Liver Diseases Flashcards
What are the viral hepatitis?
- Hepatitis A (HAV)
- Hepatitis B (HBV)
- Hepatitis C (HCV)
Describe hepatitis A
Infectious/viral (extremely contagious) that is s pread via contaminated water, food, sewage
* Associated with floods/natural disasters
* Associated with undercooked shellfish from contaminated water
* Usually resolves in a few months
* Vaccination available
* Does not tend to cause permanent liver damage
Describe hepatitis B
Transmitted through bodily fluids such as infected needles/blood and sexual activity
* Carried by ~1.25 million people in the US
* More serious, chronic illness can result
* HBV vaccinations recommended for health care workers
Describe hepetitis C
Not well understood/viral
* Transmission through blood
* 2.7million carriers in the US
* Chronic illness can result
* vaccine available and drug therapy
What else can result in hepatitis?
- Alcohol induced: precursor to cirrhosis
- Non-alcoholic fatty liver disease: lifestyle and diet? Insulin resistance.
- Chemical toxins: induces autoimmune rxn and attempt by liver to detoxify which results in damage in terms of both
alcohol induced and NAFLD most common
Hepatitis Treatment
- Diet based on lab values and symptoms
- Avoid substances that would aggravate the liver: alcohol, drugs
- Antiviral meds (Hep B and C)
- Immune system enhancers
What is cirrhosis?
A consequence of chronic liver disease where liver tissue is replaced by scar tissue blocking
blood flow
* Leads to progressive loss of liver function
Causes of Cirrhosis
- Alcoholism – “Laennec’s Cirrhosis”
- Birth defect (eg extrahepatic Biliary Atresia)
- Advanced hepatitis
- Wilson’s disease - excess Cu accumulation
- Toxins - chemo therapeutic agents
- Hemochromatosis – excess iron absorption
Describe Encephalopathy
↑ Serum ammonia levels; Treatment focused on controlling protein intake (enough to prevent lean body mass depletion) and to treat with medications such as lactulose.
* Altered mental state
What AAs are increased/decreased with encephalopathy?
↑ Aromatic aa’s (phe, tyr, trp)
* ↑ levels cross blood brain barrier
* ↑ tryptophan = ↑ serotonin = coma
↓ Branched chain aa.’s (val, leu, ile)
* due to ↑’d uptake into muscle/ ↑oxidation for energy substrate
* So want to add more branched chain
Goals for liver disease nutrition therapy
- Encourage liver tissue regeneration (more leucine)
- Prevent and correct malnutrition (consider hypermetabolism)
- Prevent and treat complications associated with liver disease
- optimize vitamin D (bone health) vitamin K, fat soluble vitamins
What should nutrition care for liver disease focus on?
- energy
- CHO
- fat
- sodium restriction
- fluid restriction
- alcohol
Energy nutrition care for liver disease
- High energy to prevent catabolism and spare protein (particularly in cholestatic liver disease)
- Be careful with obesity.
- 25-35kcal/kg dry body weight
- 40-50kcal/kg dry body weight for acute hepatitis
- Should avoid fasting as experience increase lean body mass catabolism
- Consider the use of late evening snacks (CHO vs. PRO)
CHO nutrition care for liver disease
- ↑ CHO to prevent catabolism, spare protein
- 300-400g/d
- May require insulin
- Consider late night evening snacks with lower glycemic index to avoid postprandial hyperglycemia, and to minimize gluconeogenesis
Fat nutrition care for liver disease
- As tolerated, malabsorption may be present
- 25-40% of kcal
- MCT oil more easily absorbed
