Liver Disease

Question 1

Clinical signs of liver disease (7)

Answer 1

1. Polydispsia
2. Jaundiced
3. Inappetance
4. Lethargy
5. Neurological signs
6. Vomiting
7. Uroliths

Question 2

Goals of treatment (3)

Answer 2

1. Prevent progression or resolve disease
2. Provide optimum environment for hepatic recovery
3. Control complications of disease

Question 3

Complications of liver disease (5)

Answer 3

1. Hepatic encephalopathy
2. Coagulopathies
3. Anorexia / weight loss
4. GI ulcers
5. Ascites

Question 4

Hepatic Encephalopathy
1. How is it presented?
2. Therapy (5)

Answer 4

1. Hyperactive, bizarre, or depressed. Often cyclic associated with post prandial.
2. Cornerstone: Decrease GI bacteria metabolizing nitrogen substates!
   - Low quantity / High quality protein diet
   - Nonabsorbable disaccharides
   - Antibiotics
   - Treat & prevent GI bleeding

Question 5

Nutritional Treatment of liver disease (4)

Answer 5

1. Feed multiple small meals per day
2. Protein restriction
   - ONLY if encephalopathic
3. Soy & dairy sources ideal
4. Sodium restriction of ascites problematic
5. Copper restrict for copper accumulation disease
6. Soluble fiber
   - Prevents constipation & reduces ammonia production by bacteria
7. Vitamin K
   - Decreases bleeding disorders of liver disease

Question 6

Liver disease goals (4)

Answer 6

1. Highly digestible energy source in CHO & fat, spare protein catabolism.
2. Moderate protein with high quality, branched chain amino acid.
   - Ideal protein sources: Milk, egg, vegetable
   - Low non-protein nitrogen
3. High vitamin level & reduced selected minerals.
   - Low copper, Iron, & Sodium
   - High zinc
   - Add vita K, E, & C
4. Maximize efficiency of fat metabolism
   - Added carnitine