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Advanced Medical Nutrition Therapy II > MNT for Liver Disease Part 2 > Flashcards

MNT for Liver Disease Part 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

_____ _____ is a syndrome characterized by impaired mentation, neuromuscular disturbances, and altered consciousness

A

Hepatic encephalopathy

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2
Q

The pathogenesis of hepatic encephalopathy is unknown, but two theories include…

A

-Elevated ammonia levels
-Increased aromatic amino acids (AAA) and decreased branched-chain amino acids (BCAA)

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3
Q

Symptoms of stage I of hepatic encephalopathy:

A

-Mild confusion
-Irritability
-Decreased attention

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4
Q

Symptoms of stage II of hepatic encephalopathy:

A

-Lethargy
-Disorientation
-Inappropriate behavior
-Drowsiness
-Asterixis (uncontrolled flapping of hands)

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5
Q

Symptoms of stage III of hepatic encephalopathy:

A

-Somnolent but arousable
-Confused
-Incomprehensible speech

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6
Q

Symptoms of stage IV of hepatic encephalopathy:

A

Coma

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7
Q

Precipitating causes of hepatic encephalopathy:

A

-GI bleeding (source of ammonia)
-Uremia
-Constipation (more time for bacteria to produce ammonia)
-Muscle catabolism (ammonia)
-Fluid and electrolyte abnormalities
-Infection
-Sedatives
-Portacaval shunts
-Excessive dietary protein (rare)

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8
Q

What two drugs can be used to treat hepatic encephalopathy?

A

-Lactulose
-Rifaximin

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9
Q

Lactulose is an ____ ____ that removed excess ammonia

A

Osmotic diuretic

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10
Q

What are food medications with Lactulose?

A

-Diarrhea
-Flatulence
-N/V

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11
Q

Rifaximin decreases colonic ____ production

A

Ammonia

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12
Q

Are there any food-drug interactions with Rifaximin?

A

No

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13
Q

With hepatic encephalopathy, a ____ restriction is no longer recommended

A

Protein

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14
Q

A low-protein diet increases catabolism of ___ ___ ___, which worsens hepatic encephalopathy

A

Lean body mass

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15
Q

Protein recommendation for someone with hepatic encephalopathy:

A

1.0-1.5 g/kg

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16
Q

For patients with hepatic encephalopathy requiring tube feeding, use a formula with appropriate ____ content

A

Protein

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17
Q

MNT for chronic hepatic encephalopathy includes…

A

-High fiber
-High dairy (casein is lower in AAA and higher in BCAA)
-Vegetarian diet can be used since vegetable protein is high in BCAA

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18
Q

_____ Syndrome is acute kidney failure in the absence of prior kidney disease due to decreased renal blood flow

A

Hepatorenal

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19
Q

Those with hepatorenal syndrome may require _____

A

Dialysis

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20
Q

MNT for hepatorenal syndrome:

A

-Possible restriction of fluid, Na, K+, and phosphorus (depending on treatment modality)

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21
Q

In end-stage liver disease, someone would have increased levels of ____, ____, and ____ due to the catabolic state

A

Glucagon, epinephrine, and cortisol

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22
Q

Someone with end-stage liver disease would have decreased synthesis of…

A

-Serum albumin
-Transport proteins
-Clotting factors

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23
Q

Someone with end-stage liver disease would have increased ____ levels

A

Ammonia

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24
Q

Early in end-stage liver disease, someone might experience ____ due to peripheral insulin resistance and decreased glucose uptake

A

Hyperglycemia

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25
Q

Late in end-stage liver disease, someone might experience fasting hypoglycemia due to…

A

-Loss of hepatic glycogen stores
-Decreased gluconeogenesis

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26
Q

Someone with end-stage liver disease has increased _____, leading to a depletion of fat reserved

A

Lipolysis

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27
Q

Fat malabsorption with end-stage liver disease may occur due to…

A

-Decreased production of bile
-Blocked bile ducts (cholestatic liver disease)

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28
Q

Someone with end-stage liver disease may have decreased ____, ____, ____, and ____ of micronutrients (also altered metabolism of micronutrients)

A

Intake, absorption, transport, and storage

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29
Q

Malnutrition is present in ____-___% of patients with cirrhosis

A

50-90

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30
Q

Malnutrition is more common in those with ____ liver disease

A

Alcoholic

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31
Q

____ is a defining feature of malnutrition in decompensated end-stage liver disease

A

Sarcopenia

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32
Q

Malnutrition is associated with…

A

-Compromised immune and respiratory function
-Delayed wound healing
-Longer hospital stays
-Increased risk for mortality

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33
Q

What are factors that lead to malnutrition in someone with end-stage liver disease?

A

-Inadequate oral intake
-Disturbances in macronutrient metabolism, leading to catabolism
-Decreased capacity of the liver to store nutrients
-Malabsorption of fat

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34
Q

What factors lead to inadequate intake in someone with end-stage liver disease?

A

-Anorexia
-N/V
-Dysgeusia
-Early satiety
-Restrictive diets
-Alcohol abuse
-Financial issues
-Food-medications interactions

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35
Q

What leads to malabsorption of fat?

A

-Decreased transport of bile via bile ducts
-Decreased bile acid production by the liver

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36
Q

What traditional assessment parameters are affected by liver disease?

A

-Weight, BMI, and %wt change are affected by fluid status
-Decreased synthesis of transport proteins (e.g., albumin, prealbumin)
-Hyperammonemia and hepatorenal syndrome affect validity of nitrogen balance studies

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37
Q

What should we ask in the diet history portion of the nutrition assessment for someone with end-stage liver disease?

A

-Appetite
-Weight change
-Taste changes
-Persistent GI problems
-Assessment of dietary intake
-Previous diet
-Supplement use

38
Q

What should be looked in the NFPE for someone with end-stage liver disease?

A

-Muscle wasting
-Fat stores
-Ascites or edema
-Micronutrient deficiencies

39
Q

In the nutrition assessment, we should also evaluate the current diagnosis, along with ____ and ____

A

Complications and PMHx

40
Q

What lab assessments are included in the Liver Function Tests?

A

-Albumin
-NH3 (Ammonia)
-Total bilirubin (indirect/unconjugated and direct/conjugated)
-Prothrombin time
-Alanine aminotransferase
-Aspartate aminotransferase
-Alkaline phosphatase
-Gamma-glutamyl transpeptidase

41
Q

All nutrition calculations for someone with end-stage liver disease should be based on ___ weight

A

Dry

42
Q

What are some options to use if dry weight is unavailable?

A

-Use IBW
-Adjust body weight based on the amount of ascites and peripheral edema

43
Q

If someone has mild ascites and dry weight is unknown, subtract ____% from body weight

A

5

44
Q

If someone has moderate ascites and dry weight is unknown, subtract ____% from body weight

A

10

45
Q

If someone has severe ascites and dry weight is unknown, subtract ____% from body weight

A

15

46
Q

We can subtract an additional ___% from body weight if pedal edema is present

A

5

47
Q

To calculate energy requirements for someone with end-stage liver disease, use ___ ____ if possible

A

Indirect calorimetry

48
Q

Calories requirements for those with end-stage liver disease:

A

25-35 kcal/kg

49
Q

Malnourished patients may need up to ____ kcal/kg to promote anabolism

A

40

50
Q

Protein recommendations for someone with end-stage liver disease:

A

1.2-1.5 g/kg

51
Q

For someone with end-stage liver disease, we should monitor for _____, and they may need insulin and a consistent carbohydrate diet

A

Hyperglycemia

52
Q

Someone with end-stage liver disease may experience ____ hypoglycemia

A

Fasting

53
Q

MNT for someone who is experiencing hyperglycemia or fasting hypoglycemia:

A

-Small, frequent meals and an evening snack
-Avoid alcohol

54
Q

For someone with end-stage liver disease, ___% of their total kcal should come from fat

A

30

55
Q

However, if someone is having steatorrhea, they should be on a ___ gram low-fat diet

A

40

56
Q

If someone has hypervolemia and severe hyponatremia (serum Na <125 mEq/L), a fluid restriction of ___-___ L/d may be indicated

A

1-1.5

57
Q

How should we monitor fluid intake?

A

-Input/output records
-Weight
-Serum sodium

58
Q

If someone has ascites or edema, they should have a ____ gram sodium restriction

A

2

59
Q

We should also monitor ____ due to diuretics and paracentesis

A

Electrolytes

60
Q

For those with end-stage liver disease, we should provide a ____

A

Multivitamin

61
Q

Many end-stage liver disease patients should be given fat-soluble vitamin supplements, and if someone has malabsorption, they should be given in ___-____ form

A

Water-soluble

62
Q

> 90% of patients with advanced liver disease are deficient in Vitamin ___

A

D

63
Q

If someone has alcoholic liver disease, they should receive ___-___ mg of Thiamin and ____ mg of folic acid daily

A

50-100; 1

64
Q

Many people with end-stage liver disease are deficient in vitamin ___

A

K

65
Q

We should also provide the ____ of minerals, except in specific conditions

A

DRI

66
Q

Someone with cholestatic liver disease should not receive ____ and ____ supplementation

A

Copper and manganese

67
Q

Someone with hemochromatosis should not receive any ____ supplementation

A

Iron

68
Q

Someone with Wilson’s Disease should not receive ____ supplementation

A

Copper

69
Q

If someone is having GI bleeding, they may need increased _____ supplementation

A

Iron

70
Q

If someone has alcoholism, they may require increased ____ and ____ supplementation

A

Zinc and Magnesium

71
Q

If someone is on a Diuretic, they may need increased ____, ____, ____ and ____

A

K+, zinc, magnesium, and calcium

72
Q

If someone is having Steatorrhea, they may need increased ____, ____, and ____

A

Calcium, Magnesium, and Zinc

73
Q

General recommendations for someone with end-stage liver disease:

A

-Small, frequent meals with a bedtime snack
-Avoid skipping meals
-Nutrient-dense snacks
-Poor appetite: nutrition supplements

74
Q

Someone with end-stage liver disease may require enteral nutrition due to…

A

-Poor intake
-Malnutrition
-Altered mental status
-Intubation

75
Q

Someone with end-stage liver disease on enteral nutrition should get a high ___ formula

A

Protein

76
Q

A small-bore ____ tube is appropriate for someone with non-bleeding esophageal varices

A

Nasogastric/nasoenteric

77
Q

A ____ placement is not recommended for those with ascites or gastric varices

A

PEG

78
Q

Parenteral nutrition would be indicated for someone with…

A

-Non-functioning GIT

79
Q

Parenteral nutrition can lead to…

A

-Hepatic steatosis
-Cholestasis
-Possible cirrhosis

80
Q

For someone on parenteral nutrition, we should avoid _____ of carbohydrates, lipids, or total kcal

A

Overfeeding

81
Q

For someone on parenteral nutrition, a lipid emulsion should not provide more than ____ g/kg/d

A

1

82
Q

A ____ ____ solution of parenteral nutrition should be given to someone with end-stage liver disease

A

Mixed substrate

83
Q

____ administration of parenteral nutrition is recommended for those with parenteral nutrition

A

Continuous

84
Q

For patients with cholestatic liver disease, reduce ____ and ____ provided

A

Copper and Manganese

85
Q

____ ____ is the leakage of chyle into the peritoneal cavity due to obstruction or leak from abdominal lymphatics

A

Chylous ascites

86
Q

Possible etiologies of chylous ascites:

A

-Malignant obstruction
-Abdominal surgery: AAA repair, Liver transplant
-Congenital defects of the lymphatics

87
Q

Chyle is made up of…

A

-White blood cells
-Chylomicrons
-Fat-soluble vitamins
-Protein
-Fluid
-Electrolytes

88
Q

Consequences of chylous ascites:

A

-Pain
-Anorexia
-Hypoalbuminemia
-Decreased electrolyte levels
-Fat-soluble vitamin depletion
-Essential fatty acid deficiency

89
Q

Medical management of chylous ascites includes…

A

-Conservative management (drainage, reducing chyle flow)
-Surgical repair

90
Q

The goal for MNT for chylous ascites is to reduce long-chain triglyceride (LCT) intake to less than ____ g/day while still providing adequate nutrition

A

10

91
Q

Options for diet for someone with chylous ascites:

A

-Very low-fat oral diet with MCT supplementation
-NPO with TF using a very low-fat elemental formula
-NPO with TPN

92
Q

Someone with chylous ascites should receive a high _____ diet

A

Protein

Advanced Medical Nutrition Therapy II (19 decks)

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