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Integrative Nutrition and Pathophysiology > GI 3 > Flashcards

GI 3 Flashcards

1
Q

liver cirrhosis definition
__ stage of progressive liver disease in which there is distortion of __ architecture

A

liver cirrhosis definition
late stage of progressive liver disease in which there is distortion of hepatic architecture

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2
Q

liver cirrhosis definition
__ formation of regenerative nodules that lack __ organization

A

liver cirrhosis definition
diffuse formation of regenerative nodules that lack normal organization

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3
Q

liver cirrhosis definition
nodules are surrounded by __

A

liver cirrhosis definition
nodules are surrounded by fibrous bands

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4
Q

development of cirrhosis steps

A
  1. liver cell injury
  2. activation of heaptic stellate cells (HSC)
  3. expansion of myofibroblasts
  4. fibrosis
  5. cirrhosis
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5
Q

3 mediators of activation of stellate cells and expansion of myofibroblasts

A

ROS
NO
TGF-beta

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6
Q

expansion of myofibroblasts causes increased

A

collagen
glycoproteins
proteoglycans

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7
Q

4 causes of liver cell injury

A
  1. HBV, HCV infection
  2. drugs and toxin
  3. autoimmune attack
  4. other causes
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8
Q

liver importance to nutrition (3)

A
  1. glucose homeostasis
  2. protein synthesis
  3. drug/toxin metabolism
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9
Q

impacts of malnutrition in liver disease

A
  1. increasingly recognized complications of ESLD
  2. very common (20-50% of patients with cirrhosis)
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10
Q

5 observed changes of liver disease and cirrhosis

A
  1. malnutrition
  2. direct complication of cirrhosis
  3. complications due to other organ systems
  4. physical inactivity
  5. environmental/organizational factors
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11
Q

malnutrition in liver disease and cirrhosis due to

A
  1. reduced oral intake
  2. malabsorption
  3. increased catabolic state/hypermetabolism
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12
Q

3 direct complications of cirrhosis

A
  1. altered catabolic state
  2. altered protein metabolism
  3. increased ammonia concentration (myotoxic)
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13
Q

altered catabolic state leads to

A

imbalance between energy needs and intake

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14
Q

altered protein metabolism causes

A

accelerated muscle breakdown

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15
Q

increased ammonia concentration (myotoxic) causes

A

destruction of skeletal muscle

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16
Q

3 complication due to other organ systems

A
  1. high circulating levels of inflammatory markers
  2. low levels of testosterone and changes in growth hormone secretion/sensitivity
  3. obesity
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17
Q

high circulating inflammatory markers leads to

A

reduced muscle protein synthesis and increased degradation

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18
Q

obesity leads to (3)

A
  1. metabolic dysregulation
  2. visceral fat accumulation
  3. insulin resistance
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19
Q

physical inactivity in cirrhosis

A

common in patients

20
Q

environmental/organizational factors

A
  1. social determinants of health (health literacy, food insecurity, financial strain (including that on caregivers))
  2. lack of time during clinical visits to dedicate to nutrition
21
Q

what is alcohol-associated liver disease
__ entity characterized by __ and __

A

what is alcohol-associated liver disease
distinct entity characterized by jaundice and liver function

22
Q

prevalence of alcohol-associated liver disease in US

A

2%

23
Q

morbidity and mortality and alcohol use:
incidence of alcohol-associated liver disease:

A

morbidity and mortality and alcohol use: increasing worldwide
incidence of alcohol-associated liver disease: increasing since pandemic

24
Q

severe acute alcohol-associated hepatitis has mortality of up to __% at one month

A

severe acute alcohol-associated hepatitis has mortality of up to 25-40% at one month

25
Q

alcohol is high in

A

calories

26
Q

calories from alcohol __ other claories and cause reduced __ which leads to __

A

calories from alcohol displaces other claories and cause reduced intake from more nutritious sources which leads to nutritional deficiences

27
Q

effects of alcohol on GI tract
1. shortening of __ in sm. intestine –> __
2. alteration of __
3. reduction in gut metabolism of __ –> impaired absorption of

A

effects of alcohol on GI tract
1. shortening of villi in sm. intestine –> impaired digestion and absorption
2. alteration of gut microbiome
3. reduction in gut metabolism of bile acids –> impaired absorption of fat and fat-soluble vitamins

28
Q

alcoholism + coexisting chronic __ –> __ insufficiency –> impaired digestion of __

A

alcoholism + coexisting chronic pancreatitis –> exocrine insufficiency –> impaired digestion of macronutrients

29
Q

alcohol-associated liver disease deficiencies

A

folic acid
thiamine
vit D
vit A
Mg
Zn

30
Q

alcohol-associated liver disease
folic acid deficiency can promote __
folic acid deficiency may worsen __

A

alcohol-associated liver disease
folic acid deficiency can promote oxidative stress
folic acid deficiency may worsen alcohol-related liver injury

31
Q

__% hospitalized patients with alcohol use disorder have folic acid deficiency
__% of patients with alcohol use disorder have thiamine deficiency
__% of patients with cirrhosis and __% with liver disease have vit D deficiency
__% of patients with cirrhosis have zinc deficiency

A

80% hospitalized patients with alcohol use disorder have folic acid deficiency
80% of patients with alcohol use disorder have thiamine deficiency
85% of patients with cirrhosis and 50% with liver disease have vit D deficiency
> 80% of patients with cirrhosis have zinc deficiency

32
Q

why does thiamine deficiency occur in alcohol use disorder and what can it lead to

A

occurs bc inadequate dietary intake
impaired absorption
increased release/decreased uptake in liver

can lead to Wernicke’s encephalopathy or Korsakoff psychosis

33
Q

vit D deficiency exaggerates alcohol-related __ and __

A

vit D deficiency exaggerates alcohol-related oxidative stress and liver injury

34
Q

increased severity of liver disease = increased deficiency of __

A

increased severity of liver disease = increased deficiency of vitamin A

35
Q

vit deficiency can cause

A

night blindness
hypogonadism
hypogeusia
insomnia

36
Q

which vitamin deficiency should not be supplemented? why?

A

vit A bc it can be hepatotoxic

37
Q

Mg deficiency occurs bc of

A

malabsorption and high renal excretion

38
Q

Mg deficiency can increase

A

oxidative stress

39
Q

Mg deficiency is associated with

A

poor cognition
reduced muscle strength

40
Q

symptoms of zinc deficiency

A

muscle craps
taste alteration
encephalopathy
increased infections

41
Q

how to treat zinc deficiency

A

some evidence for supplementation
(especially with severe encephalopathy)

42
Q

timing of meals for liver disease

A

benefits on muscle mass
early morning breakfast
late evening snack
small, frequent meals and snacks every 3-4 hours while awake

43
Q

protein guidelines
adults with cirrhosis:
critically ill adults with cirrhosis:
children with chronic liver disease:

A

protein guidelines
adults with cirrhosis: 1.2-1.5 g/kg ideal body weight
critically ill adults with cirrhosis: 1-2 g/kg ideal body weight
children with chronic liver disease: up to 4g/kg ideal body weight

44
Q

protein guidelines focus on

A

diversity of protein sources

45
Q

nutritional supplementation options for liver disease

A
  1. oral nutrition supplementation (NG tube feeds if patient still has issues)
  2. enteral nutrition
  3. parenteral nutrition (only for decomponsated (advanced) cirrhotic patients)

Integrative Nutrition and Pathophysiology (22 decks)

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