Liver

Question 1

Hepatic artery

Answer 1

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

Question 2

Sinusoids

Answer 2

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

Question 3

Hepatic portal vein

Answer 3

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

Question 4

Hepatic vein

Answer 4

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.

Question 5

Anatomy of the liver

Answer 5

4 lobes; right and left

Question 6

Functional unit of liver

Answer 6

lobule

Question 7

Primary blood reservoir amount

Answer 7

200-400ml

Question 8

What happens when blood makes contact with hepatocytes

Answer 8

it is filtered and detoxified

Question 9

Hepatocytes

Answer 9

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

Question 10

Features of the sinusoids

Answer 10

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.

Question 11

acute (fulminant) hepatic/liver failure

Answer 11

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

Question 12

alcoholic liver disease (ALD)

Answer 12

liver disease assoc with alcoholism

Question 13

aromatic amino acids (AAA)

Answer 13

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

Question 14

Ascites

Answer 14

accumulation or retention of free fluid within the peritoneal cavity

Question 15

asterixis

Answer 15

abnormal involuntary movements that primarily affect the extremities

Question 16

astrocytes

Answer 16

star-shaped glial cells in the brain and spinal cord

Question 17

bile

Answer 17

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

Question 18

biliary cirrhosis

Answer 18

liver cirrhosis in which there is interference with intrahepatic bile flow

Question 19

biliary sludge

Answer 19

a mixture of particulate matter and mucus that forms in bile

Question 20

biliary stasis

Answer 20

intrahepatic impairment of bile flow

Question 21

biliary tract (tree)

Answer 21

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

Question 22

bilirubin

Answer 22

the yellow breakdown product of normal heme catabolism

Question 23

BCAA

Answer 23

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

Question 24

cholecystesctomy

Answer 24

surgical removal of the gall bladder

Question 25

cholecystitis

Answer 25

inflammation of the gallbladder

Question 26

choledocholithiasis

Answer 26

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

Question 27

cholelithiasis

Answer 27

presence or formation of gallstones

Question 28

cirrhosis

Answer 28

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

Question 29

distal splenorenal shunt (DSRS)

Answer 29

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

Question 30

fatty liver

Answer 30

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

Question 31

hepatic encephalopathy (HE)

Answer 31

a syndrome characterized CNS dysfunction in assoc w/ liver failure

Question 32

hepatitis

Answer 32

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

Question 33

hepatosteatosis

Answer 33

accumulation of fat in the interstitial tissue of the liver

Question 34

jaundice

Answer 34

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

Question 35

Korsakoff's psychosis

Answer 35

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

Question 36

Kupffer cells

Answer 36

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

Question 37

non-alcoholic fatty liver disease (NAFLD)

Answer 37

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

Question 38

pancreatitis

Answer 38

inflammation of pancreas

Question 39

paracentesis

Answer 39

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

Question 40

portal hypertension

Answer 40

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

Question 41

Wenicke-Korsakoff syndome

Answer 41

manifestation of thiamin def usually seen in individuals suffering from alcoholism

Question 42

Wernicke's encephalopathy

Answer 42

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

Question 43

Elevated serum bilirubin levels

Answer 43

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

Question 44

Unconjugated hyperbilirubinemia

Answer 44

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

Question 45

Conjugated hyperbilirubinemia

Answer 45

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

Question 46

Elevated serum billirubin test results may also be caused by

Answer 46

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

Question 47

Portal Hypertension

Answer 47

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

Question 48

TIPS

Answer 48

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

Question 49

Ascites

Answer 49

accumulation of fluid in the peritoneal cavity; most common complication

Question 50

Three factors responsible for ascites in chronic liver disease

Answer 50

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

Question 51

Paracentesis

Answer 51

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.

Question 52

Diseases of the liver

Answer 52

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

Question 53

Common causes of Acute Liver Failure

Answer 53

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

Question 54

ALF is characterized by

Answer 54

Hepatic necrosis Coagulopathy Encephalopathy (brain disease)

Question 55

Hep A

Answer 55

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

Question 56

Hep B

Answer 56

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

Question 57

Hep C

Answer 57

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

Question 58

Viral Hepatitis

Answer 58

``` 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 ```

Question 59

Nutrition Therapy for Viral Hepatitis

Answer 59

``` 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 ```

Question 60

Hepatitis Nutrition Therapy cont

Answer 60

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

Question 61

Alcoholic Liver Disease

Answer 61

``` 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 ```

Question 62

Fatty Liver

Answer 62

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

Question 63

Alcoholic hepatitis

Answer 63

10-35% heavy drinkers

Question 64

Fibrosis

Answer 64

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

Question 65

Non Alcoholic FLD

Answer 65

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

Question 66

Effect of alcohol on vitamins and minerals

Answer 66

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

Question 67

Alcoholic Hepatitis

Answer 67

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

Question 68

Nutrition Therapy for Alcohol Hep

Answer 68

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)

Question 69

Nutrition Intervention

Answer 69

``` 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 ```

Question 70

Cirrhosis

Answer 70

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

Question 71

Classification Tool to diagnose Cirrhosis

Answer 71

Child-Turcotte-Pugh Table (CPT)

Question 72

Prognostic model for End Stage Liver Disease

Answer 72

MELD scores

Question 73

Clinical manifestations of Cirrhosis

Answer 73

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

Question 74

Nutrition Implications for Cirrhosis

Answer 74

``` 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 ```

Question 75

Nutirtion Dx for Cirrhosis

Answer 75

Ascites Esophageal Varices Encephalopathy

Question 76

Nutrition Intervention for Cirrhosis

Answer 76

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