MNT for Hepatobiliary and Pancreatic Disorders

Question 1

Main functions of the liver

Answer 1

Metabolism of macronutrients
• activation and storage of vitamins & minerals
• Formation and excretion of bile
• Metabolism of steroids
• Conversion of ammonia to urea
• Detoxification of drugs, alcohol, organic compounds • filter and “flood chamber”

Question 2

What is hemochromatosis

Answer 2

Inherited disease of iron overload

Question 3

What is Wilson’s disease

Answer 3

Autosomal restive disease associated with impaired biliary copper excretion (build up in liver brain cornea and kidneys

• typically diagnosed before 40 - will need treatment for life

Question 4

What is ascites, how is it treated, what should be monitored and what does MNT include?

Answer 4

Ascites is a complication of liver disease

Treated with:
- large volume paracentesis
- diuretic therapy

What should be monitored: (during diuretic therapy)
- weight
- abdominal girth
- urinary sodium concentration
- serum levels of urea nitrogen, creatinine, albumin, Uric acid and electrolytes

Medical nutrition therapy:
- sodium restriction (often less than 2g/day) more severe limitations may be imposed

Question 5

What is the MNT for hepatic encephalopathy?

Answer 5

• protein restriction in patients with low grade hepatic encephalopathy is outdated
• true protein intolerance is rare except in fulminant hepatic failure
• unnecessary protein restriction can worsen body protein losses and should be avoided
• over 95% of pts with cirrhosis can tolerate mixed-protein diets up to 1.5g/kg body weight

Question 6

Explain the nutrient requirements for cirrhosis

Answer 6

• For those with end stage liver disease but without ascites - energy requirements are between 1.2 - 1.4X the REE
• requirements increase to 1.5 or 1.75 in the presence of ascites, infection and/or malabsorption
• equates to around 25-35 kcal/kg
• use dry body weight or ideal weight to avoid overfeeding

Question 7

Explain protein need in liver failure

Answer 7

For uncomplicated cirrhosis or hepatitis: 1.0 - 1.5g/kg/day
- to achieve positive nitrogen balance, minimum 1.2-1.3G/kg/day is required

Decompensated disease (sepsis, infection, GI bleed, severe ascites) or alcoholic hepatitis:
- minimum 1.5g/kg/day

Nitrogen balance may be improved by consuming several small meals/day and a late evening snack of 500-700 calories is necessary

Question 8

Explain pancreatitis

Answer 8

Inflammation of the pancreas
- characterized by edema, cellular exudate, fat necrosis
- ranges in severity from mild to severe
- ransom identified 11 signs that, when monitored in the first 48 hours, have prognostic significance

Question 9

Some dietary fat can be substituted with ___________ to improve fat absorption and weight gain

Answer 9

Medium-chain triglycerides