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DTC 330: Medical Nutrition Therapy > Liver > Flashcards

Liver Flashcards

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USMLE® Step 1 flashcards
1
Q

Hepatic artery

A

a branch of the aorta that carries oxygenated blood to the liver

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2
Q

Sinusoids

A

capillaries of the liver where the exchanges take place, they are lined by a single layer of endothelial cells with gaps between them.

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3
Q

Hepatic portal vein

A

brings blood from the capillaries of the small intestines. It is at low pressure and deoxygenated since it has already flowed through an organs capillary bed

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4
Q

Hepatic vein

A

blood leaves the liver via hepatic vein; deoxygenated, low pressure blood, does not contain a wide variety of nutrients since they have been dropped off in the lover for storage, returns to heart and lungs to be oxygenated.

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5
Q

Anatomy of the liver

A

4 lobes; right and left

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6
Q

Functional unit of liver

A

lobule

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7
Q

Primary blood reservoir amount

A

200-400ml

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8
Q

What happens when blood makes contact with hepatocytes

A

it is filtered and detoxified

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9
Q

Hepatocytes

A

A structural component of the liver that are large polyhedral cells organized as plates

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10
Q

Features of the sinusoids

A

allows large molecules (proteins) to be exchanged between hepatocytes and blood stream, and allow direct contact between blood and liver cells for maximum efficiency, they also contain Kupffer cells that breakdown older red blood cells.

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11
Q

acute (fulminant) hepatic/liver failure

A

the severe impairment of hepatic function in the absence of preexisting liver disease

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12
Q

alcoholic liver disease (ALD)

A

liver disease assoc with alcoholism

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13
Q

aromatic amino acids (AAA)

A

amino acids containg an aromatic side chain (Phenylalanine, tyrosine, and tryptophan)

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14
Q

Ascites

A

accumulation or retention of free fluid within the peritoneal cavity

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15
Q

asterixis

A

abnormal involuntary movements that primarily affect the extremities

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16
Q

astrocytes

A

star-shaped glial cells in the brain and spinal cord

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17
Q

bile

A

an emulsifying agent produced in the liver and eventually secreted into the duodenum

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18
Q

biliary cirrhosis

A

liver cirrhosis in which there is interference with intrahepatic bile flow

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19
Q

biliary sludge

A

a mixture of particulate matter and mucus that forms in bile

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20
Q

biliary stasis

A

intrahepatic impairment of bile flow

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21
Q

biliary tract (tree)

A

the common anatomical term for the path by which bile that has been secreted by the liver travels on its way to the small intestine

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22
Q

bilirubin

A

the yellow breakdown product of normal heme catabolism

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23
Q

BCAA

A

branched chain amino acids that have a branched side chain (leucine, isoleucine, and valine)

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24
Q

cholecystesctomy

A

surgical removal of the gall bladder

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25
Q

cholecystitis

A

inflammation of the gallbladder

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26
Q

choledocholithiasis

A

the presence of gallstones (usually originally formed in the gallbladder) in the common bile duct

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27
Q

cholelithiasis

A

presence or formation of gallstones

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28
Q

cirrhosis

A

any pathological condition where fibrous connective tissue replaces healthy tissue in an organ, usually as a consequence of inflammation or other injury

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29
Q

distal splenorenal shunt (DSRS)

A

a surgical procedure in which the distal splenic vein (a part of the portal venous system) is attached the left renal vein

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30
Q

fatty liver

A

yellow discoloration of the liver due to fatty degeneration of liver parenchymal cells

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31
Q

hepatic encephalopathy (HE)

A

a syndrome characterized CNS dysfunction in assoc w/ liver failure

32
Q

hepatitis

A

inflammation of the liver and liver disease involving degenerative or necrotic alteration of hepatocytes

33
Q

hepatosteatosis

A

accumulation of fat in the interstitial tissue of the liver

34
Q

jaundice

A

a clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes

35
Q

Korsakoff’s psychosis

A

a condition characterized by amnesia, confabulation (false memories), and hallucinations

36
Q

Kupffer cells

A

specialized phagocytic cells of the reticuloendothelial system found on luminal surfaces of the hepatic sinusoids; they filter bacteria and small foreign proteins out of the blood and dispose of worn-out red blood cells

37
Q

non-alcoholic fatty liver disease (NAFLD)

A

a wide spectrum of non alcohol related liver diseases ranging from fatty liver (steatosis) to non-alcoholic steatohepatitis, to cirrhosis

38
Q

pancreatitis

A

inflammation of pancreas

39
Q

paracentesis

A

procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument

40
Q

portal hypertension

A

abnormally increased pressure in the hepatic portal venous system; frequently seen in cirrhosis of the liver and in other conditions that cause obstruction of the portal vein

41
Q

Wenicke-Korsakoff syndome

A

manifestation of thiamin def usually seen in individuals suffering from alcoholism

42
Q

Wernicke’s encephalopathy

A

condition character by confusion, nystagmus (involuntary eye moment), anisocoria (unequal size of the pupils), ataxia, and sluggishness

43
Q

Elevated serum bilirubin levels

A

increased production, decreased conjugation, decreased secretion by the liver, or blockage of the bile ducts

44
Q

Unconjugated hyperbilirubinemia

A

accelerated erythrocyte hemolysis in the newborn absence of glucuronyl transferase, or hepatocellular disease

45
Q

Conjugated hyperbilirubinemia

A

obstruction of billary ducts, as with gallstones such as cirrhosis or hepatitis

46
Q

Elevated serum billirubin test results may also be caused by

A

effects of many different drugs including antibiotics, barbiturates, steroids, or oral contraceptives

47
Q

Portal Hypertension

A

liver damage/blockage can lead to elevated blood pressure in the portal vein d/t fibrosis and destruction of parenchymal cells which leads to ascites with GI bleeding from varices and encephalopathy

48
Q

TIPS

A

trans-jugular intrahepatic postsystemic shunt is used when the portal vein is obstructed. They make a tunnerl through the liver with a needle to connect the portal vein to one of the hepatic veins. And a metal stent is placed in this tunnel to keep the track open. This reduces portal hypertension

49
Q

Ascites

A

accumulation of fluid in the peritoneal cavity; most common complication

50
Q

Three factors responsible for ascites in chronic liver disease

A

1) Hepatic fibrosis d/t portal hypertension and lymphatic obstruction
2) Reduced osmotic pressure d/t failure of liver to synthesize albumin
3) Increased retention of sodium; increased aldosterone production

51
Q

Paracentesis

A

Procedure of removal of fluid from the abdomen via catheter. 15.5L of ascitic fluid can collect in the ab cavity. Has Pro concentration of 1-2g/100mL. Removal of this is extensive PRO losses. 4L of fluid removed will also remove 40-80mg of PRO.

52
Q

Diseases of the liver

A

1) Acute liver failure
2) Hepatitis
3) Alcohlic Liver Disease- fatty liver (alcohol or non alcohol)
4) Cirrhosis

53
Q

Common causes of Acute Liver Failure

A

Viral hepatitis and drug induced hepatotoxicity, secondary to virus, toxin, inborn errors of metabolism. autoimmune.
This is rare but often fatal
Sudden loss of hepatic function
No prior history of liver disease

54
Q

ALF is characterized by

A

Hepatic necrosis
Coagulopathy
Encephalopathy (brain disease)

55
Q

Hep A

A

transmitted almost exclusively by fecal oral route contanimated drinking water, food, sewage

56
Q

Hep B

A

transmitted by transfusions of blood or blood derived fluids and improper sterilization of medical instruments, dental drills, tattooing needles

57
Q

Hep C

A

Exposure to blood or body fluids from an infected person like sharing needles, hemodialysis patients, or infants born to infected mothers

58
Q

Viral Hepatitis

A 
D and E
Uncommon requires HBV to replicate
Transmits only from person already with Hep B
Contacted with infected blood
Acute infection rare in US
59
Q

Nutrition Therapy for Viral Hepatitis

A 
Implications:
WL and Nutr Def
Assessment:
Weight, food intake, lifestyle factors
Dx: 
Inadequate food/oral bev intake
Intervention:
Spare liver, nutrients needed, avoidance alcohol, small freq meals, M&E
60
Q

Hepatitis Nutrition Therapy cont

A

Increase intake 30-35kcal/kg
PRO: 1-1.2g/kg
Fat: 30-40% of kcal from fat (may not be well tolerated if bile is interefered
Small freq meals

61
Q

Alcoholic Liver Disease

A 
Morbidity resulting from alcoholism
12th leading cause of death in US
Third leading lifestyle related cause of death
1) fatty liver
2) alcohlic hepatitis
3) cirrhosis
62
Q

Fatty Liver

A

Fatty infilitration of the liver (steatosis) 90% heavy drinkers
Lipid accumulation of >5% of liver weight
In 25% of Gen U.S. pop
Virtually asymptomatic
Severe dark urine
Slightly elevated GGT and AST&ALT
Benign and reversible

63
Q

Alcoholic hepatitis

A

10-35% heavy drinkers

64
Q

Fibrosis

A

formation or development of excess fibrous connective tissue in an organ or tissue as a reperative or reactive process

65
Q

Non Alcoholic FLD

A

strong assoc with obesity, diabetes, metabolic syndrome most common among adolescents

66
Q

Effect of alcohol on vitamins and minerals

A

Folate, Thiamin, Vit B6
Alcohol interferes with absorption, transport, storage, and release by the liver
Thiamin: required in energy metabolism

67
Q

Alcoholic Hepatitis

A

Toxic liver injury assoc w/ chronic ethanol consumption
increased susceptability to infections
fatigue, weakness, anorexia, fever, hepatomegaly

68
Q

Nutrition Therapy for Alcohol Hep

A

Implications:
Malnutrition, maldigestion, increased excretion of some vitamins
Assessment:
Weight, physical, dietary, lifestyle factors
use of complementary or alternative medicine
Diagnosis:
Increased EE, Inadequate intake, Inappropriate intake of AAA and BCAA, inadequate vit/mineral intake (thiamin)

69
Q

Nutrition Intervention

A 
Avoidance of further damage to liver
nutrients needed for regeneration
Small frequent feedings
30-35kcal/kg
Protein 1.5-2.0g/kg
High Carb 6-8g/kg
Consider fat restriction
M&E
70
Q

Cirrhosis

A

chronic disease of the liver where connective tissue is put on and results in loss of liver function. It is caused by damage from toxins, metabolic problems, chronic viral hep or other causes. It is irreversible but treatment will slow down or halt damage

71
Q

Classification Tool to diagnose Cirrhosis

A

Child-Turcotte-Pugh Table (CPT)

72
Q

Prognostic model for End Stage Liver Disease

A

MELD scores

73
Q

Clinical manifestations of Cirrhosis

A 
Enlarged liver-fat
Fatigue, weakness
Jaundice
Dark Urine
Light stools
Steatorrhea
Bloating
Malnutrition
Bruising/Bleeding
74
Q

Nutrition Implications for Cirrhosis

A 
Implications:
Early satiety from ascites
Impaired nutrient digestion and absorp
portal HTN and pancreatic insuff
Increased EE
Hypoglycemia d/t hyperinsulinemia
Hyperglycemia- insulin resistant DM- later stages
75
Q

Nutirtion Dx for Cirrhosis

A

Ascites
Esophageal Varices
Encephalopathy

76
Q

Nutrition Intervention for Cirrhosis

A

Energy Nutrients:
30-40kcal/kg
Protein 1,6kg/day
Protein should be restricted with severe HE
Fat restriction when steatorrhea
Consider enteral or parenteral when oral is not meeting needs
w/ esophageal varices- mech soft diet

DTC 330: Medical Nutrition Therapy (5 decks)

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