Liver Disease Flashcards
What are the 2 sources that the liver receives blood from?
hepatic artery & hepatic portal vein
Name some of the liver functions.
- carb metabolism
- lipid metabolism
- protein metabolism
- enzyme metabolism
- vitamin metabolism
- bile acid metabolism
- heme metabolism
- storage
- detoxification, degradation, conjugation
What are the common disease/conditions of liver?
- hepatitis (A-E)
- alcoholic hepatitis and cirrhosis
- NAFLD
- NASH
- fibrosis
- cirrhosis
- liver failure
Which type of bilirubin is more toxic?
unconjugated
What is prothrombin time (PT)?
the number of seconds for blood clot (it is prolonged in liver disease)
What are some clinical manifestations of liver disease?
- hepatomegaly
- ascites
- jaundice
- esophageal varices
- spider angiomas
- encephalitis and coma
- hepatorenal syndrome
- coagulopathies
What can jaundice be caused by? (3-4 things)
- excessive bilirubin production due to hemolysis
- acute or chornic hepotocellular injury
- obstruction of bile ducts
- newborn jaundice
What can icteric sclera be caused by (4)?
- hypoalbuminemia (less bilirubin bound)
- response to TPN (less binding of bilirubin)
- liver diseases
- trauma (excess and possible liver dysfunction)
What are 5 complications of ascites?
- respiratory distress syndrome
- sepsis
- dilutional hyponatremia
- renal dysfunction
- umbilical hernias
What are the 3 possible treatments for ascites?
- sodium/fluid restriction
- use of diuretics
- paracentesis (withdrawal of fluid from the abdomen via a catheter)
What is the treatment for HE?
- lactulose
- antibiotics
- Pro 1.2-1.5 g/kg/d
What is the MELD?
used to predict mortality rate after TIPS
calculate a patient’s likelihood of dying within three months
high score = severe liver disease
3 blood tests:
- bilirubin
- PT
- creatinine
Describe the 4 types of hepatitis.
A:
transmitted almost only through oral-fecal route
B:
Transmitted via blood-derived fluids, improperly sterilized medical instruments
C:
exposure to blood or body fluids from an infected person
D&E:
very uncommon - acute infection
What is acute liver failure characterized by (3)?
hepatic necrosis, coagulopathy, encephalopathy
treatment: liver transplant
What are the nutritional implications of having hepatitis?
- nausea and vomiting, abdominal pain
- anorexia with weight loss
- hypoglycemia (decreased gluconeogenesis)
- fluid and electrolyte imbalances
- prolonged PT
What are the nutrition interventions for hepatitis?
30-35kcal/kg
1-1.2g/kg pro
high energy and high protein diet
What is NAFLD?
refers to a wide spectrum of liver disease ranging from steatosis to nonalcoholic steatohepatitis (NASH) and to cirrhosis
more common in men
What are the nutrition interventions for NAFLD?
- intensive lifestyle intervention leading to weight loss
- abstinence from alcohol
- use of vitamin E
- adopt mediterranean diet
What is the hepatotoxic alcohol threshold?
40g for men -> 4 drinks
20g for women -> 2 drinks
What are the 3 liver disorders associated with ALD?
- fatty liver (hepatic steatosis)
- alcoholic hepatitis
- cirrhosis
What are the clinical presentations of ALD? (nonspecific and specific symptoms)
fatigue weakness nausea anorexia fever
jaundice hepatomegaly ascites portal hypertensive bleeding hepatic encephalopathy
What are the minor alcohol withdrawal symptoms and complications?
insomnia tremulousness mild anxiety gastrointestinal upset anorexia headache diaphoresis
withdrawal seizures
alcoholic hallucinosis
delirium tremens
micronutrient deficiencies
What are the vitamin and mineral deficiencies in ALD?
B vitamins
selenium
zinc
magnesium
What are the nutrition interventions for ALD?
- correct malnutrition
- correct nutritional deficiencies
- restriction of sodium, fluid and others
- ensure adequate energy and protein intake without increasing the risk of HE
What are the 5 main causes of cirrhosis?
- hepatitis
- alcoholic liver disease
- hepatitis C + alcoholic liver disease
- cryptogenic causes
hepatitis B
What are the clinical manifestations of cirrhosis? (nonspecific and specific symptoms)
fatigue weakness nausea poor appetite malaise vit and mineral deficiencies
jaundice dark urine light stools steatorrhea itching abdominal pain bloating
What are the major clinical complications of cirrhosis?
- portal hypertension
- hepatic encephalopathy
- ascites
- hepatorenal syndrome
- esophgeal varices
What is the compensated and decompensated state of cirrhosis?
Compensated: cirrhosis without ascites or encephalopathy
Decompensated: cirrhosis with ascites or encephalopathy
What are the nutritional implications of having cirrhosis?
- increased energy expenditure related to acute complications
- malnutrition
- sarcopenia
- micronutrient deficiencies
- early satiety from ascites
- hypoglycemia
What are the nutrition interventions for cirrhosis?
30-35kcal/kg
1.2-1.5g/kg
For OBESE patients:
25kcal/kg IBW
2.0-2.5g/kg IBW
- Replace vitamins and minerals
- Sodium restriction in ascites
- Soft diet for patients with esophageal varices
- Lifestyle interventions
What do furosemide and spironolactone do?
Furosemide:
increase excretion of Na, K, Mg, Ca
Diet high in K, Mg, Ca
Spironolactone:
increase reabsorption of K
avoid salt substitutes, avoid excess K in diet
What are the interventions for liver transplant?
- oral or EN preferred
- patients should be managed according to ERAS
- 30-35kcal/kg
1. 2-1.5g/kg
for OBESE patients:
25kcal/kg IBW
2.0-2.5g/kg IBW
