Liver Disease

Question 1

What are the 4 different causes of liver disease and examples of each.

Answer 1

Metabolic
-parenteral nutrition
-obesity
-inborn errors
Infectious
-viral
-parasites
Autoimmune
-primary biliary cirrhosis
-autoimmune hepatitis
Drugs/Toxins
-alcohol
-acetemainophen
-illegal drugs
-rx drugs 
-mushrooms

Question 2

What is the nutrition recommendations for hepatitis?

Answer 2

Energy: Basal + 20%, 30-35 kcal/kg
Protein: 1.0 g/kg -1.2 g/kg.

Question 3

What are the 10 s/s of hepatitis?

Answer 3

1. anorexia
2. Nausea
3. vomiting
4. Diarrhea
5. rt upper quad pain
6. fever
7. joint pain
8. dark urine
9. jaundice
10. fatigue

Question 4

For Hep C. For every 100 people…..
____ will develop a chronic infection
____ will develop chronic liver cirrhosis
____ will develop cirrhosis

Answer 4

• 75-85
• 60-70
• 5-20

Question 5

What is the leading cause of the liver transplantation in the U.S. ?

Answer 5

Hepatitis C

Question 6

Where is Hep E common and uncommon?

Answer 6

Common in Mexico, Asia, and Africa

Uncommon in US

Question 7

Describe the Prodromal (Early) phase

Answer 7

• 25% affected
  1. fever
  2. joint pain
  3. arthritis
  4. rash
  5. angioedema

Question 8

Describe the Pre-icteric (pre-jaundice) phase

Answer 8

1. malaise
2. fatigue
3. myalgia
4. anorexia
5. nausea
6. vomiting
7. dsyguesia- altered taste
8. . epigrastric
9. dysosmia- altered smell

Question 9

Describe the Icteric phase

Answer 9

jaundice appears

Question 10

describe the convalescent phase

Answer 10

jaundice and other s/s begin to subside

Question 11

What is most common liver disease in the U.S.?

Answer 11

alcoholic liver disease

Question 12

Describe the process of alcoholic liver disease

Answer 12

hepatic steatosis => alcoholic hepatitis=> cirrhosis

Question 13

What is the formula for alcoholic metabolism?

Answer 13

C2H5OH + 3O2 —> 2CO2 + 3H20 +18 ATP

Question 14

How much alcohol can a normal liver metabolize for males and females?

Answer 14

Females : 30-60 gm/day

Males: 80-100 gm/day

Question 15

What are the 2 pathways of alcohol metabolism?

Answer 15

• alcohol dehydrogenase

- microsomal ethanol-oxidizing system

Question 16

What are the metabolic disturbances of hepatic steatosis?

Answer 16

• increase in fatty acid mobilization from adipose tissue
• increase in fatty acid synthesis
• increase in triglyceride production
• trapping of TG in liver
• decrease in fatty acid oxidation

Question 17

What can hepatic steatois turn into and describe it?

Answer 17

steatohepatitis, includes inflammation with steatosis

Question 18

What does alcoholic hepatitis have an increased need for?

Answer 18

thiamin, b12, vitamin c, folic acid

Question 19

What are the protein recommendations for hepatic failure?

Answer 19

• 1.2-2.0 g/kg

Question 20

What are the nutrition recommendations for cirrhosis?

Answer 20

- energy: basal + 20%
                25-30 kcal/kg
                 40 kcal/kg for malnutrition
-protein: 1.2-2.0 g/kg 
- use MCT for malabsorption

Question 21

When the serum sodium level is below 128, what do you do? Below 125?

Answer 21

• restrict to 1200-1500 ml of fluid

- restrict to 1000-12000 ml of fluid

Question 22

As a dietitian what do you do to help the patient with cirrhosis get enough food?

Answer 22

1. diet understanding
2. snack suggestions
3. diminished appetite suggestions
4. suggestion for sodium
5. offer support and care

Question 23

What are the contributing factors that lead to malnutrition in liver disease?

Answer 23

1. anorexia
2. early satiety
3. nausea
4. vomiting
5. abdominal bloating, gas, or distention
6. altered taste
7. diarrhea or constipation
8. fatigue or inactivity
9. restrictions
10. malabsorption

Question 24

Describe the process that leads to portal hypertension

Answer 24

increases in portal pressure —>impaired circulation—>

compensatory hepatic shunting and disturbed intrahepatic circulation—> portal hypertension

Question 25

Describe the early, middle, and late stages of hepatic encephelopathy

Answer 25

early stage- lack of awareness, lethargy, or apathy
middle- semistupor, disorientation
late- confused, coma