Liver Diseases

Question 1

function of the liver, and what can happen if damaged

Answer 1

• Essential role in protein, carbohydrate and fat metabolism as well as micronutrient metabolism
  >Damage can affect metabolism and utilization of nutrients
• Tremendous storage capacity, functional reserve and regenerative capacity

Question 2

liver disease presentations

Answer 2

• elevations in liver enzymes without clinical signs
• to severe cirrhosis with hepatic encephalopathy and ascites

Question 3

Goals for Nutritional Management of liver disease

Answer 3

Directed at clinical manifestation rather than specific cause

• Maintain normal metabolic processes and homeostasis without overwhelming the
  damaged liver
  > Energy metabolism
  > Oxidative damage
  > Electrolyte balance
• Provide sufficient nutrients for hepatocellular repair and regeneration
• Avoid or manage hepatic encephalopathy

Question 4

key nutritional factors for dogs and cats with liver disease

Answer 4

Most patients with liver disease can continue to eat a complete and balance diet for their life stage

-if signs of hepatic encephalopathy, DM protein levels should be limited to 10-15% for dogs and 25-30% for cats until signs resolve

Question 5

dietary fat considerations in cases of liver disease

Answer 5

Beneficial
* Energy source > protein-sparing effect
* Essential fatty acids
* Fat soluble vitamin absorption
* Enhance palatability

• No need for restriction unless steatorrhea
• Cholestatic disease (biliary duct obstruction, gall bladder removal)
• Concurrent diseases causing fat malassimilation
• Avoid high fat in dogs predisposed to pancreatitis or hyperlipidemia

Question 6

dietary protein considerations in cases of liver disease

Answer 6

• NOT restricted unless signs of hepatic encephalopathy (increased ammonium)
• Minimum set by AAFCO should be met and exceeded provided patient tolerance
• Protein intake relative to current intakeDiet history!!
• Meet essential amino acid requirements
• Especially taurine and arginine in cats
• Taurine supplementation may be needed in dogs
• Plant-based and dairy protein reduce signs of HE

Question 7

what is hepatic encephalopathy

Answer 7

is a reversible syndrome observed in patients with advanced liver dysfunction
- accumulation of neurotoxic substances in the bloodstream (and ultimately in the brain)

Question 8

diet for HE dog considerations

Answer 8

-want to reduce protein to reduce ammonia…but also minimum protein requirements must be met

Question 9

what can help reduce ammonia absorption from the gut

Answer 9

soluble fibre

Question 10

avoid copper at what levels in diet to stop copper-associated hepatotoxicosis, in certain breeds

Answer 10

• Copper restriction < 5.0 mg/kg DM

Question 11

key nutritional factor for hepatic lipidosis

Answer 11

high protein