Liver disease

Question 1

Which lobe of the liver is bigger?

Answer 1

The right one

Question 2

Does the liver have high tissue turnover?

Answer 2

Yeah

Question 3

Is this class boring?

Answer 3

Yeah

Question 4

Describe the blood supply to the liver.

Answer 4

Portal vein, hepatic artery.

Question 5

Name some things that the liver synthesizes.

Answer 5

AAs, transaminases, urea, plasma proteins, lipoproteins, bile acids, cholesterol, phospholipids.

Question 6

What does the liver store?

Answer 6

Glycogen, B12, fat soluble vitamins, and iron/ferritin

Question 7

What is the progression of liver disease?

Answer 7

Inflammation –> fibrosis –> scarring –> cirrhosis

Question 8

Is cirrhosis reversible?

Answer 8

Nope

Question 9

Name a liver function test.

Answer 9

Blood transaminase levels (ALT, AST)

Question 10

Name four causes of liver disease.

Answer 10

1. Hep A
2. Hep B
3. Hep C
4. Toxins

Question 11

Which metabolite of alcohol is hepatotoxic?

Answer 11

Acetaldehyde

Question 12

Which metabolic pathway of alcohol generates free radicals?

Answer 12

CYP450 MEOS

Question 13

Make the Dx: Patient has history of alcohol abuse. Lab findings show AST : ALT is 2:1 and both are less than 300.

Answer 13

Alcoholic hepatitis

Question 14

What comes before alcoholic hepatitis? What comes after?

Answer 14

Steatosis comes first, cirrhosis comes after

Question 15

What is NASH and how is it often caused?

Answer 15

Non-alcoholic steatohepatitis is fatty infiltration + inflammation. Caused by metabolic disease and “second hit” - something else that causes inflammation.

Question 16

What is NAFLD? How is it caused?

Answer 16

Non-alcoholic fatty liver disease. Caused by metabolic disease like diabetes. Constant gluconeogenesis results in constant FFA release –> fatty liver.

Question 17

Can you damage your liver by overdosing on Tylenol?

Answer 17

Yeah

Question 18

How do hemochromatosis and Wilson’s disease cause liver disease?

Answer 18

Excessive iron and copper are hepatotoxic.

Question 19

What are varices and how are they caused?

Answer 19

Dilated veins in the esophagus, stomach, and rectum that are a complication of liver cirrhosis and increased portal hypertension. They can bleed.

Question 20

What is portal gastropathy?

Answer 20

Varices in the stomach

Question 21

How does liver disease cause ascites? What nutritional modifications should be made for patients with liver disease and ascites or edema?

Answer 21

Portal hypertension and low albumin levels. Must limit sodium and fluids; small frequent meals are also recommended.

Question 22

How is hepatic encephalopathy caused? How is it treated?

Answer 22

When the liver is damaged it can’t clear the body of harmful metabolites like ammonia and it messes up your head. Treated with lactulose, which binds ammonia in the colon and causes diarrhea.

Question 23

Why are patients with liver disease often malnourished?

Answer 23

Poor dietary intake, maldigestion, malabsorption, and abnormalities in metabolism and storage

Question 24

What is the goal of nutrition management for patients with end stage liver disease?

Answer 24

To prevent or correct malnutrition and supply adequate calories without precipitating hepatic encephalopathy

Question 25

On average, by what percentage is REE changed in patients with cirrhosis?

Answer 25

20-40% increase over normal REE

Question 26

Is protein restriction indicated in patients with hepatic encephalopathy? What should be done?

Answer 26

No. It theoretically may lower ammonia levels but patients are often protein depleted so it may worsen body losses. Vitamin and mineral supplementation is done and BCAA intake is encouraged.

Question 27

What are the manifestations of cirrhosis?

Answer 27

Jaundice, scleral icterus (yellow eyes), ascites

Question 28

What is the ultimate treatment for end stage liver disease?

Answer 28

Transplantation

Question 29

Are normal assessment methods chill for patients with end stage liver disease?

Answer 29

No, not really. Should use skinfold tests, grip strength, and nitrogen balance study. Ascites is a confounder of BMI.