Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Medical Nutrition Therapy 2 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Hepatitis A ; 3

A

Fecal and oral route
Water, sewage, food
RUQ Pain, jaundice, N,V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hepatitis B C

A

Transmitted via blood, body fluids - semen, saliva

May progress to chronic states with cirrhosis and liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

NAFLD - Non Alcoholic Fatty Liver Disease

A

Fat droplets accumulate in liver
Associate with T2DM, obesity, hyperlipemia
May progress to NASH and NASH cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Effects of acetaldehyde on brain / heart

A

Hyperacetaldehydemia Malfunction of brain and heart tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Stages of ALCHOLIC LIVER DISEASE

A

1- Hepatic steatosis fatty liver
2- Alcoholic hepatitis
3- Alcoholic cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 Mechanisms affected by alchol

A

1- CHO - we eat food and CHO is digested an absorbed witht he help of insulin. In liver diease/alcoholism pts don’t eat well.
2- Glycogenolysis - glycogen stores in liver are depleted
3- GNG - formation of glucose is inhibited because liver function is impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2 Dangerous by products of alcohol metabolism

A

Acetaldehyde and hydrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acetaldehyde, 2

A

Toxic by product of alcohol metabolism

Damages mitochondria membrane and affects liver function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx for NAFLD

A 
Wt loss of 3-5% improves
Need 10 % weight loss for NASH 
Omega 3 for TG 
Vit e for oxidatve stress
OHA diabetic for NASH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Levels of albumin in liver disease

A

It is normal to drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

STAGE 1 of alcoholic liver disease

A

Increase in fatty acid mobilization from adipose tissue
Slow of reactions requiring NAD, ratio of NADH to NAD increase; which increases TG
Asymptomatic usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Problem with hydrogen as byproduc of alcohol

A

Replaces fat as fuel, therefore more fat accumulates - more fatty liver
Hyperlipidemia, Ketosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Effects of acetaldehyde in liver

A

Hepatotoxicity, impacts function of liver
Decreases vitamin activation - hypovitaminia
Inflammation, necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Renin angiotensin in ascites

A

Levels of aldosterone increase triggers resorption of sodium and water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3 main causes of ascites

A

Low albumin levels
Increased tissue pressure, lymphatic blockage
Renin Angiotensin mechanisms triggering more sodium and water reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

GI Bleeding

A

If there is GI bleeding - no EN
PN is patient will be PNO for more than 5-7 days
NG used with baloon to press on bleeding vessel
Medications to stop bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

STAGE 2 O of alcholic disease

A

Alcoholic Hepatitis
Hepatomegaly
Increased ASL and ALT transaminase
Anorexia, some jaundice, coagulopathy, encelopathy, ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Portal Hypertension

A

Coagulation of abdominal vessels
Collateral circulation - esophageal varices - enlargement of veins
Foods tat are easy to swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

STAGE 3 of alcoholic disease

A 
Acoholic cirhosis 
Portal hypertension 
Ascites
Encephalopaty
GI Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Medical treatment for ascites Meds

A

Furosemide - Lasix

Spironolactone - Aldactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What accumulates in ascites?

A

Fluid, Na, protein

In peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Vitamin impacted by renin angiotensin mechanism

A

Vitamin K lowers

Monitor!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hepatic Encephalopathy - Mechanism #2

A

Altered neurotransmitter theory
No GNG so body is using BCAA for energy
serum BCAA decreases and AAA increases
amino acid imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hepatic Encephalopathy Mechanism 1

A

N toxins cross brain barriers

Ammonia cant be converted into urea by the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Med TX for HE
Lactulose, rifaximin
26
Mechanisms for Hepatic Encephalopathy
1- N toxins cross brain barrier 2- Altered neutransmitter theory - serum amino acid imbalance 3- BCAA uptake from brain is limited by high leves of AAA they compete
27
What can cause hyponatremia in ascites?
Low levels of albumin ADH - renin angio tensin mechanism Excessive Na restriction Paracentesis
28
MNT for Ascites
1ST - 2 g Na restriction Be careful with hyponatremia Fluid restriction if they are on low sodium with hyponatremia 1-1.5 l hyponatremia <125 m Eq
29
Hepatic Encephalopathy
Mild confusion, decreased attention, comma, lethargy, agitation
30
Treatment for refractory ascites
More paracentesis distal Splenorenal shunt Liver transplant
31
Fluid restriction condition for ascites
If patient is on low sodium with hyponatremia <125 mEq | 1-1.5 L / day
32
Ascites tx other than meds
Paracentesis | Make sure replenish protein needs due to lossess
33
Malnutrition in Liver Disease
``` Steatorrhea - malabsorption and maldigestion Decrease vitamin activation Poor appetite Paracentesis - protein loss Anorexia Early satiety Dysguesia N,V ```
34
MNT Liver disease. What to do poor appetite?
Attractive foods | Nutrient dense foods
35
Assessment for Liver Disease
Global Subjetive Assessment Hx: diet, appetite, wt change!! etc Physical findings: measure abdominal girth !
36
Vitamin defficiency associated with liver disease
Thiamine | Wernickle Syndrome
37
MNT for Hepatic Encephalophaty
Vegetable protein preferred over meat source because it is higher in BCAA, the problem is the caloric content.
38
Lab data look at in liver disease
Na, BUN, ammonia
39
Other amino acids that increase with liver disease
Histidine Glutamine Asparagine Methionine
40
BCAA that decrease with liver disease
Leucine Valine Isoleucine
41
AAA that increase with liver disease
Free tryptophan Phenylamine Tyrosine
42
Hepatic Encephalopathy Mechanism 3
Brain uptake of BCAA is impacted by high levels of AAA - they compete
43
MNT Lipids | Liver Disease
``` 30% fat Fat absorption might be impaired due to reduced production of ble salts Pancreatic enzymes Medication - Cholestyramine MVT oil is steatorrhea Low fat trial ```
44
MNT CHO reqs | Liver Disease
``` 1/3 develop diabetes 2/3 develop glucose intolerance Small frequent meals to help with hypoglycemia Fasting hypoglycemia - reduced GNG Insulin resistance peripheral resistance ```
45
Which weight to use for energy requirements, liver disease, ascites
Dry weight, ideal body weight
46
MNT Energy requirements | Liver disease
ESLD no ascites 120-140 % REE Ascites, infection, nutrition repletion needed: 150-175% REE 20-35 kcal/kg
47
MNT early satiety with ascites
Small frequent meals | Also improves hypoglycemia and N balance
48
If tube feeding in liver disease ?
Prefer Naso gastric =, if there is no bleeding
49
Tube feeding, EN in liver disease
Nasoenteric with J tube placed lower - jejunal - to minimize pancreatic stiulation
50
Liver disease - high levels of these minerals
Copper and Manganese So we dont supplement Can take out if PN
51
MNT Liver disease | Pro
``` N balance 1.2-1.3 Uncomplicated HEPATITIS 1-1.5 alcoholic hepatitis, sepsis, Gi bleeding, infection, >1.5 Pts may use more protein because o GNG ```
52
Mineral malabsorption due to steatorrhea
Ca, Mg, Zn
53
Protein requirements for patients with alcoholic hepatitis, or with sepsis, infection, GI bleeding, severe ascites
> 1.5
54
Protein requirements for patients with uncomplicated hepatitis, with or without HE
1-1.5
55
Thiamine deficiency in liver disease
Supplement with 100 mg if suspected
56
Protein and high ammonia levels in liver disease
No longer restrict high protein intake
57
Water soluble vitamin deficiency in liver disease
``` thiamine B12 niacin folate pyridoxine ```
58
Vitamins of concern with liver disease
ADEK, fat soluble vitamins Thiamin Vit D - bc activation takes place in liver
59
Minerals affected by alcoholism due to diuretic effect
Zn and Mg
60
Effects of alcohol consumption on GNG
Inhibits
61
Whats Wilson Disease
Excess copper in organs | Because copper in excreted in bile
62
Liver disease - osteopenia
May be due to long term use of steroids | supplement 1000-3000 to prevent
63
What can happen with Fe in liver disease?
Decrease if GI bleeding
64
Minerals of concern in Liver disease
Ca, Mg, Zn Fe Mn Cu
65
Cholecystitis
Inflammation of gallbladder when bile flow is interrupted by stones
66
Choledocholithiasis
gallbladder stones slip into CBD, | RUQ PAIN!!!!
67
cholelithiasis
formation of gallbladder stones no infection usually asymptomatic
68
Possible causes of gallbladder disease
High dietary fat - any kind of fat | Rapid weight loss - surgeries, etc
69
Gallbladder disease - 5
Stones form slip into CBD cause interrutpion of bile flow back up of bile - jaundice and secondary billary cirrhosis obstruction of distal CBD with blockage of pancreatic duct - pancreatitis
70
MNT Chronic Cholecystitis
long term low fat 25-30 % you want some fat sub SAT fats for PUFAs eliminate gas forming foods
71
Gallstones medical treatment
Endoscopic removal - most common Shock waves Litotic therapy - breaks into smaller pieces Cholecystectomy
72
In gallbladder disease, backup of bile results in :
Jaundice, secondary billary cirrhosis | Obstruction of distal CBD with blockage of pancreatic duct - pancreatitis
73
MNT for Acute Cholecystitis
Not eating, keeping gallbladder inactive When pt eats, low fat not to overstimulate gallbladder 30-45 g
74
ni
75
EN used in severe acure pancreatitis
Naso enteral with tube placed 40 cm lower. Jejunal feeding to minimize pancreatic stimulation
76
What is pancreatitis
Repeated episodes of epgastric pain that may radiate to the back. Can worsen with fatty foods
77
Feeding severe prolonged cases of severe acute pancreatitis
PN Then fat emulsion are okay Not okay if patiwnt ha high TG
78
With PN in pancreatitis, medication used
Somatostatin, pancreatic inhibitor
79
PN in severe pancreatitis, when is fat emulsion not okay?
TG > 400
80
Pancreatitis no using Gi
May exacerbate stress response and disease severity
81
Treatment acute pancreatitis
Feeding migt be difficult When pain is managed, low fat or normal fat, any consistency is okay Clear liquid not required
82
Acute pancreatitis cause
Gallbladder stones
83
Alcohol effect on pancreatitis
Duodenitis and edema of papilla of Vater | Digestive juice back up into pancreas digest pancreas and surrounding issues
84
Pancreatitis, tool used to screen patients
Ranson's criteria
85
Gallbladder surgery MNT
Vit C Diet progress as tolerated Low fat Adequate soluble fiber
86
Reason for low serum Ca in acute pancreatitis
Ca in bound to albumin. Low albumin therefore low calcium | Soap formation by calcum and fatty acids in gut created by fat necrosis
87
Pancreatitis symtpoms
``` PAIN!!!!!! N V Abdominal distention steatorrhea, no enzyme ```
88
Glucose in patients with pancreatitis
Monitor because they may have insulin resistance

Medical Nutrition Therapy 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions