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Medical Nutrition Therapy 2 > Liver Disease > Flashcards

Liver Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

Hepatitis A ; 3

A

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

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2
Q

Hepatitis B C

A

Transmitted via blood, body fluids - semen, saliva

May progress to chronic states with cirrhosis and liver failure

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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

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4
Q

Effects of acetaldehyde on brain / heart

A

Hyperacetaldehydemia Malfunction of brain and heart tissues

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5
Q

Stages of ALCHOLIC LIVER DISEASE

A

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

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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

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7
Q

2 Dangerous by products of alcohol metabolism

A

Acetaldehyde and hydrogen

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8
Q

Acetaldehyde, 2

A

Toxic by product of alcohol metabolism

Damages mitochondria membrane and affects liver function

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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
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10
Q

Levels of albumin in liver disease

A

It is normal to drop

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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

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12
Q

Problem with hydrogen as byproduc of alcohol

A

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

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13
Q

Effects of acetaldehyde in liver

A

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

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14
Q

Renin angiotensin in ascites

A

Levels of aldosterone increase triggers resorption of sodium and water

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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

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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

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17
Q

STAGE 2 O of alcholic disease

A

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

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18
Q

Portal Hypertension

A

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

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19
Q

STAGE 3 of alcoholic disease

A 
Acoholic cirhosis 
Portal hypertension 
Ascites
Encephalopaty
GI Bleeding
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20
Q

Medical treatment for ascites Meds

A

Furosemide - Lasix

Spironolactone - Aldactone

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21
Q

What accumulates in ascites?

A

Fluid, Na, protein

In peritoneal cavity

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22
Q

Vitamin impacted by renin angiotensin mechanism

A

Vitamin K lowers

Monitor!

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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

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24
Q

Hepatic Encephalopathy Mechanism 1

A

N toxins cross brain barriers

Ammonia cant be converted into urea by the liver

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25
Q

Med TX for HE

A

Lactulose, rifaximin

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26
Q

Mechanisms for Hepatic Encephalopathy

A

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

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27
Q

What can cause hyponatremia in ascites?

A

Low levels of albumin
ADH - renin angio tensin mechanism
Excessive Na restriction
Paracentesis

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28
Q

MNT for Ascites

A

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

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29
Q

Hepatic Encephalopathy

A

Mild confusion, decreased attention, comma, lethargy, agitation

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30
Q

Treatment for refractory ascites

A

More paracentesis
distal Splenorenal shunt
Liver transplant

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31
Q

Fluid restriction condition for ascites

A

If patient is on low sodium with hyponatremia <125 mEq

1-1.5 L / day

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32
Q

Ascites tx other than meds

A

Paracentesis

Make sure replenish protein needs due to lossess

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33
Q

Malnutrition in Liver Disease

A 
Steatorrhea - malabsorption and maldigestion 
Decrease vitamin activation 
Poor appetite
Paracentesis - protein loss
Anorexia
Early satiety 
Dysguesia
N,V
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34
Q

MNT Liver disease. What to do poor appetite?

A

Attractive foods

Nutrient dense foods

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35
Q

Assessment for Liver Disease

A

Global Subjetive Assessment
Hx: diet, appetite, wt change!! etc
Physical findings: measure abdominal girth !

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36
Q

Vitamin defficiency associated with liver disease

A

Thiamine

Wernickle Syndrome

37
Q

MNT for Hepatic Encephalophaty

A

Vegetable protein preferred over meat source because it is higher in BCAA, the problem is the caloric content.

38
Q

Lab data look at in liver disease

A

Na, BUN, ammonia

39
Q

Other amino acids that increase with liver disease

A

Histidine
Glutamine
Asparagine
Methionine

40
Q

BCAA that decrease with liver disease

A

Leucine
Valine
Isoleucine

41
Q

AAA that increase with liver disease

A

Free tryptophan
Phenylamine
Tyrosine

42
Q

Hepatic Encephalopathy Mechanism 3

A

Brain uptake of BCAA is impacted by high levels of AAA - they compete

43
Q

MNT Lipids

Liver Disease

A 
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
Q

MNT CHO reqs

Liver Disease

A 
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
Q

Which weight to use for energy requirements, liver disease, ascites

A

Dry weight, ideal body weight

46
Q

MNT Energy requirements

Liver disease

A

ESLD no ascites
120-140 % REE
Ascites, infection, nutrition repletion needed:
150-175% REE 20-35 kcal/kg

47
Q

MNT early satiety with ascites

A

Small frequent meals

Also improves hypoglycemia and N balance

48
Q

If tube feeding in liver disease ?

A

Prefer Naso gastric =, if there is no bleeding

49
Q

Tube feeding, EN in liver disease

A

Nasoenteric with J tube placed lower - jejunal - to minimize pancreatic stiulation

50
Q

Liver disease - high levels of these minerals

A

Copper and Manganese
So we dont supplement
Can take out if PN

51
Q

MNT Liver disease

Pro

A 
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
Q

Mineral malabsorption due to steatorrhea

A

Ca, Mg, Zn

53
Q

Protein requirements for patients with alcoholic hepatitis, or with sepsis, infection, GI bleeding, severe ascites

A

> 1.5

54
Q

Protein requirements for patients with uncomplicated hepatitis, with or without HE

A

1-1.5

55
Q

Thiamine deficiency in liver disease

A

Supplement with 100 mg if suspected

56
Q

Protein and high ammonia levels in liver disease

A

No longer restrict high protein intake

57
Q

Water soluble vitamin deficiency in liver disease

A 
thiamine 
B12
niacin
folate
pyridoxine
58
Q

Vitamins of concern with liver disease

A

ADEK, fat soluble vitamins
Thiamin
Vit D - bc activation takes place in liver

59
Q

Minerals affected by alcoholism due to diuretic effect

A

Zn and Mg

60
Q

Effects of alcohol consumption on GNG

A

Inhibits

61
Q

Whats Wilson Disease

A

Excess copper in organs

Because copper in excreted in bile

62
Q

Liver disease - osteopenia

A

May be due to long term use of steroids

supplement 1000-3000 to prevent

63
Q

What can happen with Fe in liver disease?

A

Decrease if GI bleeding

64
Q

Minerals of concern in Liver disease

A

Ca, Mg, Zn
Fe
Mn Cu

65
Q

Cholecystitis

A

Inflammation of gallbladder when bile flow is interrupted by stones

66
Q

Choledocholithiasis

A

gallbladder stones slip into CBD,

RUQ PAIN!!!!

67
Q

cholelithiasis

A

formation of gallbladder stones
no infection
usually asymptomatic

68
Q

Possible causes of gallbladder disease

A

High dietary fat - any kind of fat

Rapid weight loss - surgeries, etc

69
Q

Gallbladder disease - 5

A

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
Q

MNT Chronic Cholecystitis

A

long term low fat 25-30 %
you want some fat
sub SAT fats for PUFAs
eliminate gas forming foods

71
Q

Gallstones medical treatment

A

Endoscopic removal - most common
Shock waves
Litotic therapy - breaks into smaller pieces
Cholecystectomy

72
Q

In gallbladder disease, backup of bile results in :

A

Jaundice, secondary billary cirrhosis

Obstruction of distal CBD with blockage of pancreatic duct - pancreatitis

73
Q

MNT for Acute Cholecystitis

A

Not eating, keeping gallbladder inactive
When pt eats, low fat not to overstimulate gallbladder
30-45 g

74
Q

ni

A
75
Q

EN used in severe acure pancreatitis

A

Naso enteral with tube placed 40 cm lower. Jejunal feeding to minimize pancreatic stimulation

76
Q

What is pancreatitis

A

Repeated episodes of epgastric pain that may radiate to the back.
Can worsen with fatty foods

77
Q

Feeding severe prolonged cases of severe acute pancreatitis

A

PN
Then fat emulsion are okay
Not okay if patiwnt ha high TG

78
Q

With PN in pancreatitis, medication used

A

Somatostatin, pancreatic inhibitor

79
Q

PN in severe pancreatitis, when is fat emulsion not okay?

A

TG > 400

80
Q

Pancreatitis no using Gi

A

May exacerbate stress response and disease severity

81
Q

Treatment acute pancreatitis

A

Feeding migt be difficult
When pain is managed, low fat or normal fat, any consistency is okay
Clear liquid not required

82
Q

Acute pancreatitis cause

A

Gallbladder stones

83
Q

Alcohol effect on pancreatitis

A

Duodenitis and edema of papilla of Vater

Digestive juice back up into pancreas digest pancreas and surrounding issues

84
Q

Pancreatitis, tool used to screen patients

A

Ranson’s criteria

85
Q

Gallbladder surgery MNT

A

Vit C
Diet progress as tolerated
Low fat
Adequate soluble fiber

86
Q

Reason for low serum Ca in acute pancreatitis

A

Ca in bound to albumin. Low albumin therefore low calcium

Soap formation by calcum and fatty acids in gut created by fat necrosis

87
Q

Pancreatitis symtpoms

A 
PAIN!!!!!!
N 
V
Abdominal distention 
steatorrhea, no enzyme
88
Q

Glucose in patients with pancreatitis

A

Monitor because they may have insulin resistance

Medical Nutrition Therapy 2 (2 decks)

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