Nutrition 222 Exam 4 Lecture 16
Terms in this set (63)
The most metabolically active organ in the body.
Roles of the liver
Processes, stores, and redistributes the nutrients.
Synthesizes and produces proteins: albumin, blood clotting proteins, transport proteins
Detoxifies drugs and alcohol
Processes excess nitrogen
Liver disease progresses...
Primary symptom of liver disease
What is the principle means of avoiding liver failure or transplantation?
Preventing additional damage
What are the two most common disorders affecting the liver?
Fatty liver and hepatitis
Accumulation of fat in the liver tissue
How does fatty liver develop?
When the amount of fat produced in the liver or picked up from the blood exceeds the amount the liver can use or export to the blood via lipoproteins.
Causes of fatty liver
Defects in metabolism, alcoholic liver disease, exposure to drugs & toxic metals, inherited disorders.
Primary risk factor of fatty liver
Fatty liver frequently accompanies
Diabetes mellitus, obesity, marasmus & kwashiorkor, GI bypass surgery, and long term TPN
Most patients suffering from fatty liver are
Consequences of fatty liver
Liver enlargement (hepatomegaly), inflammation (steatohepatitis), fatigue. If liver damage and scarring develop: cirrhosis, liver failure, liver cancer. Frequent cause of abnormal liver enzyme levels in blood (ALT and AST tests), increased levels of triglycerides, cholesterol, and glucose.
Consequences of fatty liver can actually...
Be fixed/reversed but can lead to more serious problems
Treatment of fatty liver
Eliminate the factors that cause it:
Decrease lipid levels, stop alcohol/drug use, weight loss (but not too rapid), increased physical activity, control blood glucose, increase insulin sensitivity.
Lifestyle modifications are always successful in reversing fatty liver, especially in patients who lack the usual risk factors. True or False
Condition of liver inflammation resulting from liver tissue damage
Most often causes of liver damage leading to hepatitis
Infection with specific viruses, A, B, C, D, E. Or excessive alcohol intake, exposure to some drugs and toxic chemicals, and fatty liver disease.
Some herbal products that cause hepatitis
Chaparral, germander, ma huang, jin bu huan, kava kava, kombucha, senna, and skullcap.
Less common causes of liver damage leading to hepatitis
Infection with other viruses and autoimmune diseases.
Hepatitis most often caused by infection with hepatitis virus A, B, or C.
Hepatitis A virus (HAV)
Primarily spread via fecal-oral transmission, extremely contagious, doesn't lead to chronic disease, vaccination available. Associated with floods and other natural disasters, contaminated water supplies.
Hepatitis B virus (HBV)
Primarily transmitted via infected blood or needles, sexual contact, or mother-to-infant childbirth. Chronic illness develops in less than 10% of cases. Vaccinations available.
Hepatitis C virus (HCV)
Primarily spread via infected blood or needles but NOT by sexual contact or childbirth. Major form that causes chronic hepatitis, and is also the most common cause of chronic liver disease! No vaccination is available! Preventative measures include blood donor screening, viral inactivation of blood products, infection control practices in health care settings, and risk reduction counseling to high-risk individuals.
Depend on the cause and severity.
Individuals with mild or chronic can be asymptomatic.
Acute hepatitis: fatigue, malaise, nausea, anorexia, and pain in the liver area. Liver usually enlarged. Jaundice. Fever, muscle weakness, skin rashes, elevated liver enzymes.
Yellow discoloration of tissues
Chronic hepatitis can cause complications that are typical of liver cirrhosis and may lead to
How is hepatitis treated?
With supportive care (bed rest) and an appropriate diet. Patients should avoid liver irritants such as alcohol, drugs, and dietary supplements causing liver damage.
Hepatits A patients: usually resolves without the use of medications.
Hepatits A & B patients: antiviral agents may be used such as lamivudine & ribavirin (block viral replication), and interferon alfa (both inhibits viral replication and enhances immune responses).
Nonviral forms of hepatitis patients: anti-inflammatory and immunosuppresant drugs.
Nutritional hepatitis treatment therapy
adequate protein (malnourished individuals)
small meals (anorexia or abdominal discomfort)
low fat diet (those with steatorrhea)
fluid & electrolyte balance (persistant vomiting)
Late stage of chronic liver disease. "End-stage". Gradually destroys liver tissue leading to scarring (fibrosis) and some areas of healthy tissue. Liver is irregular shaped with a nodular appearance.
What is cirrhosis characterized by?
Impaired liver function that can eventually result in liver failure
Chronic liver disease and cirrhosis together rank as the ______ leading cause of death in the United States
Causes of cirrhosis
1) Chronic hepatitis C
2) Alcohol liver disease
3) Bile duct blockages
4) Any type of untreated hepatitis
5) Drug induced liver injury
- Prescribed drugs
- Illegal drugs
6) Certain inherited disorders
How does bile duct blockages cause cirrhosis?
The blockages cause bile acids to accumulate to toxic levels in the liver.
What are some of the symptoms of cirrhosis?
40% cases are asymptomatic
Initial symptoms: fatigue, weakness, anorexia, weight loss
Later symptoms: anemia, blood clotting impairment, susceptibility to infection, jaundice, pruritus, fat malabsorption, ascites, varices.
Advanced cirrhosis: can disrupt kidney, lung, and brain function
Consequences of cirrhosis
Portal Hypertension, Ascites, Hepatic encephalopathy, elevated blood ammonia, malnutrition & wasting, reduced food intake, malabsorption of nutrients, altered metabolism
A rise in blood pressure within the portal vein. The portal vein supplies 3/4 the flow of blood to the liver. When scar tissue impedes the flow of blood, vasodilators (nitric oxide) are released increasing the volume of blood within the liver. Blood is diverted to collaterals which become enlarged & engorged forming varices that could rupture.
Smaller blood vessels surrounding liver that develop and expand throughout the GI tract and in regions near the abdominal wall.
Varicose vein that gets enlarged during portal hypertension. Most common are the esophageal and gastric varices.
Accumulation of fluid in the abdominal cavity, indicates that the liver damage has reached a critical stage.
Primarily a consequence of: portal hypertension, altered kidney function (sodium and water retention), reduced albumin.
Symptoms of ascites
Abdominal discomfort, early satiety, weight gain
Feeling full after consuming only a small amount of food
Disorder characterized by abnormal neurological functioning: personality changes, behavior, mood, mental ability, and motor functions. Is fully reversible with medical treatment. Exact causes are unknown.
Early stages of hepatic encephalopathy
Short attention span
Lack of coordination
Middle stages of hepatic encephalopathy
Disorientation, impaired memory
Anxiety, impaired judgement
Slurred speech, abnormal reflexes
Later stages of hepatic encephalopathy
Muscular rigidity, abnormal reflexes
How is cirrhosis treated?
-avoid liver toxins
Abstinence from alcohol
-lactalose (reduce ammonia)
-rifaximin (reduce ammonia)
Medical nutrition therapy for cirrhosis
Energy, Protein, CHO & Fat, Sodium & Fluid, Vitamins & Minerals, Enteral & parenteral
Energy cirrhosis nutrition
35-40 kcal/kg body weight per day. May be higher in patients with hyper metabolism, infection, malabsorption, or malnutrition. In patients with ascites, use estimated dry body weight when calculating nutritional needs:
Protein cirrhosis nutrition
Meet normal protein requirements, 0.8-0.2 g/kg per day
CHO & Fat cirrhosis nutrition
No carbohydrate restrictions unless patient has diabetes or insulin resistance, may need to restrict fats.
Sodium & Fluid cirrhosis nutrition
Restrict sodium & fluid (if ascites) and diuretic therapy. Potassium intake should be monitored.
Vitamin & Mineral cirrhosis nutriton
Liquid supplements (esophageal varices)
Fat soluble nutrients
Enteral vs Parenteral nutrient intake
Enteral: either orally or feeding tube, high calorie
Parenteral: through veins, high calorie
What is the only remaining option after liver failure has occurred?
Approximately 50% of the liver transplant cases are preceded from what?
Hepatits C and alcohol liver disease
What are some of the post-transplant concerns associated with liver transplants?
Organ rejection and infection
What is the primary cause of liver disease?
Alcohol can be toxic to the
Brain, GI tract, pancreas
Chronic alcohol abuse can lead to nutrient deficiencies and can displace essential nutrients. What are some of these nutrients?
Reduces risk of heart disease through an increase in HDL's, and a reduced risk of blood clotting.
Alcohol abuse is the most common cause of _____ deficiency in the United States
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