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Advanced MNT 2 > Liver Disease Part 1 > Flashcards

Liver Disease Part 1 Flashcards

1
Q

General Function of the liver is Macronutrient metabolism

More specifically…
______ storage
____________

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

___________
______ production

A

glycogen
gluconeogenisis

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

FA beta oxidation
ketone production

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2
Q

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 _______

A

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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3
Q

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

A

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

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4
Q

What are the types of viral hepatitis?

A

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

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5
Q

how can hep A be transmitted

A

fecal-oral route
contaminated drinking water
food

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6
Q

How can Hep B and C be transmitted

A

blood
other body fluids

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7
Q

Symptoms of Acute Viral Hepatitis

A

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

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8
Q

goal of acute viral hepatitis

A

recovery and regeneration of hepatic cells

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9
Q

MNT for acute viral hepatitis

A

no specific MNT
symptom management

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10
Q

chronic hepatitis is when there is ≥____ course of hepatitis

can progress and lead to ______

A

6 month

cirrhosis

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11
Q

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

Can also be from metabolic disorders such as ________ or _________

A

HBV or HCV
autoimmune
hepatotoxic

Wilson’s disease
hemochromatosis

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12
Q

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

A

anorexia and nausea
poor intake and wt loss

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13
Q

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

avoid ______
inquire about ______

A

35
1.2-1.5

alcohol
supplement use

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14
Q

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

A

alchoholic liver disease

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15
Q

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

A

acetaldehyde
mitochondria
hepatocyte

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16
Q

ALD stages

A

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

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17
Q

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

A

decreased FA oxidation
increased hepatic lipogenesis
trapping TG in liver

no symptoms

yes with abstinence from alcohol

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18
Q

ALD Stage 2: Alcoholic Hepatitis

Whats happening?
Manifestations?
Symptoms?

A

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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19
Q

ALD Stage 3: Alcoholic Cirrhosis

A

liver injury and degeneration
end stage liver disease
irreversible

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20
Q

MNT for Alcoholic Hepatitis

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

supplementation:
_______(3)

A

35
1.2-1.5

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

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21
Q

NAFLD is now known as ________

A

metabolic dysfunction-associated fatty liver disease (MAFLD)

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22
Q

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

A

fat
hepatocytes

increases uptake of lipids
increases hepatic lipogenesis
decreases fat oxidation

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23
Q

MAFLD is often benign but _________ can lead to _________

this is cause by ?

A

steatohepatitis
cirrhosis

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

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24
Q

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

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

A

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

CHO
Mediterranean

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25
Q

MNT for MAFLD

MNT & PA to improve glucose control

Hypertriglyceridemia=>_____, _____, _____, _____

Vitamin ___ supplementation: ____ IU/day

A

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

E
800

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26
Q

cholestatic liver disease

Caused by chronic ______ injury to the _____
These involve ____________ + ______________

Results in _______ and reflux of _____ into the _____=> hepatocyte damage

A

autoimmune
bile ducts

Primary Biliary Cirrhosis (PBC)
Primary Sclerosing Cholangitis (PSC)

cholestasis
bile acids
liver

27
Q

progressive destruction of the intrahepatic bile ducts

A

Primary Biliary Cirrhosis (PBC)

28
Q

fibrosing inflammation of the extrahepatic & intrahepatic bile ducts

A

Primary Sclerosing Cholangitis (PSC)

29
Q

cholestatic liver disease sign and symptoms

A

jaundice

pruritis

elevated serum bilirubin & alkaline phosphatase levels

fat malabsorption/fat vitamin deficiencies

osteopenia

slow progression to ESLD

30
Q

MNT for cholestatic liver disease

A

if fat malabsorption, 40 g/d
fat-soluble vitamin supplement in water soluble form

Ca supplementation
monitor for wt loss

31
Q

Hemochromatosis is a _______ disorder

A

recessive genetic disorder

32
Q

what happens in hemochromatosis

A

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

33
Q

hemochromatosis complications

A

ESLD
hepatocellular carcinoma
glucose intolerance
arthritis
cardiac involvement

34
Q

hemochromatosis treatment

A

phlebotomy to remove Fe from blood & chelating agents

35
Q

MNT for Hemochromatosis

A

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

36
Q

Wilson’s Disease is an _______ disorder

results in impaired ________

A

autosomal recessive

biliary copper excretion

37
Q

in wilsons disease copper accumulates in the ?

A

liver
brain
kidneys
cornea

38
Q

complications of wilson’s disease

A

chronic hepatitis
ESLD
neurologic symptoms

39
Q

treatment for wilson’s disease

A

copper chelating agents
Zn supplementation

40
Q

MNT for Wilson’s Disease

A

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

41
Q

high copper foods include

A

lamb, pork, duck, organ meats
salmon, shellfish

nuts, seeds, chocolate
soy protein & milk
dried beans
bran cereals
mushrooms

42
Q

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 ________

A

fulminant hepatitis

preexisting liver disease

43
Q

acute liver failure is…

Rapid clinical deterioration with the onset of ______, ______, and ______

A

jaundice
coagulopathy
hepatic encephalopathy

44
Q

causes of acute liver failure

A

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

45
Q

Complications of ALF

A

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

46
Q

MNT for ALF

Energy expenditure _______ by up to ___%
________ state

Usually require _______

Increased intracranial pressure &/or ascites=>_____________

A

increases
30%
Hypercatabolic

enteral nutrition

sodium & possible fluid restriction

47
Q

End Stage Liver Disease (ESLD) is also known as

A

cirrhosis

48
Q

End Stage Liver Disease (ESLD)

Caused by chronic injury to hepatocytes=> ________ and disruption of liver tissue & ________

Altered structure causes=>_________=> _______

Liver becomes ______
reversible?

A

fibrosis
vascular architecture

increased intrahepatic vascular resistance
portal hypertension

necrotic
Irreversible

49
Q

Causes of ESLD

A

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

50
Q

ESLD Stages

A

compensated
decompensated

51
Q

compensated ESLD

A

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

52
Q

decompensated ESLD

A

Extensive scarring
liver is unable to function properly
complications

53
Q

jaundice is a result of hyper_______.

A

bilirubinemia

53
Q

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

A

Hemoglobin metabolism
conjugation
bile

54
Q

jaundice occurs due to

A

obstruction in bile ducts or hepatocyte damage

55
Q

what is coagulopathy

A

Decreased production of clotting factors=> increased bleeding risk

56
Q

Portal Hypertension is ?

A

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

57
Q

Portal hypertension results in

A

ascites
esophageal varices
splenomegaly

58
Q

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=> _______

A

collateral circulation

Opening & dilation
veins
superior & inferior vena cava

varices
Portacaval shunt

59
Q

Fragile, dilated collateral veins caused by portal hypertension

A

esophageal varices

60
Q

if esophageal varices rupture, results in a _________

A

GI bleed

61
Q

treatment for Esophageal varices ?
medications ?

A

Endoscopic band ligation

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

62
Q

MNT for Esophageal Varices

A

No oral or nasoenteral nutrition during acute bleeding episodes

After bleeding resolved…
Full liquid diet=>Easy-to-Chew diet

Chew food thoroughly

63
Q
A

Advanced MNT 2 (17 decks)

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