Liver Disease Flashcards
What occurs with sinusoid obstruction and why?
Blood flow decreases so pressure builds and fluid leaves into the peritoneal cavity (ascites)
What is ascites?
4-8 extra liters of fluid in the peritoneal cavity
Where is bile reabsorbed?
Ileum, along with bile salts
How is cholestyramine r/t enterohepatic circulation?
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.
What is jaundice?
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
What do Kupffer cells do?
In the liver, they are macrophages
Filter bacteria and proteins
Break and get rid of old RBC
What are LFTs and what do the screen for?
Liver disfunction Bilirubin Alkaline phosphatase ALT/AST Albumin PTT
Key lab: what happens to blood ammonia when liver function decreases?
It goes up because the liver is not turning it into urea for excretion
What can cause hepatitis?
Hep B (tools and body fluids) Hep C (needles and sex and BB virus) Anorexia, fatigue, high bilirubin, AP, AST
MNT with hepatitis?
Decrease protein
30-35 kcal/kg (>3000kcals)
1.1-1.2 g/kg
Water sol vits and maybe MCT
Alcoholism common deficiencies
Protein Folic acid Thiamin (ADH cofactor) Vitamin A Zinc (needed and ADH cofactor)
If alcohol to ADH ratio is too high, or NAD is low, what pathway breaks alcohol?
MEOS
Microsomal ethanol oxidizing system and it uses energy without making any
How do you find kcals in EtOH?
%alcohol of beverage x 2=proof
Then .8 kcal per proof
carbohydrate functions of liver
Glucogenesis Gluconeogenesis Glycogenesis Glycolysis Glycogenolysis
Protein functions of liver
Ammonia to urea
Aa turned to glucose
Make albumin, transferrin, PA, prothrombin and fibrinogen
Lipid functions of liver
FA to energy (B oxidation)
Make ketones
Make TG, lipids and cholesterol
Make VLDL and HDL
Vitamin functions of liver
Store fat soluble Activate Vit D Folate into active 5-THF B carotene to Vit A Store minerals: Fe, Mg, B12, Zn, Cu
2 levels of NAFLD?
Steatosis- fat accumulates in interstitial space of liver
Steatohepatitis- inflammation and fat accumulation in liver
What 3 conditions is NAFLD associated with?
DM2
Metabolic syndrome
Obesity
What is NASH?
Non alcoholic steatohepatitis
Fibrous tissue formed in liver
Could be insulin resistance caused
Manage with DM2 drugs and wt loss
3 stages of liver disease?
Fatty liver (steatosis)- reversible
Alcoholic hepatitis- toxic liver injury, high labs
Cirrhosis- portal HTN, GI bleeding, Ascites, hepatic encephalopathy
What is cirrhosis specifically caused by EtOH?
Laennec’s Cirrhosis
What is esophageal varices?
Thin lining of esophagus tends to bleed with portal HTN
Difference between ascites and Anasarca?
Ascites- edema in peritoneal
Anasarca- extreme edema everywhere
MNT goal with Ascites
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
What is hepatic encephalopathy?
Can’t eliminate toxic products so toxic to brain
Delirious
Usually high ammonia levels
MNT with advanced liver disease
Low protein
Restrict fluids
Antibiotic (neomycin to kill fluid retaining Bact)
2 drugs used to manage encephalopathy?
Lactulose- laxative
Makes colon acidic so Ammonia is not absorbed
Neomycin- antibiotic
Destroys colonic bacteria that make ammonia
MNT references for liver disease
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
How does high NH4 affect BCAA in blood
High ammonia stimulates glucagon which causes hyperglycemia and high insulin. Muscles uptake BCAA and BCAA in blood are low.
What is Wilson’s disease?
Autosomal recessive disorder
Less biliary copper excretion
Copper accumulates
Might supplement with zinc to decrease CU absorption.
