CH. 20 Liver

Question 1

What are the functions of the liver?? (many)

Answer 1

• Central in processing, storing and redistributing nutrients.
  1. Regenerative tissue
  2. produces bile
  3. detoxifies body
  4. converts protein to ATP
  5. Stores glycogen & fat sol. vitamins
  6. Produces some blood clotting factor
  7. Fructose and galactose converted to glucose
  8. major gluconeogenesis site
  9. Can store fat
  10. Production of TG’s from fatty acids
  11. Make cholesterol, transport via LDL’s to tissue.
  12. synthesizes non-essential amino acids
  13. Site for break down of dead red blood cells. Heme converted to bile acids and is excreted.
  14. Hormone secretion and regulation

Question 2

What is the spectrum of liver disorders?

Answer 2

Fatty liver—-Liver fibrosis—-cirrhosis—-liver transplant

Question 3

Role of alcohol in fatty liver?

Answer 3

1. Enhances lipolysis
2. inhibits fatty acid oxidation in the liver
3. inhibits release of VLDL into blood
4. up regulates fatty acid transport proteins(moves from fat to liver cells)

Question 4

Those @ risk for fatty liver?

Answer 4

1. alcoholic liver disease
2. exposure to drugs/toxic metals
3. diabetes
4. Metabolic syndrom
5. obesity
6. malnutrition: kwashiorkor(swollen belly from low protein)
7. Long term TPN
8. Obese children

Question 5

NAFLD more common if?

Answer 5

1. increased age
2. increased BMI
3. mexican american
4. male

Question 6

Symptoms of fatty liver?

Answer 6

1. asymptomatic
2. hepatomegaly(enlarged liver)
3. inflammation
4. fatigue

Question 7

Elevated blood values for fatty liver?

Answer 7

1. AST
2. ALT
3. TG’s
4. Cholesterol
5. Glucose

Question 8

Treatment of fatty liver?

Answer 8

Goal is to eliminate causal factors:

1. Alcohol abuse
2. lower blood lipid levels
3. weight reduction
4. increase physical activity

Question 9

What is hepatitis?

Answer 9

Liver inflammation

Question 10

What causes hepatitis?

Answer 10

Any factor causing damage to liver tissue

• Usually from infection w/ virus
• Dont have to have fatty liver to get this. Can jump right ot this stage.

Question 11

Other causes of Hepatits?

Answer 11

• Alcohol abuse
• Fatty liver disease
• Autoimmune disease
• exposure to drugs, herbs, toxic chemicals

Question 12

Symptoms of Hepatitis?

Answer 12

-Slightly enlarge and tender liver
-Jaundice: From bilirubin
-Fatigue
-N/V
-Anorexia(low appetite)
-Pain in liver area and joints
-Fever
-Muscle weakness
-Skin rashes
-Elevated liver enzymes in blood: Raised: AST, ALT, Alk Phos, Bili
Lowered: Albumin

Question 13

How is Hep A,B,C each contracted?

Answer 13

A: Fecal oral transmission
B: Infected blood, needles, sexual contact, mother to baby
C: Infected blood or needles

Question 14

Which Hep has vaccinations?

Answer 14

A and B

Question 15

How fast does Hep A resolve?

Answer 15

3-6 months

Question 16

How much of the world infected with Hep B?

Answer 16

1/3

Question 17

Prevelance of chronic illness in Heb B?

Answer 17

Less than 10 percent

Question 18

Heb B contributes to 780,000 deaths per year world wide

Answer 18

.

Question 19

Is Hep C spread by sexual contact?

Answer 19

Not usually

Question 20

Hep C. almost always progresses to chronic illness and most common cause of liver disease in U.S.

Answer 20

.

Question 21

Medical treatment for hepatitis?

Answer 21

1. Bed rest
2. Avoidance of alcohol, drugs, supplements that lead to liver damage
3. Antiviral drugs

Question 22

Dietary treatment for Hep?

Answer 22

• No standard treatment. You just address the general symptoms.
• Anorexia
• Malnutrition
• Low fat diet if steatorrhea(Give med. chain TRG’s)
• Fluid and Elec. replacement if vomiting

Question 23

What is Cirrhosis?

Answer 23

• Final phase of chronic liver disease
• Extensive scarring (fibrosis)
• Smaller liver, irregular nodular appearance
• Eventually leads to liver failure

Question 24

Causes of Cirrhosis?

Answer 24

• Alcohol
• Chronic Hep B,C
• Fatty liver
• Genetics
• Bile Duct blockages: Possibly caused by cystic fibrosis

Question 25

Mild symptoms of Cirrhosis?

Answer 25

- Fatigue, weakness, anorexia, weight loss(from fat malabsorption) - Anemia and easy bruising - Poor circulation - Jaundice & fat malabsorption(if bile obstruction)

Question 26

Advanced symptoms of Cirrhosis?

Answer 26

- Portal hypertension - Collaterals & gastroesophageal varices - Ascites - Hepatic encephalopathy - Malnutrition & Wasting

Question 27

What is portal hypertension?

Answer 27

The portal vein supplies blood to the liver. Scarring in the liver prevents blood flow which increases pressure in the portal vein.

Question 28

What are collaterals?

Answer 28

newly established vessels that bypass the liver and put the blood right back into the portal vein

Question 29

What are gastroesophageal varices?

Answer 29

Engorged blood vessels that are vulnerable to rupture | -May cause massive bleeding

Question 30

What is Ascites?

Answer 30

Accumulation of fluid in abdominal cavity

Question 31

Facts about Ascites....

Answer 31

- Result of sever liver damage - 50% of cirrhosis patients get ascites - Half with ascites die within 2 years

Question 32

Mechanism for ascites?

Answer 32

1. Damaged tissue causes portal HyperT.......2. Blood accumulates in abdominal cavity.......3. Decrease in arterial blood volume.......4. Vasoconstricters released..........5. Na & H2O retained by kidneys.........6. Accumulation of body fluid.... OR Low serum albumin (leakage of fluid)

Question 33

What is hepatic encephalopathy?

Answer 33

altered neurological function | -If severe: amnesia, seizures, hepatic coma

Question 34

cause of hepatic encephalopathy?

Answer 34

Exact cause unclear but it is thought to be caused by in increased levels of ammonia in the blood from not being converted to urea in the liver. -Limit protein intake to avoid excess nitrogen

Question 35

Treatment goals for cirrhosis?

Answer 35

1. correct underlying cause of illness | 2. monitor and manage complications

Question 36

Medical treatment for cirrhosis?

Answer 36

* Depends on cause... Can include: - Antivirals, antihypertensives, diuretics, antibiotics, appetite stimulants, ammonia reducing, antihyperglycemics - Screening for gastroesophageal varices and liver cancer

Question 37

Nutrition therapy goals for cirrhosis?

Answer 37

- Customized - Treat complications like PEM, muscle wasting, ascites - Avoid alcohol, herbal supplements, high doses of Vit's/Min's which may damage liver further.

Question 38

Energy recommendations for cirrhosis?

Answer 38

- 20-40% above RMR - No activity factor necessary if patient is sedentary - If weight gain desired.. Add 500 kcal/day

Question 39

Protein recommendation for cirrhosis?

Answer 39

- 0.8-1.2 grams/kg per day | - If hepatic encephalopathy- 0.8 g spread throughout the day

Question 40

Fat recommendation for cirrhosis?

Answer 40

- If fat malabsorption exists, restrict to less than 30% of total calories - MCT's - IF SEVERE: supplement fat soluble vitamins, calcium, magnesium, zinc at less than 100% RDA

Question 41

Carb recommendation for cirrhosis?

Answer 41

- Watch for insulin resistance | - If IR, monitor carb intake and blood glucose levels

Question 42

Vitamins and minerals recommendation for cirrhosis?

Answer 42

- Multi vitamin often necessary | - If esophageal varices, try liquid supplements

Question 43

Fluid and sodium recommendations for cirrhosis?

Answer 43

-If ascites, restrict sodium to less than 2 g/day

Question 44

Medical treatment for liver transplant?

Answer 44

Organ rejection: immunosuppressive drugs: - GI side effects - Hyperglycemia - Electrolyte and fluid imbalances - Hypertension - Elevated blood lipids - Protein catabolism Infection

Question 45

Nutrition therapy for liver transplant?

Answer 45

* Meet needs of symptoms - High calorie and protein diet - Enteral supplements - Vit and Min's - Vigilant food safety!