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MNT Prep > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What occurs with sinusoid obstruction and why?

A

Blood flow decreases so pressure builds and fluid leaves into the peritoneal cavity (ascites)

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2
Q

What is ascites?

A

4-8 extra liters of fluid in the peritoneal cavity

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3
Q

Where is bile reabsorbed?

A

Ileum, along with bile salts

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4
Q

How is cholestyramine r/t enterohepatic circulation?

A

Instead of reabsorbed bile going from the ileum back to the liver, this drug captures the bile so the liver has to regenerate new bile from cholesterol.

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5
Q

What is jaundice?

A

Symptom
Lots of bilirubin in ECF
Yellow skin when >2.4-3.0mg/dL
B/c rapid destruction of RBC, decreased liver uptake of bilirubin, blocked bile ducts so bilirubin not released

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6
Q

What do Kupffer cells do?

A

In the liver, they are macrophages
Filter bacteria and proteins
Break and get rid of old RBC

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7
Q

What are LFTs and what do the screen for?

A 
Liver disfunction 
Bilirubin
Alkaline phosphatase
ALT/AST
Albumin 
PTT
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8
Q

Key lab: what happens to blood ammonia when liver function decreases?

A

It goes up because the liver is not turning it into urea for excretion

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9
Q

What can cause hepatitis?

A 
Hep B (tools and body fluids) 
Hep C (needles and sex and BB virus) 
Anorexia, fatigue, high bilirubin, AP, AST
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10
Q

MNT with hepatitis?

A

Decrease protein
30-35 kcal/kg (>3000kcals)
1.1-1.2 g/kg
Water sol vits and maybe MCT

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11
Q

Alcoholism common deficiencies

A 
Protein 
Folic acid 
Thiamin (ADH cofactor) 
Vitamin A 
Zinc (needed and ADH cofactor)
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12
Q

If alcohol to ADH ratio is too high, or NAD is low, what pathway breaks alcohol?

A

MEOS

Microsomal ethanol oxidizing system and it uses energy without making any

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13
Q

How do you find kcals in EtOH?

A

%alcohol of beverage x 2=proof

Then .8 kcal per proof

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14
Q

carbohydrate functions of liver

A 
Glucogenesis
Gluconeogenesis
Glycogenesis 
Glycolysis
Glycogenolysis
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15
Q

Protein functions of liver

A

Ammonia to urea
Aa turned to glucose
Make albumin, transferrin, PA, prothrombin and fibrinogen

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16
Q

Lipid functions of liver

A

FA to energy (B oxidation)
Make ketones
Make TG, lipids and cholesterol
Make VLDL and HDL

17
Q

Vitamin functions of liver

A 
Store fat soluble 
Activate Vit D 
Folate into active 5-THF 
B carotene to Vit A 
Store minerals: Fe, Mg, B12, Zn, Cu
18
Q

2 levels of NAFLD?

A

Steatosis- fat accumulates in interstitial space of liver

Steatohepatitis- inflammation and fat accumulation in liver

19
Q

What 3 conditions is NAFLD associated with?

A

DM2
Metabolic syndrome
Obesity

20
Q

What is NASH?

A

Non alcoholic steatohepatitis
Fibrous tissue formed in liver
Could be insulin resistance caused
Manage with DM2 drugs and wt loss

21
Q

3 stages of liver disease?

A

Fatty liver (steatosis)- reversible
Alcoholic hepatitis- toxic liver injury, high labs
Cirrhosis- portal HTN, GI bleeding, Ascites, hepatic encephalopathy

22
Q

What is cirrhosis specifically caused by EtOH?

A

Laennec’s Cirrhosis

23
Q

What is esophageal varices?

A

Thin lining of esophagus tends to bleed with portal HTN

24
Q

Difference between ascites and Anasarca?

A

Ascites- edema in peritoneal

Anasarca- extreme edema everywhere

25
Q

MNT goal with Ascites

A 
Remove fluid 
Prevent electrolyte imbalance 
Prevent loss of LBM/anorexia
Sodium 500-1000mg
FR- 1000-1500mL/day 
1.25-1.75 protein IBW
No glutamine
26
Q

What is hepatic encephalopathy?

A

Can’t eliminate toxic products so toxic to brain
Delirious
Usually high ammonia levels

27
Q

MNT with advanced liver disease

A

Low protein
Restrict fluids
Antibiotic (neomycin to kill fluid retaining Bact)

28
Q

2 drugs used to manage encephalopathy?

A

Lactulose- laxative
Makes colon acidic so Ammonia is not absorbed

Neomycin- antibiotic
Destroys colonic bacteria that make ammonia

29
Q

MNT references for liver disease

A 
BEE x 1.2-1.75 
25-35 kcals encephalopathy
20-40% fat, MCT if needed
Up to 1.6 g/kg protein 
40g/d protein- encephalopathy 
BCAA for encephalopathy
30
Q

How does high NH4 affect BCAA in blood

A

High ammonia stimulates glucagon which causes hyperglycemia and high insulin. Muscles uptake BCAA and BCAA in blood are low.

31
Q

What is Wilson’s disease?

A

Autosomal recessive disorder
Less biliary copper excretion
Copper accumulates
Might supplement with zinc to decrease CU absorption.

MNT Prep (27 decks)

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