Liver Disease Flashcards
What are the 4 different causes of liver disease and examples of each.
Metabolic -parenteral nutrition -obesity -inborn errors Infectious -viral -parasites Autoimmune -primary biliary cirrhosis -autoimmune hepatitis Drugs/Toxins -alcohol -acetemainophen -illegal drugs -rx drugs -mushrooms
What is the nutrition recommendations for hepatitis?
Energy: Basal + 20%, 30-35 kcal/kg
Protein: 1.0 g/kg -1.2 g/kg.
What are the 10 s/s of hepatitis?
- anorexia
- Nausea
- vomiting
- Diarrhea
- rt upper quad pain
- fever
- joint pain
- dark urine
- jaundice
- fatigue
For Hep C. For every 100 people…..
____ will develop a chronic infection
____ will develop chronic liver cirrhosis
____ will develop cirrhosis
- 75-85
- 60-70
- 5-20
What is the leading cause of the liver transplantation in the U.S. ?
Hepatitis C
Where is Hep E common and uncommon?
Common in Mexico, Asia, and Africa
Uncommon in US
Describe the Prodromal (Early) phase
- 25% affected
1. fever
2. joint pain
3. arthritis
4. rash
5. angioedema
Describe the Pre-icteric (pre-jaundice) phase
- malaise
- fatigue
- myalgia
- anorexia
- nausea
- vomiting
- dsyguesia- altered taste
- . epigrastric
- dysosmia- altered smell
Describe the Icteric phase
jaundice appears
describe the convalescent phase
jaundice and other s/s begin to subside
What is most common liver disease in the U.S.?
alcoholic liver disease
Describe the process of alcoholic liver disease
hepatic steatosis => alcoholic hepatitis=> cirrhosis
What is the formula for alcoholic metabolism?
C2H5OH + 3O2 —> 2CO2 + 3H20 +18 ATP
How much alcohol can a normal liver metabolize for males and females?
Females : 30-60 gm/day
Males: 80-100 gm/day
What are the 2 pathways of alcohol metabolism?
- alcohol dehydrogenase
- microsomal ethanol-oxidizing system
What are the metabolic disturbances of hepatic steatosis?
- 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
What can hepatic steatois turn into and describe it?
steatohepatitis, includes inflammation with steatosis
What does alcoholic hepatitis have an increased need for?
thiamin, b12, vitamin c, folic acid
What are the protein recommendations for hepatic failure?
- 1.2-2.0 g/kg
What are the nutrition recommendations for cirrhosis?
- energy: basal + 20%
25-30 kcal/kg
40 kcal/kg for malnutrition
-protein: 1.2-2.0 g/kg
- use MCT for malabsorptionWhen the serum sodium level is below 128, what do you do? Below 125?
- restrict to 1200-1500 ml of fluid
- restrict to 1000-12000 ml of fluid
As a dietitian what do you do to help the patient with cirrhosis get enough food?
- diet understanding
- snack suggestions
- diminished appetite suggestions
- suggestion for sodium
- offer support and care
What are the contributing factors that lead to malnutrition in liver disease?
- anorexia
- early satiety
- nausea
- vomiting
- abdominal bloating, gas, or distention
- altered taste
- diarrhea or constipation
- fatigue or inactivity
- restrictions
- malabsorption
Describe the process that leads to portal hypertension
increases in portal pressure —>impaired circulation—>
compensatory hepatic shunting and disturbed intrahepatic circulation—> portal hypertension
Describe the early, middle, and late stages of hepatic encephelopathy
early stage- lack of awareness, lethargy, or apathy
middle- semistupor, disorientation
late- confused, coma
