Liver Disease

Question 1

What occurs with sinusoid obstruction and why?

Answer 1

Blood flow decreases so pressure builds and fluid leaves into the peritoneal cavity (ascites)

Question 2

What is ascites?

Answer 2

4-8 extra liters of fluid in the peritoneal cavity

Question 3

Where is bile reabsorbed?

Answer 3

Ileum, along with bile salts

Question 4

How is cholestyramine r/t enterohepatic circulation?

Answer 4

Instead of reabsorbed bile going from the ileum back to the liver, this drug captures the bile so the liver has to regenerate new bile from cholesterol.

Question 5

What is jaundice?

Answer 5

Symptom
Lots of bilirubin in ECF
Yellow skin when >2.4-3.0mg/dL
B/c rapid destruction of RBC, decreased liver uptake of bilirubin, blocked bile ducts so bilirubin not released

Question 6

What do Kupffer cells do?

Answer 6

In the liver, they are macrophages
Filter bacteria and proteins
Break and get rid of old RBC

Question 7

What are LFTs and what do the screen for?

Answer 7

Liver disfunction 
Bilirubin
Alkaline phosphatase
ALT/AST
Albumin 
PTT

Question 8

Key lab: what happens to blood ammonia when liver function decreases?

Answer 8

It goes up because the liver is not turning it into urea for excretion

Question 9

What can cause hepatitis?

Answer 9

Hep B (tools and body fluids) 
Hep C (needles and sex and BB virus) 
Anorexia, fatigue, high bilirubin, AP, AST

Question 10

MNT with hepatitis?

Answer 10

Decrease protein
30-35 kcal/kg (>3000kcals)
1.1-1.2 g/kg
Water sol vits and maybe MCT

Question 11

Alcoholism common deficiencies

Answer 11

Protein 
Folic acid 
Thiamin (ADH cofactor) 
Vitamin A 
Zinc (needed and ADH cofactor)

Question 12

If alcohol to ADH ratio is too high, or NAD is low, what pathway breaks alcohol?

Answer 12

MEOS

Microsomal ethanol oxidizing system and it uses energy without making any

Question 13

How do you find kcals in EtOH?

Answer 13

%alcohol of beverage x 2=proof

Then .8 kcal per proof

Question 14

carbohydrate functions of liver

Answer 14

Glucogenesis
Gluconeogenesis
Glycogenesis 
Glycolysis
Glycogenolysis

Question 15

Protein functions of liver

Answer 15

Ammonia to urea
Aa turned to glucose
Make albumin, transferrin, PA, prothrombin and fibrinogen

Question 16

Lipid functions of liver

Answer 16

FA to energy (B oxidation)
Make ketones
Make TG, lipids and cholesterol
Make VLDL and HDL

Question 17

Vitamin functions of liver

Answer 17

Store fat soluble 
Activate Vit D 
Folate into active 5-THF 
B carotene to Vit A 
Store minerals: Fe, Mg, B12, Zn, Cu

Question 18

2 levels of NAFLD?

Answer 18

Steatosis- fat accumulates in interstitial space of liver

Steatohepatitis- inflammation and fat accumulation in liver

Question 19

What 3 conditions is NAFLD associated with?

Answer 19

DM2
Metabolic syndrome
Obesity

Question 20

What is NASH?

Answer 20

Non alcoholic steatohepatitis
Fibrous tissue formed in liver
Could be insulin resistance caused
Manage with DM2 drugs and wt loss

Question 21

3 stages of liver disease?

Answer 21

Fatty liver (steatosis)- reversible
Alcoholic hepatitis- toxic liver injury, high labs
Cirrhosis- portal HTN, GI bleeding, Ascites, hepatic encephalopathy

Question 22

What is cirrhosis specifically caused by EtOH?

Answer 22

Laennec’s Cirrhosis

Question 23

What is esophageal varices?

Answer 23

Thin lining of esophagus tends to bleed with portal HTN

Question 24

Difference between ascites and Anasarca?

Answer 24

Ascites- edema in peritoneal

Anasarca- extreme edema everywhere

Question 25

MNT goal with Ascites

Answer 25

``` Remove fluid Prevent electrolyte imbalance Prevent loss of LBM/anorexia Sodium 500-1000mg FR- 1000-1500mL/day 1.25-1.75 protein IBW No glutamine ```

Question 26

What is hepatic encephalopathy?

Answer 26

Can't eliminate toxic products so toxic to brain Delirious Usually high ammonia levels

Question 27

MNT with advanced liver disease

Answer 27

Low protein Restrict fluids Antibiotic (neomycin to kill fluid retaining Bact)

Question 28

2 drugs used to manage encephalopathy?

Answer 28

Lactulose- laxative Makes colon acidic so Ammonia is not absorbed Neomycin- antibiotic Destroys colonic bacteria that make ammonia

Question 29

MNT references for liver disease

Answer 29

``` BEE x 1.2-1.75 25-35 kcals encephalopathy 20-40% fat, MCT if needed Up to 1.6 g/kg protein 40g/d protein- encephalopathy BCAA for encephalopathy ```

Question 30

How does high NH4 affect BCAA in blood

Answer 30

High ammonia stimulates glucagon which causes hyperglycemia and high insulin. Muscles uptake BCAA and BCAA in blood are low.

Question 31

What is Wilson's disease?

Answer 31

Autosomal recessive disorder Less biliary copper excretion Copper accumulates Might supplement with zinc to decrease CU absorption.