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Advanced MNT 2 > Liver Disease Part 2 > Flashcards

Liver Disease Part 2 Flashcards

1
Q

ascites is the accumulation of fluid, serum _______, and electrolytes in the ______ cavity

A

proteins
peritoneal

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2
Q

ascites is caused by ________ or ________

A

portal hypertension
decreased production of albumin

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3
Q

treatment for ascites

A

paracentesis
diuretics

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4
Q

MNT for ascites

A

2 g Na rescriction

possible fluid restriction of 1-1.5 L/day

adequate protein to replace losses from frequent paracentesis

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5
Q

when would someone be given a fluid restriction

A

if hypervolemia and significant hyponatremia (<125 mEq/L)

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6
Q

syndrome characterized by impaired mentation, neuromuscular disturbances, and altered consciousness

A

hepatic encephalopathy (HE)

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7
Q

theories for why hepatic encephalopathy occurs

A

elevated ammonia levels*

increased aromatic amino acids (AAA) &
decreased branched chan amino acids (BCAA)

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8
Q

Stage 1 of Hepatic Encephalopathy

A

mild confusion
irritability
decreased attention

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9
Q

Stage 2 of Hepatic Encephalopathy

A

lethargy
disorientation
inappropriate behavior
drowsiness
asterixis

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10
Q

Stage 3 of Hepatic Encephalopathy

A

Somnolent but arousable
confused
incomprehensible speech

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11
Q

Stage 4 of Hepatic Encephalopathy

A

coma

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12
Q

precipitating cause of HE

A

GI bleeding
Uremia
Constipation
Muscle catabolism*
Fluid & electrolyte abnormalities
Infection
Sedatives
Portacaval shunts
Excessive dietary protein (rare)

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13
Q

Medications used for HE treatment

A

Lactulose
Rifaximin

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14
Q

what does lactulose do

A

osmotic laxative to remove ammonia

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15
Q

what does Rifaximin do?

A

decreases colonic ammonia production

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16
Q

food drug interactions for lactulose

A

diarrhea
flatulence
N/V

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17
Q

food drug interactions for Rifaximin

A

no food drug interactions

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18
Q

MNT for Hepatic Encephalopathy ACUTE

A

provide 1.0-1.5 g/kg of protein

for patients requiring TF - use a formula with appropriate protein content

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19
Q

MNT for Hepatic Encephalopathy CHRONIC

A

High fiber

High dairy (casein is lower in AAA and higher in BCAA)

Vegetarian diet is questionable (veg pro is high in BCAA)

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20
Q

acute kidney failure in the absence of prior kidney disease due to decreased renal blood flow

A

hepatorenal syndrome

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21
Q

hepatorenal syndrome may require _________

A

dialysis

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22
Q

MNT for hepatorenal syndrom

A

possible restriction of…
Fluid, Na, K+, Phos

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23
Q

Protein metabolism in ESLD

increased levels of _______, ______, and ______ due to the _______ state

decreased synthesis of serum ______, ______, and _______

increased ______ levels

A

glucagon, epinephrine, & cortisol
catabolic state

albumin, transport proteins, & clotting factors

ammonia

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24
Q

Carbohydrate metabolism in ESLD

EARLY in disease, individual will get ________ from __________

A

hyperglycemia

peripheral insulin resistance decreasing glucose uptake

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25
Q

Carbohydrate metabolism in ESLD
LATE in the disease, individual gets __________ from ________ and _______

A

fasting hypoglycemia

loss of hepatic glycogen stores
depressed gluconeogenesis

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26
Q

Lipid Metabolism in ESLD
_________ due to _______
______ may occur due to ______

A

Increases lipolysis
depletion of fat reserves

fat malabsorption
decreases production of bile and blocked bile ducts (cholestatic liver disease)

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27
Q

Effects of ESLD on vitamin and minerals

A

decreased intake, absorption, transport, and storage of micronutrients

altered metabolism of micronutrients

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28
Q

Factors that cause malnutrition in ESLD

A

Inadequate oral intake

Disturbances in macronutrient metabolism leading to catabolism

Decreased capacity of the liver to store nutrients

Protein losses from large-volume paracentesis

Malabsorption of fat

28
Q

Malnutrition is present in ______ of those with cirrhosis.

more common in those with _________

________ is a defining feature of malnutrition in decompensated ESLD

associated with compromised immune function & respiratory function, delayed wound healing, longer hospital stays, and increased risk for mortality

A

50-90%
alcoholic liver disease
sarcopenia

28
Q

inadequate oral intake in ESLD due to ?

A

Anorexia
N/V
Dysgeusia
Early satiety
Restrictive diets
Alcohol abuse
Financial issues
Food-drug interactions

29
Q

Malabsorption of Fat due to ?

A

Decreased transport of bile via bile ducts

Decreased bile acid production by liver

30
Q

Many traditional parameters are affected by liver disease:

Wt, BMI, & %wt change are affected by fluid status

Decreased synthesis of ________ (e.g., albumin, prealbumin)

_________ & __________ syndrome affect validity of nitrogen balance studies

A

transport proteins

Hyperammonemia & hepatorenal

31
Q

Nutrition assesment for ESLD should include…

A

diet history
NFPE
current diagnosis, complications, & PMHx
Lab assessments

32
Q

what are some lab assessments we look at ?

A

albumin
ammonia
bilirubin
prothrombin time
aminotransferase
alkaline phosphatase
gamma-glutamyl transpeptidase

33
Q

All calculations for ESLD should use ______ for weight

A

dry weight

34
Q

if dry weight is not available you can
- use _____ and adjust based on amount of ascites and peripheral edema

subtract _____ if mild ascites
______ if moderate
______ if severe

subtract additional ___ if pedal edema present

A

IBW

5%
10%
15%

5%

35
Q

ESLD energy

A

Use indirect calorimetry if possible

25-35 kcal/kg

Malnourished patients may need up to 40 kcal/kg to promote anabolism

36
Q

ESLD Protein

A

1.2-1.5 g/kg

37
Q

ESLD CHO

A

Monitor for hyperglycemia
- may need insulin and a consistent CHO diet
Fasting Hypoglycemia

MNT:
Small frequent meals and an evening snack
Avoid alcohol

38
Q

ESLD Fat

A

30% of total kcal
If steatorrhea=> 40 g low fat diet

39
Q

ESLD Fluid

A

If hypervolemia and severe hyponatremia (serum Na <125 mEq/L)=> restriction of 1 - 1.5 L/d may be needed

Monitor I & O records, wt, serum Na

40
Q

ESLD Electrolytes

A

if ascites or edema = 2g Na restriction

monitor electrolytes due to diuretics and paracentesis

41
Q

ESLD Vitamins

A

provide MVI
additional supplements as needed
- fat soluble
- thiamin and folic acid
- vitamin K

42
Q

supplementation for fat soluble vitamins
- ≥90% of patients with advanced liver disease are vitamin ____ deficient

A

D

43
Q

what vitamins for alcoholic liver disease

A

thiamin
50-10 mg

folic acid
1 mg per day

44
Q

Minerals for ESLD

A

provide DRI’s except in…
1. cholestatic liver disease
2. hemochromatosis
3. wilson’s disease
4. GI Bleeding
5. Alcoholism
6. diuretics
7. steatorrhea

45
Q

Minerals for ESLD with cholestatic liver disease

A

No Cu and Mn supplements

46
Q

Minerals for ESLD with hemachromatosis

A

no iron supplement

47
Q

Minerals for ESLD with wilson’s disease

A

no Cu supplementation

48
Q

Minerals for ESLD with Gi bleeding

A

may need increases iron

49
Q

Minerals for ESLD withalcoholism

A

may need increased Zn and Mg

50
Q

Minerals for ESLD with Diuretics

A

may need increased K+, Zn, Mg, Ca

51
Q

Minerals for ESLD with steatorrhea

A

may need increased Ca, Mg, Zn

52
Q

General Recommendations for ESLD eating…

A

small frequent meals with a bedtime snack
dont skip meals
nutrient dense snacks
nutrition supplements if poor appetite

53
Q

ENTERAL NUTRITION may be required due to _____, _____, ______, or ______

A

poor intake
malnutrition
altered mental status
intubation

54
Q

ENTERAL NUTRITION for ESLD
________ formula

A __________ tube is appropriate with non-bleeding esophageal varices

PEG placement not recommended for those with _____ or _____

A

High protein

small-bore nasoenteric

ascites or gastric varices

55
Q

indication for parenteral nutrition in ESLD

A

non-functioning GIT

56
Q

Parenteral Nutrition can cause ______, ______, and _______

A

hepatic steatosis
cholestasis
cirrhosis

57
Q

Guidelines for Use of PN for Patients with ESLD

Avoid overfeeding of _____, ____, or ____
Lipid emulsion should not provide > ____ g/kg/d
Use a _______ solution
_______ administration recommended

For patients with cholestatic liver disease=> _____________

A

CHO, lipid, or total kcal
1
mixed substrate
Cyclic

reduce Cu & Mn provided

58
Q

Chylous Ascites is Leakage of ____ into the peritoneal cavity due to _____ or ______ from ______________

A

chyle

obstruction or leak

abdominal lymphatics

59
Q

what could cause chylous ascites

A

Malignant obstruction

Abdominal surgery: AAA repair, Liver transplant

Congenital defects of the lymphatics

60
Q

what is in this chyle

A

WBC
chylomicrons (TG & fat-soluble vitamins)
protein
fluid & electrolytes

61
Q

Consequences of chyle leakage

A

pain
anorexia
hypoalbuminemia
decreased electrolyte levels
fat-soluble vitamin depletion
EFAD

62
Q

Medical Management of chylous ascites

A

drainage and reducing chyle flow (conservative)
surgical repair

63
Q

Goal of MNT for chylous ascites

A

reduce chyle flow by decreasing LCT intake to <10 g/d while still providing adequate nutrition

64
Q

MNT Options for chylous ascites

A

Very low-fat oral diet with MCT supplementation

NPO with TF using a very low-fat elemental formula

NPO with TPN

65
Q

MNT for chylous ascites…

diet should be high in _______

______ can be a concern if ____ are restricted for more than _____

A

protein

EFAD
LCT
2 weeks

66
Q
A

Advanced MNT 2 (17 decks)

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