Liver Disease Part 1 Flashcards by Sydney Perry

General Function of the liver is Macronutrient metabolism

More specifically…
______ storage
____________

synthesis of ____________
synthesis of ____, _____, ______, and ______

___________
______ production

glycogen
gluconeogenisis

non-essential amino acids
TG, cholesterol, phospholipids, and lipoproteins

FA beta oxidation
ketone production

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Another general function of the liver is storage, activation, and transport for many vitamins and minerals…

Storage of _______ (6 vit/minerals)

Synthesizes transport proteins for ______ (4)

Converts _________ to vitamin ___
converts _____ to its active form; intermediate step in _____ activation

Converts vitamin ___ to _______

fat-soluble vitamins, zinc, iron, copper, manganese, vitamin B12

vitamin A, iron, zinc, copper

beta-carotene, A
folate
Vit D

K
prothrombin

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liver also has functions for…
____ formation
converting _____ to ______
synthesis of ______ proteins = ______
synthesis of ____________ factors
filters ______ form the blood
detoxification of ___________

bile
ammonia to urea
plasma proteins=albumin
blood clotting
bacteria
drugs and alcohol

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What are the types of viral hepatitis?

hepatitis A (HAV)
hepatitis B (HBV)
hepatitis C (HCV)

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how can hep A be transmitted

fecal-oral route
contaminated drinking water
food

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How can Hep B and C be transmitted

blood
other body fluids

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Symptoms of Acute Viral Hepatitis

malaise, anorexia, nausea, RUQ pain
fever, arthralgia, rash
jaundice

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goal of acute viral hepatitis

recovery and regeneration of hepatic cells

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MNT for acute viral hepatitis

no specific MNT
symptom management

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chronic hepatitis is when there is ≥____ course of hepatitis

can progress and lead to ______

6 month

cirrhosis

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chronic hepatitis is from ____ or ____ infections.
this is an ________ disease and may be from __________ agents.

Can also be from metabolic disorders such as ________ or _________

HBV or HCV
autoimmune
hepatotoxic

Wilson’s disease
hemochromatosis

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chronic hepatitis may cause symptoms of ________ and _______ and they should be monitored for ______ and ______

anorexia and nausea
poor intake and wt loss

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MNT for Chronic hepatitis
______ kcal/kg
_______ g/kg

avoid ______
inquire about ______

35
1.2-1.5

alcohol
supplement use

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One of the most common liver diseases in the U.S.

alchoholic liver disease

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Alcohol metabolism results in _________ which damages the __________ and alters _________function

acetaldehyde
mitochondria
hepatocyte

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ALD stages

Stage 1: Hepatic Steatosis
Stage 2: Alcoholic Hepatitis
Stage 3: Alcoholic Cirrhosis

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ALD Stage 1: Hepatic Steatosis
- pathophysiology (whats happening?)
- symptoms?
- reversible?

decreased FA oxidation
increased hepatic lipogenesis
trapping TG in liver

no symptoms

yes with abstinence from alcohol

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ALD Stage 2: Alcoholic Hepatitis

Whats happening?
Manifestations?
Symptoms?

widespread inflammation of hepatocytes

hepatomegaly
elevated serum bilirubin and transaminases (AST, ALT)
possible decreased serum albumin

anorexia, RUQ pain, N/V/D, weakness, wt loss, fever

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ALD Stage 3: Alcoholic Cirrhosis

liver injury and degeneration
end stage liver disease
irreversible

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MNT for Alcoholic Hepatitis

Alcohol cessation may resolve damage
High kcal diet: ____ kcal/kg
______ g/kg protein

supplementation:
_______(3)

35
1.2-1.5

MVI with minerals
Thiamin: 50-100 mg
Folic acid: 1 mg daily

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NAFLD is now known as ________

metabolic dysfunction-associated fatty liver disease (MAFLD)

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MAFLD is the accumulation of ____ in the ______
Due to _______, _______, and/or _______.

fat
hepatocytes

increases uptake of lipids
increases hepatic lipogenesis
decreases fat oxidation

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MAFLD is often benign but _________ can lead to _________

this is cause by ?

steatohepatitis
cirrhosis

obesity
insulin resistance or type 2 DM
dyslipidemia
metabolic syndrome
parenteral nutrition

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MNT for MAFLD for Individuals with obesity=> ________, ______, and _______.

A hypocaloric, lower _____, _________ diet pattern may be beneficial

gradual wt loss
calorie restriction to lose 5-10% of body wt
increased PA

CHO
Mediterranean

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MNT for MAFLD MNT & PA to improve glucose control Hypertriglyceridemia=>_____, _____, _____, _____ Vitamin ___ supplementation: ____ IU/day

reduce intake of refined CHO limit alcohol low saturated fat/trans fat diet increase intake of omega-3 fatty acids E 800

cholestatic liver disease Caused by chronic ______ injury to the _____ These involve ____________ + ______________ Results in _______ and reflux of _____ into the _____=> hepatocyte damage

autoimmune bile ducts Primary Biliary Cirrhosis (PBC) Primary Sclerosing Cholangitis (PSC) cholestasis bile acids liver

progressive destruction of the intrahepatic bile ducts

Primary Biliary Cirrhosis (PBC)

fibrosing inflammation of the extrahepatic & intrahepatic bile ducts

Primary Sclerosing Cholangitis (PSC)

cholestatic liver disease sign and symptoms

jaundice pruritis elevated serum bilirubin & alkaline phosphatase levels fat malabsorption/fat vitamin deficiencies osteopenia slow progression to ESLD

MNT for cholestatic liver disease

if fat malabsorption, 40 g/d fat-soluble vitamin supplement in water soluble form Ca supplementation monitor for wt loss

Hemochromatosis is a _______ disorder

recessive genetic disorder

what happens in hemochromatosis

Increased iron absorption from the GIT=> Iron overload=> increased deposition of iron in tissues including the liver

hemochromatosis complications

ESLD hepatocellular carcinoma glucose intolerance arthritis cardiac involvement

hemochromatosis treatment

phlebotomy to remove Fe from blood & chelating agents

MNT for Hemochromatosis

Regular, well-balanced diet - Iron-restricted diet usually not indicated Avoid exceeding the DRI for iron - Avoid iron supplements and MVI with minerals including iron - Reduce intake of heme iron sources (Consume more of a plant-based diet) - Avoid highly fortified foods, vitamin C supplements, & alcohol

Wilson’s Disease is an _______ disorder results in impaired ________

autosomal recessive biliary copper excretion

in wilsons disease copper accumulates in the ?

liver brain kidneys cornea

complications of wilson's disease

chronic hepatitis ESLD neurologic symptoms

treatment for wilson's disease

copper chelating agents Zn supplementation

MNT for Wilson’s Disease

Low copper diet is no longer required but may be helpful in the initial phase of treatment Avoid MVI with minerals (if contains copper) Avoid alcohol - hepatotoxin

high copper foods include

lamb, pork, duck, organ meats salmon, shellfish nuts, seeds, chocolate soy protein & milk dried beans bran cereals mushrooms

Acute liver failure is also called _______ A rare syndrome resulting from acute, severe liver injury that destroys the majority of the hepatocytes=> liver failure Occurs in the absence of ________

fulminant hepatitis preexisting liver disease

acute liver failure is... Rapid clinical deterioration with the onset of ______, ______, and ______

jaundice coagulopathy hepatic encephalopathy

causes of acute liver failure

acetaminophen overdose* viral hepatitis* autoimmune hepatitis liver ischemia Wilson’s disease toxins dietary & herbal supplements

Complications of ALF

Hepatic encephalopathy Coagulopathy Hypoglycemia Systemic Inflammatory Response Syndrome (SIRS) Renal failure Respiratory failure Cerebral edema Coma Can be fatal without a liver transplant

MNT for ALF Energy expenditure _______ by up to ___% ________ state Usually require _______ Increased intracranial pressure &/or ascites=>_____________

increases 30% Hypercatabolic enteral nutrition sodium & possible fluid restriction

End Stage Liver Disease (ESLD) is also known as

cirrhosis

End Stage Liver Disease (ESLD) Caused by chronic injury to hepatocytes=> ________ and disruption of liver tissue & ________ Altered structure causes=>_________=> _______ Liver becomes ______ reversible?

fibrosis vascular architecture increased intrahepatic vascular resistance portal hypertension necrotic Irreversible

Causes of ESLD

Chronic hepatitis (HBV, HCV, autoimmune) Alcoholic liver disease Cholestatic liver disease Metabolic disorders: Hemochromatosis; Wilson’s Disease Metabolic dysfunction-associated Fatty Liver Disease (MAFLD) Cryptogenic cirrhosis

ESLD Stages

compensated decompensated

compensated ESLD

Liver is heavily scarred but still able to perform many of its functions

decompensated ESLD

Extensive scarring liver is unable to function properly complications

jaundice is a result of hyper_______.

bilirubinemia

bilirubin is the end product of _______ in liver _______ and then excretion in the ____

Hemoglobin metabolism conjugation bile

jaundice occurs due to

obstruction in bile ducts or hepatocyte damage

what is coagulopathy

Decreased production of clotting factors=> increased bleeding risk

Portal Hypertension is ?

Abnormally high blood pressure in the portal venous system due to the obstruction of blood flow through the liver

Portal hypertension results in

ascites esophageal varices splenomegaly

With portal hypertension, the ________ is used to bypass the obstructed liver ______ and ______ of preexisting blood vessels which connect ____ of the portal venous system to the ______________ Results in _____ in the GIT that are fragile and easily rupture Possible treatment=> _______

collateral circulation Opening & dilation veins superior & inferior vena cava varices Portacaval shunt

Fragile, dilated collateral veins caused by portal hypertension

esophageal varices

if esophageal varices rupture, results in a _________

GI bleed

treatment for Esophageal varices ? medications ?

Endoscopic band ligation B-adrenergic blockers (e.g., propranolol, metoprolol)

MNT for Esophageal Varices

No oral or nasoenteral nutrition during acute bleeding episodes After bleeding resolved... Full liquid diet=>Easy-to-Chew diet Chew food thoroughly