MNT for Liver Disease Part 1 Flashcards
What are the functions of the liver?
-Macronutrient metabolism
-Storage, activation, and transport of many vitamins and minerals
-Bile formation
-Converts ammonia to urea
-Synthesis of plasma proteins-> albumin
-Synthesis of blood clotting factors
-Filters bacteria from the blood
-Detoxification of drugs and alcohol
The macronutrient metabolism function of the liver includes functions like…
-Glycogen storage
-Gluconeogenesis
-Synthesis of non-essential amino acids
-Synthesis of triglycerides, cholesterol, phospholipids, and lipoproteins
-Fatty acid beta-oxidation
-Ketone production
What vitamins and minerals are stored, activated, or transported in the liver?
-Storage of fat-soluble vitamins, zinc, iron, copper, manganese, and vitamin B12
-Synthesizes transport proteins for vitamin A, iron, zinc, and copper
-Converts beta-carotene to vitamin A
-Converts folate to its active form
-Intermediate step in vitamin D activation
-Converts vitamin K to prothrombin
Hepatitis A is transmitted via ___-___ route through contaminated drinking water or food
Fecal-oral
Hepatitis B and C are transmitted via…
Blood, semen, or saliva
Symptoms of acute viral hepatitis:
-Malaise
-Anorexia
-Nausea
-Right upper quadrant pain
-Jaundice
The goal for the treatment of acute viral hepatitis is recovery and _____ of hepatic cells
Regeneration
MNT for viral hepatitis:
-No specific MNT
-Symptom management
Chronic hepatitis is a course of hepatitis that last for ____ months or more
6
Etiology of chronic hepatitis:
-Viral infection (HBV, HCV)
-Autoimmune disease
-Hepatotoxic agents (drugs, alcohol, toxins)
-Metabolic disorders-> Wilson’s disease, hemochromatosis
Chronic hepatitis can progress and lead to ____
Cirrhosis
MNT for chronic hepatitis:
-May experience anorexia and nausea
-Monitor for poor intake and weight loss
-Avoid alcohol
-Inquire about supplement use
Energy needs for someone with chronic hepatitis:
30-35 kcal/kg
Protein needs for someone with chronic hepatitis:
1-1.2 g/kg
___ ___ ___ is one of the most common liver diseases in the U.S
Alcoholic liver disease
Alcohol metabolism produces _____, which damages the mitochondria and alters the hepatocyte function
Acetaldehyde
Stage 1 of alcoholic liver disease is ____ ____
Hepatic steatosis
Pathophysiology of stage 1 of alcoholic liver disease (hepatic steatosis):
-Decreased fatty acid oxidation
-Increased hepatic lipogenesis
-Trapping triglycerides in the liver
Stage 1 of alcoholic liver disease (hepatic steatosis) frequently has no ____
Symptoms
Stage 1 of alcoholic liver disease is reversible with abstinence from ____
Alcohol
Stage 2 of alcoholic liver disease is ____ ____
Alcoholic hepatitis
Stage 2 of alcoholic liver disease (alcoholic hepatitis) causes widespread _____ of hepatocytes
Inflammation
Clinical manifestations of stage 2 alcoholic liver disease (alcoholic hepatitis):
-Hepatomegaly
-Elevated serum bilirubin
-Transaminases (AST, ALT)
-Possible decreased serum albumin
Symptoms of stage 2 alcoholic liver disease (alcoholic hepatitis):
-Anorexia
-Right upper quadrant pain
-N/V/D
-Weakness
-Weight loss
-Fever
MNT for stage 2 of alcoholic liver disease (alcoholic hepatitis):
-Alcohol cessation may resolve damage
-MVI with minerals
Energy requirements for someone with stage 2 alcoholic liver disease (alcoholic hepatitis):
35 kcal/kg
Protein requirements for someone with stage 2 alcoholic liver disease (alcoholic hepatitis):
1-1.2 g/kg
Someone with stage 2 alcoholic liver disease (alcoholic hepatitis) should get ___-____ mg of supplemental thiamin
50-100
Someone with stage 2 alcoholic liver disease (alcoholic hepatitis) should get ____ mg of supplemental folic acid
1
Stage 3 of alcoholic liver disease is ____ ____
Alcoholic cirrhosis
Stage 3 of alcoholic liver disease (alcoholic cirrhosis) is the final stage of liver injury and degradation, also known as ____ ____ ____ ____
End-stage liver disease
Stage 3 of alcoholic liver disease (alcoholic cirrhosis) is the final stage of liver injury and degradation, also known as ____ ____ ____ ____
End-stage liver disease
Stage 3 of alcoholic liver disease (alcoholic cirrhosis) is ____
Irreversible
Non-alcoholic fatty liver disease causes an accumulation of ____ in the hepatocytes
Fat
The accumulation of fat in hepatocytes with non-alcoholic fatty liver disease is due to…
-Increased uptake of lipids by the liver
-Increased hepatic lipogenesis
-Decreased fat oxidation
Non-alcoholic fatty liver disease is often benign, but can lead to _____
Cirrhosis
Non-alcoholic fatty liver disease can be caused by…
-Obesity
-Insulin resistance or type 2 diabetes mellitus
-Dyslipidemia
-Metabolic syndrome
-Parenteral nutrition
For those with non-alcoholic fatty liver disease who are obese, we should recommend…
-Gradual weight loss
-Calorie restriction to lose 5-10% of body weight
-Increased physical activity
-Hypocaloric, lower carbohydrate, Mediterranean diet pattern may be beneficial
We should recommend MNT and physical activity to improve ____ control
Glucose
If someone with non-alcoholic fatty liver disease has hypertriglyceridemia, we should recommend…
-Reduced intake of refined carbohydrates
-Limiting alcohol
-Low saturated fat/trans fat diet
-Increase intake of omega-3 fatty acids
For someone with non-alcoholic fatty liver disease, we should recommend ____ IU/day of vitamin E supplementation
800
Cholestatic liver disease is caused by chronic ____ injury to the bile duct
Autoimmune
Primary Biliary Cirrhosis causes progressive destruction of the intrahepatic ____ ____
Bile ducts
What are two cholestatic liver diseases?
-Primary Biliary Cirrhosis
-Primary Sclerosing Cholangitis
Primary Sclerosing Cholangitis causes fibrosing inflammation of the ____ and _____ bile ducts
Intrahepatic and extrahepatic
Cholestatic liver diseases result in _____ and _____ of bile acids into the liver, leading to hepatocyte damage
Cholestasis and reflux
Cholestatic liver diseases are characterized by…
-Jaundice
-Pruritis
-Elevated serum bilirubin and alkaline phosphatase levels
-Fat malabsorption; fat-soluble vitamin deficiencies
-Osteopenia
-Slow progression to end-stage liver disease
MNT for someone with cholestatic liver disease who has fat malabsorption:
-40-gram low-fat diet
-Fat-soluble vitamin supplementation in water-soluble form
-Calcium supplementation
-Monitor for weight loss
_____ is caused by increased iron absorption from the GIT, leading to iron overload
Hemochromatosis
Hemochromatosis causes increased deposition of iron in tissues, including the ____
Liver
What are some complications of hemochromatosis?
-End-stage liver disease
-Hepatocellular carcinoma
-Glucose intolerance
-Arthritis
-Cardiac involvement
Treatment for hemochromatosis:
-Phlebotomy to remove iron from blood
-Chelating agents
MNT for hemochromatosis:
-Regular, well-balanced diet (iron-restricted diet usually not indicated)
-Avoid exceeding the DRI for iron
How should we recommend someone to 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, and alcohol
____ ____ causes impaired biliary copper excretion
Wilson’s Disease
With Wilson’s Disease, copper accumulates in the…
-Liver
-Brain
-Kidneys
-Cornea
Complications of Wilson’s Disease:
-Chronic hepatitis
-End-stage liver disease
-Neurologic symptoms
Treatment for Wilson’s Disease:
-Copper chelating agents
-Zinc supplementation
MNT for Wilson’s Disease:
-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
What are examples of foods high in copper:
-Lamb
-Pork
-Duck
-Salmon
-Organ meat
-Shellfish
-Nuts
-Seeds
-Chocolate
-Soy protein and milk
-Dried beans
-Bran cereals
-Mushrooms
Acute liver failure is also known as ____ ____
Fulminant hepatitis
Acute Liver Failure is a rare syndrome resulting from acute, severe liver injury that destroys the majority of the _____, leading to liver failure
Hepatocytes
Acute liver failure occurs in the absence of _____ liver disease
Preexisting
Acute liver failure causes rapid clinical deterioration with the onset of…
-Jaundice
-Coagulopathy
-Hepatic encephalopathy
Acute liver failure can be caused by…
-Acetaminophen overdose
-Viral hepatitis
-Autoimmune hepatitis
-Liver ischemia
-Wilson’s Disease
-Toxins/supplements
Complications of acute liver failure:
-Hepatic encephalopathy
-Coagulopathy
-Hypoglycemia
-Systemic Inflammatory Response Syndrome
-Renal failure
-Respiratory failure
-Cerebral edema
-Coma
-Can be fatal without a liver transplant
MNT for acute liver failure:
-Energy expenditure increased by up to 30%
-Hypercatabolic state
-Usually require enteral nutrition
-Increased intracranial pressure and/or ascites-> sodium and possible fluid restriction
____ is caused by chronic injury to hepatocytes, leading to fibrosis and disruption of liver tissues and vascular architecture
Cirrhosis
The altered structure of the liver caused by cirrhosis causes an altered structure, which leads to increased intrahepatic vascular resistance and ____ ____
Portal hypertension
With cirrhosis, the liver becomes ______
Necrotic
Is cirrhosis reversible?
No
What are possible causes of cirrhosis?
-Chronic hepatitis
-Alcoholic liver disease
-Cholestatic liver disease
-Metabolic disorders (Hemochromatosis, Wilson’s Disease)
-Non-alcoholic fatty liver disease
-Cryptogenic cirrhosis
With ____ cirrhosis, the liver is heavily scarred but still able to perform many of its functions
Compensated
With _____ cirrhosis, there is extensive scarring, complications, and the liver is unable to function properly
Decompensated
_____ is caused by hyperbilirubinemia which leads to a yellow tinge to the skin and eyes
Jaundice
_____ is the end-product of hemoglobin metabolism which is sent to the liver and then conjugated and excreted in the bile
Bilirubin
Jaundice occurs due to either…
-Obstruction of bile ducts
-Hepatocyte damage
_____ is a decrease in the production of clotting factors, which leads to an increased risk of bleeding
Coagulopathy
____ ____ is an abnormally high blood pressure in the portal venous system due to the obstruction of blood flow through the liver
Portal hypertension
Portal hypertension results in…
-Ascites
-Esophageal varices
-Splenomegaly
With portal hypertension, _____ circulation is used to bypass the obstructed liver
Collateral
Collateral circulation is the opening and dilation of preexisting blood vessels that connect veins of the portal venous system to the ___ ___ ___
Superior vena cava
Collateral circulation results in varices in the GIT that are _____ and easily rupture
Fragile
A possible treatment for portal hypertension is a ____ ____
Portacaval shunt
Esophageal _____ are fragile, dilated collateral veins caused by portal hypertension
Varices
When esophageal varices rupture, they cause ____ ____
GI bleeding
Treatment for esophageal varices:
-Endoscopic band ligation
-Medication: B-adrenergic blockers (ex: propranolol, metoprolol)
MNT for esophageal varices:
-No oral or nasoenteral nutrition during acute bleeding episodes
-After bleeding is resolved->full liquid diet->easy to chew/mechanical soft diet
-Chew food thoroughly
____ is the accumulation of fluid, serum proteins, and electrolytes in the peritoneal cavity
Ascites
Ascites is caused by…
-Portal hypertension and/or
-Decreased production of albumin
Treatment for ascites:
-Diuretics
-Paracentesis
MNT for ascites:
-2 g sodium restriction
-Possible fluid restriction of 1-1.5 L/day if hypervolemia AND significant hyponatremia (<125 mEq/L)
-Adequate protein to replace losses from frequent paracentesis
