MNT for Hepatobiliary and Pancreatic Disorders Flashcards
The liver is made up of __ lobes
2
The (hepatic artery) supplies 1/3 of the blood to the liver. The ________ (portal vein) supplies the remaining 2/3 of the blood to the liver.
Aorta, intestines
The blood that travels from the _______ to the liver is loaded with nutrients from food absorption.
Intestines
Blood going to the liver comes via the hepatic artery and portal vein, and blood leaving the liver exits out of the _____ _____ _____.
Inferior vena cava
The liver produces ____ and releases it through ducts (located inside and outside of the liver) to transport ____ to the pancreas and gallbladder.
Bile, bile
The unique function of the liver is that it can ______ itself, which is why we can have living liver donors. We can survive with 20% of our liver.
Regenerate
Functions of the liver include:
- Produce bile to digest fat
- Detoxifier of drugs/toxins
- Synthesizes and activates nutrients
- Metabolizes alcohol/nutrients/hormones
- Storage for glycogen, fat-soluble vitamins (ADEK), minerals (zinc, iron, copper, B12)
- Conversion of ammonia (toxic) from protein digestion into urea for urinary excretion
- Filters blood to remove toxins and flood the chamber when the heart is unable to pump adequately (ex., congestive heart failure)
Liver function tests (LFTs) - 7
Hepatic excretion
Hepatic enzymes
Serum ammonia
Serum albumin
Prothrombin time
Imaging
Biopsy
Hepatic excretion includes the increase of _____ and _____ bilirubin. This is done because the liver helps excrete bilirubin within the stool along with bile. If bilirubin accumulates in the blood, ______ can occur.
Serum, urine, jaundice
With liver disease, serum bilirubin and urine bilirubin will ______ because the liver is unable to excrete bilirubin in the stool.
Increase
Hepatic enzymes such as serum ____ and ____ are transferase enzymes in the liver that can be measured.
ALT and AST
Hepatic enzymes include: (3)
Serum ALT
Serum AST
Serum alkaline phosphatase
Hepatic serum enzyme concentrations will ________ in liver disease due to the destruction of liver cells leaking enzymes into the blood. There will be ____ enzymes in the liver cells but ____ enzymes in the blood.
Increase, less, more
A healthy liver converts ammonia to urea. If the liver is damaged, there will be a _____ of ammonia in the blood, which is very common in hepatic __________.
Build-up, encephalopathy
Serum albumin _____ with liver disease due to inflammation and because a damaged liver can’t synthesize proteins.
Decreases
Prothrombin time _____ in liver disease because the liver synthesizes clotting factors, thus taking the blood ______ to clot.
Increases, longer
Imaging of the liver include (3)
Ultrasound, CT, and MRI
Symptoms of liver disease can vary or be nonexistent but sometimes include right upper _____ pain.
Quadrant
Infectious forms of hepatitis A and E are mainly spread through the _____ _____ route, usually through poor hygiene.
Fecal-oral
Serum form of hepatitis B, C, and D are spread through _____ or body _____.
Blood, fluids
Viruses cause viral hepatitis and have five forms. A and E are _______ forms, while B, C, and D are _____ forms.
Infectious, serum
Symptoms of hepatitis can include fatigue, anorexia, N/V, ________ pain, or jaundice.
RUQ - Right upper quadrant
Hepatitis B and C usually progress from acute hepatitis to _____ hepatitis.
Chronic
Nonalcoholic fatty liver disease stages
- Hepatic steatosis: fat deposits in the liver - reversible with treatment
- Nonalcoholic steatohepatitis (NASH): liver becomes fatty and inflamed - reversible with treatment
- Cirrhosis - not reversible
Risk factors for NAFLD
Obesity - abdominal fat
Type 2 diabetes (any type of insulin resistance)
Dyslipidemia
Metabolic syndrome
Treatment for nonalcoholic fatty liver disease
- Exercise to decrease insulin resistance and weight loss
- Omega 3/Anti-inflammatory diet
- Reduce foods that raise TG: alcohol, refined sugars
- Vitamin E: antioxidant properties
Cholestatic liver disease is characterized by impaired _____ flow and is an autoimmune disorder. This leads to malabsorption of fats and fat-soluble vitamins.
Bile
There are two types of cholestasis liver diseases:
Primary biliary cirrhosis
Sclerosing cholangitis
Primary biliary cirrhosis consists of the immune system destroying the __________ bile ducts.
Intrahepatic
Sclerosing cholangitis consists of the the immune system attacking and causing inflammation of ________ bile ducts and is also associated with IBD.
Extrahepatic
Complications of cholestatic liver disease include fat-soluble vitamin deficiencies and ______ softening/loss.
Bone
____ disorders affecting the liver include hemochromatosis and Wilson’s disease and are not preventable due to being genetic.
Inherited
Hemochromatosis is when there is ____ overload due to the body absorbing excessive amounts despite eating normal amounts of ____-containing foods.
Iron, iron
Measures of hemochromatosis include _____ levels of transferrin (iron transporter) saturation and ferritin (storage form of iron).
Increased
Treatment of hemochromatosis includes ________ to remove the iron from the body through blood.
Phlebotomy
MNT for hemochromatosis is a low-iron diet, especially _____ iron, limited non-heme iron, as well as ________ __.
Heme, Vitamin C
- also include more dairy foods with non-heme iron to reduce bioavilibity
Normally excess copper is excreted with bile in the stool. However, Wilson’s disease includes impaired biliary ______ excretion. Creating a buildup of _____ in the liver.
Copper, copper
Symptoms of Wilson’s disease are _____ ____ rings, as copper can build up in the corneas of the eyes.
Kayser-Fleischer
Wilson’s disease may also be present with _____ because excess copper can promote excess inflammation.
Hepatitis
Copper in the liver and urine will ______ since copper is unable to be excreted through the stool.
Increase
Treatment of Wilson’s disease includes _____ therapy to bind copper and remove it from the body through the stool.
Chelation
MNT for Wilson’s disease includes _____ supplementation and a low copper diet.
Zinc
Alcoholic liver disease begins with hepatic _____ due to excessive alcohol consumption.
Steatosis
With excessive alcohol consumption, the body decreases fatty acid oxidation and increases fatty acid _____, which increases TG levels.
Synthesis
Hepatic steatosis can be _______ with abstinence.
Reversible
Progression of Alcoholic Liver Disease includes:
Hepatic Steatosis
Alcoholic Hepatitis
Alcoholic Cirrhosis
Alcohol hepatitis may resolve with abstinence, but since it inflames the liver, it _____ liver function.
Impairs
T/F: Hepatic steatosis may go undetected with lab values, however, alterations in lab values can be seen in alcoholic hepatitis.
True
During alcoholic cerrhosis the damage is irreversible because scar tissue replaces ______ liver cells, progressing to end-stage liver disease.
Healthy
_______ is toxin that can damage the liver, leading to inflammation/hepatits and possibly lead to cirrhosis.
Acetaldehyde
The fat portion of alcohol comes from _____.
Hydrogen
Alcohol is broken down into _______ and _______.
Acetaldehyde, Hydrogen
Excessive alcohol intake results in ____ replacing fat as a fuel source, causing a decrease of fat breakdown and increase of fat accumulation.
Hydrogen
The main symptoms of cirrhosis include:
- Encephalopathy
- Ascites
- Esophageal varices
- Jaundice
- Bruising
- Asterixis
Ascites, a symptom of cirrhosis, consists of build up fluid in the abdomen due to ____ albumin and portal _______.
low, hypertension
Encephalopathy, a symptom of cirrhosis, alters brain function due to a build-up of _____.
Ammonia
Esophageal varices are a result of portal _______ because blood traveling from the intestines to the liver becomes backed up in the portal circulation, resulting in ______ in the esophagus becoming swollen with blood. Patients with this should avoid rough foods.
Hypertension, capillaries
Bruising occurs due to a decrease of ______ factors.
Clotting
Asterixis (chronic tremors) is due to ____ buildup.
Toxin
Stages of hepatic encephalopathy
- Confusion, agitation, irritability
- Lethargy, inappropriate behavior
- Incomprehedile speech, aggressive behavior
- Coma
Hepatic encephalopathy can be reversible if ______ levels can be brought down unless the patient reaches a stage of a coma.
Ammonia
MNT for liver disease
- Increased energy intake with small frequent meals (25-35 kcals - use dry weight)
- 1-1.5 kg protein - BCAA’s (leucine)
- Na restriction due to fluid retention
- MCT oil for steatorrhea
- Oral or enteral tube feeding
_____ lowers ammonia levels, which can be helpful in liver disease. However, it can cause _____.
Lactulose, diarrhea
T/F: Patients with liver diseases such as hepatic encephalopathy should have low-protein diets since protein contains nitrogen.
False, we want to increase protein intake, especially BCAA-like leucine that can be metabolized outside of the liver
MCT oil is helpful for steatorrhea (fat malabsorption) since medium-chain triglycerides don’t require ____ for absorption.
Bile
Patients with esophageal varices should consume a ____ fiber diet.
Low
Patients with alcoholic liver disease should supplement with ______ and ______.
Thiamin and folate
Patients with ascites should be on a fluid and _____ restriction due to fluid buildup in the abdomen.
Sodium
_______ can help reduce ammonia levels for patients with hepatic encephalopathy.
Probiotics
End-stage liver disease may require a liver ______.
Transplant
Liver transplantation energy needs include a ____ - ____% energy increase and 1.2 - ___ g/kg of protein.
20-30, 2 kg
Medications post-liver transplantation result in nutritional side effects (3)
Sodium retention/hypertension - limit sodium intake
Hyperglycemia - limit simple CHO intake
Hyperlipidemia - limit fat and simple CHO intake
The main functions of the gallbladder include ____ and ____ bile into the small intestine.
Storing, secreting
The main functions of the pancreas include _______ functions, such as secreting the hormones insulin and glucagon. ______ functions of the pancreas include secreting digestive enzymes to break down CHO, fat and protein.
Endocrine, exocrine
The pancrease secretes _______ to neutralize the chyme released from the stomach to protect the intestines.
Bicarbonate
The gallbladder and pancreas are stimulated by the hormone ______, which is released in the presence of acid. This hormone tells the pancreas to release ________ to neutralize the acid.
Secretin, bicarbonate
____ is a hormone released when food reaches the duodenum, stimulating the gallbladder to secrete bile and the pancreas to secrete digestive enzymes.
CCK
Cholestasis includes a lack of bile secretion or bile flow obstruction and is a result of ____ and can be treated with oral or _____ feeding to stimulate the gut.
NPO, Enteral
Cholelithiasis are gallstones made up of cholesterol, bilirubin, and ______ salts.
Calcium
Prevention of cholelithiasis (gallstones) includes a _____ fat, high fiber diet, vitamin C, and maintaining a normal weight/avoiding rapid weight loss.
Low
T/F: A low-fat diet is recommended to treat cholelithiasis to reduce the amount of cholesterol and bile required to digest the fats.
True
T/F: Vitamin C is suggested for cholelithiasis (gallstones) because it helps the conversion of cholesterol into bile.
True
Treatment of cholelithiasis includes a ____________ (full removal of the gallbladder)
Cholecystectomy
________ , inflammation of the gallbladder, sometimes as a result of gallstones, may also require a cholecystectomy.
Cholecytsis
Acute cholecystitis can be more severe, requiring removal of the gallbladder. However, chronic cholecystitis is low-grade and requires a ___ fat diet.
Low
T/F: Without the gallbladder, there is no way to store/secrete bile.
False, the liver will take over to store and secrete bile (unless there is overconsumption of fat then there will be fat malabsorption)
Pancreatitis risk factors include alcoholism, gallstones, biliary tract disease, and premature activation of ________ causing autodigestion (digestion of the pancreatic tissue).
Trypsin
Symptoms of pancreatitis include abdominal pain, N/V, and _______ due to a reduction of pancreatic lipase enzymes in the small intestine.
Steatorrhea
Diagnosis of acute (severe) pancreatitis includes (2) because a damaged pancreas will leak enzymes into the blood, creating an increase of these enzymes in the serum.
Serum pancreatic amylase and lipase
Diagnosis of chronic pancreatitis includes a _______ stimulation test to detect if bicarbonate is released.
Secretin
Diagnosis of chronic pancreatitis includes a _______ tolerance test to detect if insulin is released.
Glucose
The diagnosis of chronic pancreatitis includes a 72-hour ____ fat test. More than 7g of fat in the stool means fat malabsorption (steatorrhea).
Stool
____ blockers help with pancreatitis because they lower the acid content of the stomach, which will spare the pancreas from having to secrete bicarbonate.
Acid
__________ is used for acute pancreatitis because it inhibits all pancreatic release of enzymes and hormones.
Somatostatin
Severe acute pancreatitis may include _____ nutrition. The tube can be placed in the jejunum beyond the LOT for improved tolerance, as this placement doesn’t require pancreatic enzymes for digestion.
Enteral
As inflammation resolves, advance to a low-fat diet with ____ _______ meals.
Small frequent
Chronic pancreatitis may be treated with pancreatic enzyme ________ therapy (PERT), which help digest/absorb food.
Replacement
Chronic pancreatitis should consume extra calories (35 kcals) and protein (1-1.5 kg) with normal amounts of ____ (30% of kcals).
Fat
Chronic pancreatitis patients should supplement with fat-soluble vitamins and _____.
B12
B12 should be supplemented in chronic pancreatitis because acid blockers reduce the ________ of B12 in the stomach.
Absorption
What hepatitis virus is primarily transmitted by blood and body fluids?
- Hepatitis B
- Hepatitis E
- Hepatitis A
- None
Hepatitis B
What kind of food may cause pain if eaten by a patient with cholecystitis?
High-fat foods
What occurs when pancreatitis progresses to the point where the ability to secrete a sufficient quantity of enzymes is impaired?
Steatorrhea
How is serum alkaline phosphatase used to diagnose liver disease?
It increases in cholestasis
What is the medical treatment of ascites?
Paracentesis- removing the fluid from the abdomen with a needle
Patients with cirrhosis of the liver may have problems digesting ______.
Fat
Causes of ascites in patients with liver disease include (2)
Portal hypertension and hypoalbuminemia
Patients with chronic cholecystitis often require
A low fat diet to spare the gallbladder
Steatosis
Excess fat build up in the liver
____ is the most common liver disease, affecting around 32% of people globally.
NAFLD
NAFLD is most common in _____, non hispanic whites and asian americans. It is less common in non hispanic blacks.
Hispanics
When the liver’s capacity for secreting or oxidizing fatty acids is surpassed, fat starts to _______, filling liver cells with large fat droplets, which can damage or scar the cells
Accumulate
Gradual weight loss of 3% to __% of total body weight by creating a calorie deficit often is recommended to improve steatosis and prevent NAFL from progressing to NASH, but a weight loss of 7% to __% may be needed to improve fibrosis and prevent NASH from becoming more severe
5, 10
NAFDL: Increase protein to __% of daily calories from plant sources, fish, and lean, unprocessed animal sources
20
NAFDL: Reduce dietary fat to __% of daily calories, replacing saturated fats and trans fats in the diet with unsaturated fats from nuts, seeds, avocados, olives, and olive oil, and especially with omega-3 fatty acids from fish, walnuts, flax, and chia seeds. Multiple studies have found that nut intake is inversely associated with the likelihood of having NAFLD.
30
NAFDL: Limit carbohydrates to 50% of daily calories, and emphasize low-glycemic, high-fiber carbohydrates such as vegetables, whole grains, legumes, and most fruits.
50
Cholestatic liver disease is an ________ disorder, which affects bile flow due to primary biliary cirrhosis and sclerosing cholangitis.
Autoimmune - cant be fixed with lifestyle
Stage 1: Hepatic encephalopathy
Mild confusion, agitation, sleep disturbance, decreased attention, irritability
Stage 2: Hepatic encephalopathy
Lethargy, disorientation, inappropriate behavior, drowsiness
Stage 3: Hepatic encephalopathy
Confusion, aggression, incomprehendible
Stage 4: Hepatic encephalopathy
Coma
MCT oil is great for steatorrhea since it doesn’t require ___ for absorption.
Bile
_______ is released in the presence of acid and tells the pancreas to secrete bicarbonate.
Secretin
The presence of nutrients in the duodenum stimulates CCK to signal the gallbladder to release bile and the pancreas to release pancreatic ____ and ____.
Amylase, lipase
Chronic pancreatitis tests include:
Secretin stimulation test
Glucose tolerance test
72 hr stool fat test
Acute pancreatitis tests include:
Blood levels of pancreatic amylase and lipase
Alcoholic liver disease impairs ______ and ______ metabolism. Banana bags are special IV fluids that include these B vitamins.
Thiamin, folate
MNT Acute pancreatitis includes:
Mild- oral feeding if tolerated
Severe: EN, below jejunum LOT
Advance to low-fat diet with SFM
(6 SFM)
MNT Chronic pancreatitis
PERT with food
Extra calories 35kcals
Extra protein 1-1.5g
Regular fat 30% kcals
Fat-soluble vitamins and B12
