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Advanced Medical Nutrition Therapy II > MNT for Liver Disease Part 1 > Flashcards

MNT for Liver Disease Part 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the functions of the liver?

A

-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

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2
Q

The macronutrient metabolism function of the liver includes functions like…

A

-Glycogen storage
-Gluconeogenesis
-Synthesis of non-essential amino acids
-Synthesis of triglycerides, cholesterol, phospholipids, and lipoproteins
-Fatty acid beta-oxidation
-Ketone production

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3
Q

What vitamins and minerals are stored, activated, or transported in the liver?

A

-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

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4
Q

Hepatitis A is transmitted via ___-___ route through contaminated drinking water or food

A

Fecal-oral

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5
Q

Hepatitis B and C are transmitted via…

A

Blood, semen, or saliva

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6
Q

Symptoms of acute viral hepatitis:

A

-Malaise
-Anorexia
-Nausea
-Right upper quadrant pain
-Jaundice

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7
Q

The goal for the treatment of acute viral hepatitis is recovery and _____ of hepatic cells

A

Regeneration

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8
Q

MNT for viral hepatitis:

A

-No specific MNT
-Symptom management

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9
Q

Chronic hepatitis is a course of hepatitis that last for ____ months or more

A

6

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10
Q

Etiology of chronic hepatitis:

A

-Viral infection (HBV, HCV)
-Autoimmune disease
-Hepatotoxic agents (drugs, alcohol, toxins)
-Metabolic disorders-> Wilson’s disease, hemochromatosis

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11
Q

Chronic hepatitis can progress and lead to ____

A

Cirrhosis

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12
Q

MNT for chronic hepatitis:

A

-May experience anorexia and nausea
-Monitor for poor intake and weight loss
-Avoid alcohol
-Inquire about supplement use

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13
Q

Energy needs for someone with chronic hepatitis:

A

30-35 kcal/kg

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14
Q

Protein needs for someone with chronic hepatitis:

A

1-1.2 g/kg

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15
Q

___ ___ ___ is one of the most common liver diseases in the U.S

A

Alcoholic liver disease

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16
Q

Alcohol metabolism produces _____, which damages the mitochondria and alters the hepatocyte function

A

Acetaldehyde

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17
Q

Stage 1 of alcoholic liver disease is ____ ____

A

Hepatic steatosis

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18
Q

Pathophysiology of stage 1 of alcoholic liver disease (hepatic steatosis):

A

-Decreased fatty acid oxidation
-Increased hepatic lipogenesis
-Trapping triglycerides in the liver

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19
Q

Stage 1 of alcoholic liver disease (hepatic steatosis) frequently has no ____

A

Symptoms

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20
Q

Stage 1 of alcoholic liver disease is reversible with abstinence from ____

A

Alcohol

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21
Q

Stage 2 of alcoholic liver disease is ____ ____

A

Alcoholic hepatitis

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22
Q

Stage 2 of alcoholic liver disease (alcoholic hepatitis) causes widespread _____ of hepatocytes

A

Inflammation

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23
Q

Clinical manifestations of stage 2 alcoholic liver disease (alcoholic hepatitis):

A

-Hepatomegaly
-Elevated serum bilirubin
-Transaminases (AST, ALT)
-Possible decreased serum albumin

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24
Q

Symptoms of stage 2 alcoholic liver disease (alcoholic hepatitis):

A

-Anorexia
-Right upper quadrant pain
-N/V/D
-Weakness
-Weight loss
-Fever

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25
Q

MNT for stage 2 of alcoholic liver disease (alcoholic hepatitis):

A

-Alcohol cessation may resolve damage
-MVI with minerals

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26
Q

Energy requirements for someone with stage 2 alcoholic liver disease (alcoholic hepatitis):

A

35 kcal/kg

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27
Q

Protein requirements for someone with stage 2 alcoholic liver disease (alcoholic hepatitis):

A

1-1.2 g/kg

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28
Q

Someone with stage 2 alcoholic liver disease (alcoholic hepatitis) should get ___-____ mg of supplemental thiamin

A

50-100

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29
Q

Someone with stage 2 alcoholic liver disease (alcoholic hepatitis) should get ____ mg of supplemental folic acid

A

1

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30
Q

Stage 3 of alcoholic liver disease is ____ ____

A

Alcoholic cirrhosis

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31
Q

Stage 3 of alcoholic liver disease (alcoholic cirrhosis) is the final stage of liver injury and degradation, also known as ____ ____ ____ ____

A

End-stage liver disease

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32
Q

Stage 3 of alcoholic liver disease (alcoholic cirrhosis) is the final stage of liver injury and degradation, also known as ____ ____ ____ ____

A

End-stage liver disease

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33
Q

Stage 3 of alcoholic liver disease (alcoholic cirrhosis) is ____

A

Irreversible

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34
Q

Non-alcoholic fatty liver disease causes an accumulation of ____ in the hepatocytes

A

Fat

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35
Q

The accumulation of fat in hepatocytes with non-alcoholic fatty liver disease is due to…

A

-Increased uptake of lipids by the liver
-Increased hepatic lipogenesis
-Decreased fat oxidation

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36
Q

Non-alcoholic fatty liver disease is often benign, but can lead to _____

A

Cirrhosis

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37
Q

Non-alcoholic fatty liver disease can be caused by…

A

-Obesity
-Insulin resistance or type 2 diabetes mellitus
-Dyslipidemia
-Metabolic syndrome
-Parenteral nutrition

38
Q

For those with non-alcoholic fatty liver disease who are obese, we should recommend…

A

-Gradual weight loss
-Calorie restriction to lose 5-10% of body weight
-Increased physical activity
-Hypocaloric, lower carbohydrate, Mediterranean diet pattern may be beneficial

39
Q

We should recommend MNT and physical activity to improve ____ control

A

Glucose

40
Q

If someone with non-alcoholic fatty liver disease has hypertriglyceridemia, we should recommend…

A

-Reduced intake of refined carbohydrates
-Limiting alcohol
-Low saturated fat/trans fat diet
-Increase intake of omega-3 fatty acids

41
Q

For someone with non-alcoholic fatty liver disease, we should recommend ____ IU/day of vitamin E supplementation

A

800

42
Q

Cholestatic liver disease is caused by chronic ____ injury to the bile duct

A

Autoimmune

43
Q

Primary Biliary Cirrhosis causes progressive destruction of the intrahepatic ____ ____

A

Bile ducts

44
Q

What are two cholestatic liver diseases?

A

-Primary Biliary Cirrhosis
-Primary Sclerosing Cholangitis

45
Q

Primary Sclerosing Cholangitis causes fibrosing inflammation of the ____ and _____ bile ducts

A

Intrahepatic and extrahepatic

46
Q

Cholestatic liver diseases result in _____ and _____ of bile acids into the liver, leading to hepatocyte damage

A

Cholestasis and reflux

47
Q

Cholestatic liver diseases are characterized by…

A

-Jaundice
-Pruritis
-Elevated serum bilirubin and alkaline phosphatase levels
-Fat malabsorption; fat-soluble vitamin deficiencies
-Osteopenia
-Slow progression to end-stage liver disease

48
Q

MNT for someone with cholestatic liver disease who has fat malabsorption:

A

-40-gram low-fat diet
-Fat-soluble vitamin supplementation in water-soluble form
-Calcium supplementation
-Monitor for weight loss

49
Q

_____ is caused by increased iron absorption from the GIT, leading to iron overload

A

Hemochromatosis

50
Q

Hemochromatosis causes increased deposition of iron in tissues, including the ____

A

Liver

51
Q

What are some complications of hemochromatosis?

A

-End-stage liver disease
-Hepatocellular carcinoma
-Glucose intolerance
-Arthritis
-Cardiac involvement

52
Q

Treatment for hemochromatosis:

A

-Phlebotomy to remove iron from blood
-Chelating agents

53
Q

MNT for hemochromatosis:

A

-Regular, well-balanced diet (iron-restricted diet usually not indicated)
-Avoid exceeding the DRI for iron

54
Q

How should we recommend someone to avoid exceeding the DRI for iron?

A

-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

55
Q

____ ____ causes impaired biliary copper excretion

A

Wilson’s Disease

56
Q

With Wilson’s Disease, copper accumulates in the…

A

-Liver
-Brain
-Kidneys
-Cornea

57
Q

Complications of Wilson’s Disease:

A

-Chronic hepatitis
-End-stage liver disease
-Neurologic symptoms

58
Q

Treatment for Wilson’s Disease:

A

-Copper chelating agents
-Zinc supplementation

59
Q

MNT for Wilson’s Disease:

A

-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

60
Q

What are examples of foods high in copper:

A

-Lamb
-Pork
-Duck
-Salmon
-Organ meat
-Shellfish
-Nuts
-Seeds
-Chocolate
-Soy protein and milk
-Dried beans
-Bran cereals
-Mushrooms

61
Q

Acute liver failure is also known as ____ ____

A

Fulminant hepatitis

62
Q

Acute Liver Failure is a rare syndrome resulting from acute, severe liver injury that destroys the majority of the _____, leading to liver failure

A

Hepatocytes

63
Q

Acute liver failure occurs in the absence of _____ liver disease

A

Preexisting

64
Q

Acute liver failure causes rapid clinical deterioration with the onset of…

A

-Jaundice
-Coagulopathy
-Hepatic encephalopathy

65
Q

Acute liver failure can be caused by…

A

-Acetaminophen overdose
-Viral hepatitis
-Autoimmune hepatitis
-Liver ischemia
-Wilson’s Disease
-Toxins/supplements

66
Q

Complications of acute liver failure:

A

-Hepatic encephalopathy
-Coagulopathy
-Hypoglycemia
-Systemic Inflammatory Response Syndrome
-Renal failure
-Respiratory failure
-Cerebral edema
-Coma
-Can be fatal without a liver transplant

67
Q

MNT for acute liver failure:

A

-Energy expenditure increased by up to 30%
-Hypercatabolic state
-Usually require enteral nutrition
-Increased intracranial pressure and/or ascites-> sodium and possible fluid restriction

68
Q

____ is caused by chronic injury to hepatocytes, leading to fibrosis and disruption of liver tissues and vascular architecture

A

Cirrhosis

69
Q

The altered structure of the liver caused by cirrhosis causes an altered structure, which leads to increased intrahepatic vascular resistance and ____ ____

A

Portal hypertension

70
Q

With cirrhosis, the liver becomes ______

A

Necrotic

71
Q

Is cirrhosis reversible?

A

No

72
Q

What are possible causes of cirrhosis?

A

-Chronic hepatitis
-Alcoholic liver disease
-Cholestatic liver disease
-Metabolic disorders (Hemochromatosis, Wilson’s Disease)
-Non-alcoholic fatty liver disease
-Cryptogenic cirrhosis

73
Q

With ____ cirrhosis, the liver is heavily scarred but still able to perform many of its functions

A

Compensated

74
Q

With _____ cirrhosis, there is extensive scarring, complications, and the liver is unable to function properly

A

Decompensated

75
Q

_____ is caused by hyperbilirubinemia which leads to a yellow tinge to the skin and eyes

A

Jaundice

76
Q

_____ is the end-product of hemoglobin metabolism which is sent to the liver and then conjugated and excreted in the bile

A

Bilirubin

77
Q

Jaundice occurs due to either…

A

-Obstruction of bile ducts
-Hepatocyte damage

78
Q

_____ is a decrease in the production of clotting factors, which leads to an increased risk of bleeding

A

Coagulopathy

79
Q

____ ____ is an abnormally high blood pressure in the portal venous system due to the obstruction of blood flow through the liver

A

Portal hypertension

80
Q

Portal hypertension results in…

A

-Ascites
-Esophageal varices
-Splenomegaly

81
Q

With portal hypertension, _____ circulation is used to bypass the obstructed liver

A

Collateral

82
Q

Collateral circulation is the opening and dilation of preexisting blood vessels that connect veins of the portal venous system to the ___ ___ ___

A

Superior vena cava

83
Q

Collateral circulation results in varices in the GIT that are _____ and easily rupture

A

Fragile

84
Q

A possible treatment for portal hypertension is a ____ ____

A

Portacaval shunt

85
Q

Esophageal _____ are fragile, dilated collateral veins caused by portal hypertension

A

Varices

86
Q

When esophageal varices rupture, they cause ____ ____

A

GI bleeding

87
Q

Treatment for esophageal varices:

A

-Endoscopic band ligation
-Medication: B-adrenergic blockers (ex: propranolol, metoprolol)

88
Q

MNT for esophageal varices:

A

-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

89
Q

____ is the accumulation of fluid, serum proteins, and electrolytes in the peritoneal cavity

A

Ascites

90
Q

Ascites is caused by…

A

-Portal hypertension and/or
-Decreased production of albumin

91
Q

Treatment for ascites:

A

-Diuretics
-Paracentesis

92
Q

MNT for ascites:

A

-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

Advanced Medical Nutrition Therapy II (19 decks)

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