakness

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10
Q

Liver function tests:

Bilirubin

A

Pigment
Excretory product of haemoglobin
>17mmol/L = greater severity of damage

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11
Q

Liver function tests:

Aminotransferases

A

ALT/AST
Enzymes sensitive to liver damage
High levels can suggest obstruction or hepatitis

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12
Q

Liver function tests:

ALP

A

High in cholestatic liver disease

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13
Q

Liver function tests:

GGT

A

Sensitive marker of liver cell damage
High serum levels due to liver/biliary disease
Interpret with ALP to confirm liver damage

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14
Q

Liver function tests:

INR

A

Blood clot time
Produces + clears coagulating factors

Increase may be due to

  • low serum vit K
  • poor vit K utilisation
  • increased risk of bleeding
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15
Q

Liver function tests:

Alpha fetoprotein

A

Malignancy marker

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16
Q

Liver function tests:

Immunoglobins

A

Liver degraded antigen
Poor liver function = high circulatory antigens
Activated immune response (IgG, IgM, IgA)

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17
Q

CLD:

Symptoms

A 
Spider angiomas
Blotchy red skin
Easy bruising 
Very itchy skin
Hair loss
18
Q

CLD - symptoms:

Jaundice

A

Yellowing of eyes and/or skin

Accumulation of bilirubin

19
Q

CLD - symptoms

Hepatic encephalopathy

A

Neuropsychiatric signs of cerebral irritation
Unclear pathogenesis

To treat

  • bowel cleansing
  • remove precipitants
20
Q

CLD - symptoms

Steatorrhoea

A

Faecal matter full of fat
Impaired bile secretion
Decreased lipase action

21
Q

CLD - symptoms

Ascites

A

Excessive ECF in peritoneal cavity
80% cases due to liver cirrhosis
Most common cirrhosis complication
Diagnosis - swollen abdo or ultrasound (small vol)
Leads to - SOB, abdo pain, decreased mobility

22
Q

Nutritional assessment

A 
Require v detailed
A - weight, height, MUAC, handgrip
B - albumin, transport proteins
C - observation, history
D - consider reliability
23
Q

Calculating requirements

A

Use estimated dry weight if pt fluid overloaded

2 methods

  • energy/kg body weight
  • Henry equation for BMR + stress factor
24
Q

Malnutrition
More common in…
Contributing factors…

A

More common in decompensated

Contributing factors

  • clinical symptoms: steatorrhoea, odema
  • dietary: restrictions, unpalatable diet
  • treatment related: fluid restrictions, altered taste
25
Q

Dietetic aims

A

Symptom management
Increasing energy + protein intake improves - liver function, nutritional status, survival

Acute/end stage - minimise protein loss by meeting increased requirements w/o overfeeding

Early stage/post-transplant - recovery phase, increase or maintain bosy stores

26
Q

Early onset starvation

A

Cirrhosis prevents storage + release of glycogen
Even induced by 2hr fast

Prevention

  • regular meals
  • late night snack to shorten nocturnal fasting
  • study 2011: 50g CHO eve snack maintains lean muscle stores by sparing N utilisation overnight
27
Q

Nutritional support

A

Enteral feeding

Gastrostomy + jejunostomy contraindicated (e.g. impaired coagulation)

28
Q

Steatorrhoea treatment

A

Restriction of fat intake only if symptomatic (decrease to tolerance level to limit deficiencies)

Replace with CHO + protein foods (consider supplements)

May need to supplement with fat soluble vitamins

29
Q

Varices

A

Dilated veins in lower end of oesophagus

Medical/surgical - NBM until resolves, variceal banding

Dietetic - establish oral intake ASAP, NG tube with fine bore tube is safe

30
Q

Ascites treatment
Aims
(4)

A

Aims - 500ml net fluid loss/day + watch for dehydration

Sodium restriction - less Na available to be reabsorbed so less fluid retained, severe may promote malnutrition

Fluid restriction - 750-1500ml, only used when previous treatment ineffective

Diuretic therapy - blocks Na conserving mechanisms in kidney to result in increased urinary Na excretion (monitor for rapid weight loss)

Paracentesis - catheter inserted into peritoneal cavity to drain fluid, increased protein requirements, albumin loss

31
Q

Liver transplant

A

Treatment for end stage liver disease

32
Q

Liver transplant:

Malnutrition

A

Increased

  • infection rates
  • mortality
  • operative blood loss
33
Q

Liver transplant:

Obesity

A

Increased

  • wound infection rates
  • mortality
34
Q

Liver transplant:

Post-transplant

A

Metabolic response to injury
Early (12-14h) post-op feeding beneficial

Complications

  • hypertension (62-69% pts)
  • hyperlipidaemia (45-85% pts)
  • obesity (increased QoL + no restrictions)
  • drug-nutrient interactions
  • food bourne illness
  • bone disease
35
Q

Gallstones

A

May arise due to rapid weight loss (limit to 1.5kg loss/wk)
May cause cholecystitis or obstruction (pyrexia, nausea, poor appetite)
No evidence for low fat diet beyond healthy diet
Recommend healthy diet + weight loss if req

36
Q

Gallstones:

Cholecystectomy

A

Surgical removal of gallbladder
Diarrhoea may present post op
CHO rich drink prior surgery associated with decreased post op N+V

37
Q

Gallstones:

Dietary factors

A

Refined CHO
Dietary fibre
Alcohol (protective)

38
Q

Gallstones:

Symptoms

A

Asymptomatic
Pain
Jaundice

39
Q

Primary biliary cirrhosis (PBC)

A

Autoimmune disease
Chronic inflammation + destruction of intrahepatic bile ducts

Predominately females affected
Symptoms - jaundice, dark urine, steatorrhoea, increased lethargy

40
Q

Primary sclerosing cholangitis (PSC)

A

Inflammation + fibrosis bile ducts -> cirrhosis -> portal hypertension -> liver failure

41
Q

Treating PBC + PSC

A 
Treat cirrhosis as in CLD
Dietary advice for malnutrition
May need advice regarding fat malabsorption
Lifestyle advice
Consider Ca + vit D supplements

Dietetics written exam (48 decks)

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