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FN 125 > MNT for Liver > Flashcards

MNT for Liver Flashcards

1
Q

The liver has over ____ functions

A

500

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2
Q

Manufactures blood proteins

A

Rough ER

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3
Q

Produce bile salts and detoxifies blood-borne poisons

A

Smooth ER

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4
Q

Detoxify other poisons, including alcohol

A

Peroxisomes

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5
Q

Supplies energy

A

Mitochondria

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6
Q

Packages

A

Golgi apparatus

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7
Q

Stores sugar and regulates blood glucose levels

A

Glycosomes

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8
Q

Produce ____ - _____ mL bile each day

A

500-1000

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9
Q

Regeneration capacity is done through:

A

Liver stem cells

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10
Q

Liver manufactures

A

Protein
Glycogen
Bile
Cholesterol

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11
Q

Liver stores

A

Iron
Fat-soluble vitamins
Glycogen

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12
Q

Liver wastes

A

Ammonia
Drugs and alcohol
Bilirubin
Bacteria

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13
Q

Diseases of the liver

A

Hepatitis - acute viral, fulminant, chronic
Alcoholic liver disease, alcoholic hepatitis, and cirrhosis
NASH
Cholestatic liver disease (primary biliary cirrhosis, cholangitis)
Inherited disorders
Other liver diseases

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14
Q

Features similar to acute hepatitis but with more severe liver damage and serious clinical state

A

Acute liver failure

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15
Q

Present in acute liver failure but not in acute hepatitis

A

Encephalopathy
Poor coagulation
Hepatic atrophy
Brain edema
High risk of death without transplant

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16
Q

Hallmark of infection

A

HBsAg

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17
Q

Acute infection (serological marker)

A

Anti-HBc IgM

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18
Q

Resolved infection (serological marker)

A

Anti-HBc total

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19
Q

High viral load and high infectivity

A

HBeAg

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20
Q

Antibody to HBeAg, indicates decreasing HBV DNA

A

Anti-HBe

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21
Q

Recovery from acute infection

A

Anti-HBs

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22
Q

Widespread inflammation of the liver caused by hepatitis viruses A, B, C, D, and E

A

Acute hepatitis

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23
Q

Hepatitis A:

A

Oral and fecal route

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24
Q

Hepatitis B and C:

A

Body fluids

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25
Q

Hepatitis D

A

Occurs only in parts with B

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26
Q

Hepatitis E:

A

Oral fecal route, most seen in Asia, Africa, and Mexico

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27
Q

4 phases of symptoms

A

Prodromal
Pre-icteric
Icteric
Convalescent

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28
Q

Malaise, fatigue, low-grade fever, nausea vomiting, aversion to food, mild itching, joint/muscle pain

A

Prodromal

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29
Q

Icteric

A

Yellow eyes, dark urine, light stool

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30
Q

Gradual recovery

A

Convalescent

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31
Q

Risk factors for chronic hepatitis

A

Injection drug use
Chronic hemodialysis
Blood transfusion
Blood receipt
Clotting factor receipt
Unvaccinated health care worker
Asian ancestry
Birth to mother with chronic HBV or HCV

32
Q

Possible risk factors

A

Piercings or tattoos
Multiple sexual partners
Health care worker
Exposure to positive person

33
Q

6-month course of hepatitis or evidences of liver disease with confirmatory biopsy

A

Chronic hepatitis

34
Q

Caused by alcohol excess and abuse

A

Alcohol liver disease

35
Q

Most common liver disease

A

Alcoholic liver disease

36
Q

Stages of alcoholic liver disease

A

Hepatic steatosis (fatty liver)
Alcoholic Hepatitis
Alcoholic Cirrhosis

37
Q

Alcoholic liver disease: metabolic changes

A

Steatorrhea
Wernicke-Korsakoff syndrome
Pellagrous psychosis
Peripheral neuropathy
Folate deficiency

38
Q

Possible characteristics of end-stage alcoholic liver disease

A

Malnutrition
Portal hypertension with varices
Ascites
Hyponatremia
Hepatic encephalopathy
Glucose alteration
Fat malabsorption
Osteopenia
Thrombocytopenia with anemia

39
Q

Histologically resembles alcoholic hepatitis
Most common cause of chronic hepatic injury other than viruses or alcohol
Most common cause of cryptogenic cirrhosis
Common in middle-aged women with obesity or diabetes

40
Q

True or False: ALT is higher than AST for NASH

41
Q

True or False: ALT is higher than AST for NASH

42
Q

T or F: People with NASH generally have normal lipid profiles

43
Q

Give some clinical manifestations of cirrhosis

A

Ascites
Spider angioma
Jaundice
Testicular atrophy
Caput medusae
Gynecomastia
Alopecia
Icteric sclera
Asterixis
Palmar erythema
Altered hair distribution
Edema
Bruising
Muscle wasting

44
Q

These are the enzymes released into circulation following injury or death of cells in the liver, heart, lungs, etc.

A

ALT and AST

45
Q

True or False. High AST and ALT are indicative of liver disease in the presence of jaundice or other symptoms. Levels are lower for acute hepatic injury than in chronic liver disease

A

Statement 1 - True
Statement 2 - False (higher)

46
Q

Transaminase levels will relate more to the ____ rather than the _____.

A

Cause; prognosis

47
Q

Usually normal in chronic and acute liver disease

48
Q

ALP

A

Alkaline phosphatase

49
Q

High levels are indicative of obstruction of biliary drainage

50
Q

Viral hepatitis: bilirubin is

A

> 257 mcmol

51
Q

Alcoholic hepatitis, bilirubin is

A

> 428 mcmoles per L - likelihood of death

52
Q

Protein-bound, related to the breakdown of RBCs

A

Unconjugated/indirect bilirubin

53
Q

Non-protein bound with increased in blockage of the liver

A

Conjugated/direct bilirubin

54
Q

Non-protein bound with increased in blockage of the liver

A

Conjugated/direct

55
Q

Conditions related to increased direct bilirubin

A

Viral hepatitis
Cirrhosis
Infectious mononucleosis
Reaction to drugs (chlorpromazine - a sedative used for psychotic orders)
Obstruction of the CBD (gallstones, neoplasms)

56
Q

Conditions related to increased indirect bilirubin

A

Blood transfusion
Pernicious anemia
Sickle cell anemia
Transfusion reactions

57
Q

Low ceruloplasmin indicates

A

High unbound copper

58
Q

Hepatolenticular degeneration caused by abnormal copper accumulation in the body

A

Wilson’s disease

59
Q

Most cost-effective screening test for metabolic or drug-induced liver injury

60
Q

Predictors of prognosis

A

PTT
Albumin - low - high risk of death

61
Q

Causes of Malnutrition in Liver disease

A

Restricted diets
Anorexia
Altered metabolism
Maldigestion of malabsorption
Early satiety or dysguesia
Nausea and vomiting

62
Q

Medical Management of liver disease

A

Diuretic therapy
Management of portal hypertensive bleeding
Medication of encephalopathy
Monitoring of blood glucose

63
Q

MNT for liver disease

A

Increased energy intake - small, frequent feedings
Sodium restriction for ascites
Fluid restriction for hyponatremia
Carbohydrate-controlled for hyperglycemia
V &M Supplements
Oral liquid supplements or TF

64
Q

Vitamin/Mineral Deficits in severe liver disease

A

ADEK
B1 B3 B6 B9 B12
Zn Mg Fe K P

65
Q

Refers to any type pf cerebral dysfunction that is due to liver insufficiency and/or portosystemic shnting

A

Hepatic encephalopathy

66
Q

Major causes of encephalopathy

A

GI bleeding
Fluid and electrolyte abnormalities
Uremia
Use of sedatives
Hypo/hyperglycemia
Alcohol withdrawal
Constipation
Acidosis

67
Q

Non-absorbable disaccharide that acidifies colonic contents and acts as laxative

68
Q

Non-absorbable antibiotic that decreases colonic ammonia production

69
Q

True or false: Ascites increases REE by 10%

70
Q

Energy, protein, and fat recommendations for MNT end-stage liver disease

A

Energy - 25-30 kcal/kg BW
Protein - 1-1.5 g/kg
Fat - 25-40% of kcal

71
Q

Recommendations for sodium

A

1500-2000 mg/day

72
Q

Recommendations for fluid

A

1000-1500 mL/day

73
Q

In liver diseases, aromatic AA are usually decreased and BCAAs are increased

74
Q

Aromatic AA

A

Free tryptophan, tyrosine, phenylalanine

75
Q

If steatorrhea is present, replace

A

LCT with MCT

76
Q

If steatorrhea is present, replace

A

LCT with MCT

FN 125 (3 decks)

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