Nutrition 222 Exam 4 Lecture 16 – Flashcards
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Liver
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The most metabolically active organ in the body.
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Processes, stores, and redistributes the nutrients. Synthesizes and produces proteins: albumin, blood clotting proteins, transport proteins Digestion: Bile Detoxifies drugs and alcohol Processes excess nitrogen
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Roles of the liver
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Slowly
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Liver disease progresses...
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Fatigue
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Primary symptom of liver disease
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Preventing additional damage
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What is the principle means of avoiding liver failure or transplantation?
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Fatty liver and hepatitis
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What are the two most common disorders affecting the liver?
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Accumulation of fat in the liver tissue
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Fatty liver
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When the amount of fat produced in the liver or picked up from the blood exceeds the amount the liver can use or export to the blood via lipoproteins.
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How does fatty liver develop?
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Defects in metabolism, alcoholic liver disease, exposure to drugs & toxic metals, inherited disorders.
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Causes of fatty liver
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Insulin resistance
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Primary risk factor of fatty liver
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Diabetes mellitus, obesity, marasmus & kwashiorkor, GI bypass surgery, and long term TPN
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Fatty liver frequently accompanies
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Asymptomatic
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Most patients suffering from fatty liver are
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Liver enlargement (hepatomegaly), inflammation (steatohepatitis), fatigue. If liver damage and scarring develop: cirrhosis, liver failure, liver cancer. Frequent cause of abnormal liver enzyme levels in blood (ALT and AST tests), increased levels of triglycerides, cholesterol, and glucose.
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Consequences of fatty liver
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Be fixed/reversed but can lead to more serious problems
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Consequences of fatty liver can actually...
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Eliminate the factors that cause it: Decrease lipid levels, stop alcohol/drug use, weight loss (but not too rapid), increased physical activity, control blood glucose, increase insulin sensitivity.
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Treatment of fatty liver
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False
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Lifestyle modifications are always successful in reversing fatty liver, especially in patients who lack the usual risk factors. True or False
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Condition of liver inflammation resulting from liver tissue damage
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Hepatitis
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Infection with specific viruses, A, B, C, D, E. Or excessive alcohol intake, exposure to some drugs and toxic chemicals, and fatty liver disease.
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Most often causes of liver damage leading to hepatitis
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Chaparral, germander, ma huang, jin bu huan, kava kava, kombucha, senna, and skullcap.
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Some herbal products that cause hepatitis
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Infection with other viruses and autoimmune diseases.
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Less common causes of liver damage leading to hepatitis
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Hepatitis most often caused by infection with hepatitis virus A, B, or C.
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Acute Hepatitis
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Primarily spread via fecal-oral transmission, extremely contagious, doesn't lead to chronic disease, vaccination available. Associated with floods and other natural disasters, contaminated water supplies.
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Hepatitis A virus (HAV)
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Primarily transmitted via infected blood or needles, sexual contact, or mother-to-infant childbirth. Chronic illness develops in less than 10% of cases. Vaccinations available.
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Hepatitis B virus (HBV)
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Primarily spread via infected blood or needles but NOT by sexual contact or childbirth. Major form that causes chronic hepatitis, and is also the most common cause of chronic liver disease! No vaccination is available! Preventative measures include blood donor screening, viral inactivation of blood products, infection control practices in health care settings, and risk reduction counseling to high-risk individuals.
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Hepatitis C virus (HCV)
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Depend on the cause and severity. Individuals with mild or chronic can be asymptomatic. Acute hepatitis: fatigue, malaise, nausea, anorexia, and pain in the liver area. Liver usually enlarged. Jaundice. Fever, muscle weakness, skin rashes, elevated liver enzymes.
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Hepatitis symptoms
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Yellow discoloration of tissues
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Jaundice
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Liver cancer
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Chronic hepatitis can cause complications that are typical of liver cirrhosis and may lead to
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With supportive care (bed rest) and an appropriate diet. Patients should avoid liver irritants such as alcohol, drugs, and dietary supplements causing liver damage. Hepatits A patients: usually resolves without the use of medications. Hepatits A & B patients: antiviral agents may be used such as lamivudine & ribavirin (block viral replication), and interferon alfa (both inhibits viral replication and enhances immune responses). Nonviral forms of hepatitis patients: anti-inflammatory and immunosuppresant drugs.
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How is hepatitis treated?
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Diet: adequate protein (malnourished individuals) small meals (anorexia or abdominal discomfort) low fat diet (those with steatorrhea) fluid & electrolyte balance (persistant vomiting)
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Nutritional hepatitis treatment therapy
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Late stage of chronic liver disease. "End-stage". Gradually destroys liver tissue leading to scarring (fibrosis) and some areas of healthy tissue. Liver is irregular shaped with a nodular appearance.
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Cirrhosis
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Impaired liver function that can eventually result in liver failure
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What is cirrhosis characterized by?
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12th
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Chronic liver disease and cirrhosis together rank as the ______ leading cause of death in the United States
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1) Chronic hepatitis C 2) Alcohol liver disease 3) Bile duct blockages 4) Any type of untreated hepatitis 5) Drug induced liver injury - Prescribed drugs - Illegal drugs 6) Certain inherited disorders - Metabolism
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Causes of cirrhosis
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The blockages cause bile acids to accumulate to toxic levels in the liver.
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How does bile duct blockages cause cirrhosis?
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40% cases are asymptomatic Initial symptoms: fatigue, weakness, anorexia, weight loss Later symptoms: anemia, blood clotting impairment, susceptibility to infection, jaundice, pruritus, fat malabsorption, ascites, varices. Advanced cirrhosis: can disrupt kidney, lung, and brain function
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What are some of the symptoms of cirrhosis?
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Itchy skin
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Pruritus
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Portal Hypertension, Ascites, Hepatic encephalopathy, elevated blood ammonia, malnutrition & wasting, reduced food intake, malabsorption of nutrients, altered metabolism
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Consequences of cirrhosis
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A rise in blood pressure within the portal vein. The portal vein supplies 3/4 the flow of blood to the liver. When scar tissue impedes the flow of blood, vasodilators (nitric oxide) are released increasing the volume of blood within the liver. Blood is diverted to collaterals which become enlarged & engorged forming varices that could rupture.
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Portal Hypertension
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Smaller blood vessels surrounding liver that develop and expand throughout the GI tract and in regions near the abdominal wall.
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Collaterals
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Varicose vein that gets enlarged during portal hypertension. Most common are the esophageal and gastric varices.
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Varices
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Accumulation of fluid in the abdominal cavity, indicates that the liver damage has reached a critical stage. Primarily a consequence of: portal hypertension, altered kidney function (sodium and water retention), reduced albumin.
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Ascites
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Abdominal discomfort, early satiety, weight gain
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Symptoms of ascites
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Feeling full after consuming only a small amount of food
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Early satiety
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Disorder characterized by abnormal neurological functioning: personality changes, behavior, mood, mental ability, and motor functions. Is fully reversible with medical treatment. Exact causes are unknown.
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Hepatic encephalopathy
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Short attention span Depression, irritability Lack of coordination Tremor Sleep disorders
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Early stages of hepatic encephalopathy
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Disorientation, impaired memory Anxiety, impaired judgement Slurred speech, abnormal reflexes Lethargy
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Middle stages of hepatic encephalopathy
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Confusion, amnesia Anger, paranoia Muscular rigidity, abnormal reflexes Semi-stupor Hepatic coma
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Later stages of hepatic encephalopathy
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Supportive care: -appropriate diet -avoid liver toxins Abstinence from alcohol Liver transplantations Drug therapy: -diuretic -appetite stimulant -lactalose (reduce ammonia) -rifaximin (reduce ammonia)
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How is cirrhosis treated?
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Energy, Protein, CHO & Fat, Sodium & Fluid, Vitamins & Minerals, Enteral & parenteral
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Medical nutrition therapy for cirrhosis
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35-40 kcal/kg body weight per day. May be higher in patients with hyper metabolism, infection, malabsorption, or malnutrition. In patients with ascites, use estimated dry body weight when calculating nutritional needs:
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Energy cirrhosis nutrition
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Meet normal protein requirements, 0.8-0.2 g/kg per day
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Protein cirrhosis nutrition
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No carbohydrate restrictions unless patient has diabetes or insulin resistance, may need to restrict fats.
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CHO & Fat cirrhosis nutrition
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Restrict sodium & fluid (if ascites) and diuretic therapy. Potassium intake should be monitored.
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Sodium & Fluid cirrhosis nutrition
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Liquid supplements (esophageal varices) Fat soluble nutrients
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Vitamin & Mineral cirrhosis nutriton
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Enteral: either orally or feeding tube, high calorie Parenteral: through veins, high calorie
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Enteral vs Parenteral nutrient intake
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Liver transplantation
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What is the only remaining option after liver failure has occurred?
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Hepatits C and alcohol liver disease
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Approximately 50% of the liver transplant cases are preceded from what?
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Organ rejection and infection
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What are some of the post-transplant concerns associated with liver transplants?
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Alcohol abuse
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What is the primary cause of liver disease?
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Brain, GI tract, pancreas
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Alcohol can be toxic to the
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Vitamin A Folate Thiamine
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Chronic alcohol abuse can lead to nutrient deficiencies and can displace essential nutrients. What are some of these nutrients?
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Reduces risk of heart disease through an increase in HDL's, and a reduced risk of blood clotting.
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Alcohol moderation
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Thiamine
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Alcohol abuse is the most common cause of _____ deficiency in the United States
