Medical Nutrition Therapy - B. Liver, Biliary, Pancreatic Disorders (p. 6-9

Question 1

Functions of the _____ include: storing and releasing blood, filtering toxic elements, metabolizes and storing nutrients, and regulating fluid and electrolyte balance.

Answer 1

Liver

Question 2

_____ levels in the blood are elevated when tissue damage causes them to leak into circulation. Elevated _____ levels indicate tissue damage.*

Answer 2

Enzyme *Elevated enzyme levels indicate tissue damage.

Question 3

**In liver disease, enzyme levels are ALL _____. AST is decreased in uncontrolled diabetes.

Answer 3

In liver disease, enzyme levels are ALL ELEVATED.

Question 4

Condition characterized by inflammation and partial necrosis of the liver.

Answer 4

Acute viral hepatitis

Question 5

*ANOREXIA is a major symptom of _____.

Answer 5

*ANOREXIA is a major symptom of HEPATITIS.

Question 6

Diet therapy for hepatitis: Care varies by symptoms and pt nutritional status. Increase fluids to prevent ______. Increase _____ (to 50-55% cal) to REPLENISH LIVER GYLCOGEN, AND SPARE PROTEIN. Increase protein (1-1.2 g/kg) to provide for cell regeneration, and to PROVIDE LIPOTROPIC AGENTS to covert FAT–>Lipoproteins for transport out of the liver (PREVENT FATTY LIVER) Limit fat if steatorrhea *SMALL, FREQUENT FEEDINGS DUE TO ANOREXIA

Answer 6

Diet therapy for hepatitis: Care varies by symptoms and pt nutritional status. Increase fluids to prevent dehydration. Increase CHO (to 50-55% cal) to REPLENISH LIVER GYLCOGEN, AND SPARE PROTEIN. Increase protein (1-1.2 g/kg) to provide for cell regeneration, and to PROVIDE LIPOTROPIC AGENTS to covert FAT–>Lipoproteins for transport out of the liver (PREVENT FATTY LIVER) Limit fat if steatorrhea *SMALL, FREQUENT FEEDINGS DUE TO ANOREXIA

Question 7

The difficulty in providing nutritional support is that hepatitis patients are often ______. Small, frequent feedings are advised.

Answer 7

The difficulty in providing nutritional support is that hepatitis patients are often ANOREXIC. Small, frequent feedings are advised.

Question 8

In ______, the liver attempts to repair its damaged cells by replacing them with bands of connective tissue, which is NON-FUNCTIONAL. The connective tissue divides the liver into clumps, rerouting many veins and capillaries. BLOOD FLOW IN THE LIVER IS DISRUPTED. Poor food intake leads to deficiencies.

Answer 8

Cirrhosis

Question 9

In cirrhosis, _____ deficiencies lead to ascites, fatty liver, and impaired blood clotting.

Answer 9

Protein

Question 10

** ______ occurs when blood can’t LEAVE the liver.

Answer 10

Ascites

Question 11

In cirrhosis, connective tissue blocks blood from leaving the liver, so it accumulates. Once the liver has reached capacity, fluid (plasma) leaks into peritoneal cavity. Plasma is high osmolar load, causing additional fluid to be pulled into peritoneal cavity to dilute the load. This leads to sodium and water retention. **This accumulation of fluid and the sodium that carries it IS _____.

Answer 11

Ascites

Question 12

________ ______ occur when blood can’t ENTER the liver.

Answer 12

Esophageal varices

Question 13

In esophageal varies, _______ _______ overgrowth disrupts blood flow, causing blood to back up into the portal vein. This increased pressure is PORTAL HYPERTENSION, which causes the varices (dilated blood vessels).

Answer 13

Connective tissue

Question 14

Varices are FRAGILE and can burst on their own, or be torn open with a diet ____ in roughage (fiber).

Answer 14

High

Question 15

**Diet for Cirrhosis is _____ protein _____ calorie _____ fat

Answer 15

Diet for cirrhosis is HIGH protein (0.8 - 1.0 g/kg) (at least 1.5 in stress) HIGH calorie (25-35 kcal/kg) MODERATE fat (25-40%) Low FIBER if varices present. Low SODIUM if edema/ascites. Fluid restriction if hyponatremia.

Question 16

_______ _______ ______ has 3 stages. 1.Hepatic steatosis (fat build up) 2. Alcoholic hepatitis (inflammation) 3. Cirrhosis

Answer 16

Alcoholic liver disease

Question 17

Alcoholic liver disease is due to the constant presence of alcohol and the metabolic changes it causes. Alcohol–>Acetaldehyde conversion forms excess production of HYDROGEN, which disrupts liver metabolism. _______ steps into TCA cycle in place of _____, causing fat to accumulate in liver.

Answer 17

Hydrogen in place of fat.

Question 18

_______ usually accompanies cirrhosis.

_____ replaces _____ in the diet.

Alcohol causes _________ of the GI tract, and interferes with the absorption of THIAMIN, FOLATE, B12, AND C.

Also increased needs for B VITAMINS to metabolize the alcohol and MAGNESIUM which is excreted after alcohol consumption.

Answer 18

Malnutrition

Alcohol, food

Inflammation

Question 19

_________ deficiency leads to Wernicke-Korsakoff syndrome.

Wernicke-Korsakoff syndrome is a brain disorder.

2 distinct syndromes -

Werknicke encephalopathy: characterized by an acute/subacute confusional state, often reversible

Korsakoff syndrome: persistent and irreversible dementia

Answer 19

THIAMIN deficiency leads to Wernicke-Korsakoff syndrome.

Question 20

Hepatic failure (ESLD) is when liver function is decreaed to __% or less of normal.

Answer 20

25%

Question 21

In hepatic failure, the liver cannot convert _______ to _______, causing _____ to accumulate (toxic).

Answer 21

The liver cannot convert AMMONIA to UREA, causing AMMONIA to accumulate.

–>confusion, drowsiness, COMA

Question 22

Hepatic Failure Diet

Moderate to High ______

High _____

High _____

Answer 22

Hepatic Failure Diet

Moderate to High PROTEIN (1.0-1.5 g/kg)

High CALORIE (30-35 kcal/kg)

High FAT (30-35% kcal)

Extra energy from CHO & FAT to minimize catabolism of muscle.

Question 23

In ESLD, the normal ratio between neurotransmitters in altered in encephalopathy.

There is an _____ in BCAA (used by muscles for energy, and a ______ in AAA (damaged liver unable to clear).

Answer 23

There is an INCREASE in BCAA, and a DECREASE in AAA.

Question 24

ESLD

A therapeutic approach is to attempt to correct the imbalance by giving ____ BCAA, and _____ AAA.

However, this seldom reduces symptoms.

Answer 24

ESLD

A therapeutic approach is to attempt to correct the imbalance by giving MORE BCAA, and LESS AAA.

However, this seldom reduces symptoms.

Question 25

Standard treatment of ESLD is ______ (hyperosmotic laxative that removes N) and neomycin (antibiotic that destroys ammonia-producing bacterial flora)

Answer 25

Lactulose (hyperosmotic laxative that removes N)

Question 26

Inflammation of the gallbladder.

Answer 26

Cholecystitis

Question 27

MNT for cholecystitis includes:

Low ___ diet.

Answer 27

Low fat diet

Question 28

Post-cholecystectomy (removal of the gallbladder), BILE is now secreted DIRECTLY from the _____ to the _____.

Answer 28

Bile is secreted directly from the liver to the intestine.

Question 29

Inflammation of the pancreas with edema, cellular exudate, and fat necrosis.

Exudate: A fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation

Fat necrosis: The pancreas digests itself

Answer 29

PANCREATITIS

Question 30

A common characteristic of pancreatitis is the premature activation of _____ within the pancreas, leading to autodigestion.

Answer 30

Activation of enzymes.

Pancreatic enzymes digest the pancreas.

Question 31

Diet therapy for ACUTE pancreatitis:

Pancreatic rest, no PO intake

Maintain hydration (IV)

Progress as tolerated to easily digestible, low fat foods

-**ELEMENTAL (pre-digested) EN into jejunum may be tolerated**

Answer 31

Diet therapy for CHRONIC pancreatitis

Pancreatic enyme replacement therapy (PERT) with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase.

(MCTs do not require pancreatic lipase)

May need to supplement B12 (pancreatic protease splits vitamin from carrier) and antacids (pancreatic bicarbonate secretion defective).

Eating stimulates the pancreas, causing pain (avoid large meals with fatty foods).

Question 32

Disease of the EXOCRINE GLANDS

Secretion of thick mucus that obstructs glands and ducts - especially in the lungs and pancreas.

Answer 32

Cystic fibrosis

Question 33

______ ______ leads to chronic pulmonary disease, pancreatic enzyme deficiency, and malabsorption.

Answer 33

Cystic fibrosis

Question 34

Diet Therapy CF:

______ with meals and snacks

______ protein, ____ calorie, _____ fat, _____ salt

Supplement fat-soluble vitamins

Answer 34

Pancreatic enzyme replacement therapy (PERT)

HIGH protein (due to malabsorption)

HIGH calorie

UNRESTRICTED fat (to compensate for high energy needs and malabsorption)

LIBERAL salt (losses in sweat)

Supplement fat soluble vitamins