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HCFN 430 Carine Souza The liver performs many essential functions for life. These functions include metabolism, synthesis and storage of nutrients. The liver is essential in the metabolism of alcohol. Alcohol is produced through the fermentation of yeast, sugars and starches, and it can be divided in three main categories. Liver damage is a common consequence of chronic alcoholism. Alcoholism is a physical dependence characterized by the excessive intake of alcohol. Malnutrition is often observed among these population because alcohol interferes with nutrients digestion, absorption, storage, utilization and excretion. Acute or chronic alcohol abuse can lead to alcoholic liver disease. The etiology of the disease is related to genetic factors, toxicity of alcohol and personal susceptibility. The effects of alcoholic liver disease varies among individuals depending on the time and quantity of alcohol abuse. Alcoholic liver disease can progress in three stages: fatty liver, hepatitis and cirrhosis. Fatty liver is the most common alcoholic liver disease and it is marked by excessive accumulation of fat in the liver. Alcoholic hepatitis is characterized by inflammation of the liver cells that occur with the consumption of a large quantity of alcohol over a period of time. Alcoholic cirrhosis is the final stage of the disease; and it is characterized by the replacement of healthy tissue for scar tissue. Some of the symptoms of the alcoholic liver disease include accumulation of fluids in the abdomen, liver cancer, enlarged spleen, kidney failure, jaundice and high blood pressure in the liver. Physical recover may be possible with proper nutrition, alcohol abstinence and if adequate exercise is followed. The liver is the largest gland in the body The cells in the liver are called hepatocytes Hepatocytes have different concentration of glycolytic enzymes and enzymes involved in lipid metabolism Two lobes (right and left) that are enclosed and divided in a common connective tissue The portal vein an the hepatic artery carries blood that enter the liver The average flow of blood through the liver is 1,400ml/min (2) Available at: http://www.clarian.org/ADAM/doc/graphics/images/e n/8848.jpg. Accessed on February 13, 2010. Metabolism of nutrients (carbohydrates, lipid, protein, vitamins, minerals and alcohol) Stores glucose as glycogen (glycogenesis) and break down glycogen to glucose (glycogenolysis) Synthesize fatty acids Source of factors necessary for blood coagulation Source of albumin Control the concentration of many nutrients Prepare waste materials to be disposed in the urine Production of bile Vitamin A storage Stores Vitamin D, Vitamin E and a small amount of vitamin K Stores iron, copper and influence the metabolism of sodium, potassium, calcium, phosphorus and chloride. The liver is essential in the metabolism of ALCOHOL Detoxication (hormones, toxins, drugs) Alcohol can be divided into three categories: beer, wine and distilled liquor Produced by the fermentation of yeast, starches and sugars Rapidly absorbed from the stomach and small intestine into the bloodstream Drink Amount (oz) Absolute Alcohol (g) Total Calories Beer 12 12 144 Wine 5 12 105 Liquor 1.5 12 96 Available at: http://www.infoniac.com/uimg/alcoh ol-drinks.jpg. Accessed on February 13, 2010. (6) Chronic alcohol intake influence regulatory factors of appetite and inflammation, which may decrease the amount eaten Alcohol damages the mucosa of the upper gastrointestinal tract Alcohol interferes with the nutrition process by affecting digestion, absorption, storage, utilization and excretion of nutrients It is recommended to drink alcohol in moderation, meaning no more than one drink a day for women and two drinks a day for men. 1g of alcohol provides 7.1kcal A physical dependence characterized by excessive consumption of alcohol accompanied by alcohol dependence and impaired control Affects 9 to 11 million people in the United States Cause acute effects (shortly after intake) or can cause effects with chronic abuse Have social, economic and physiologic consequences including liver disease Research suggests that certain genes can increase the risks for alcoholism Available at: http://3.bp.blogspot.com/_LYoXnaQeh2k/SkrioLVCi FI/AAAAAAAAAaM/Iyay1rK5GYs/s320/alcoholism.jp. Accessed on February 13, 2010. (9) Alcoholics often eat poorly, consequently their supply of essential nutrients are limited which affect body energy supply and maintenance Malnutrition is often observed in this population because of: Gastrointestinal problems Reduced nutrient absorption Metabolic changes Increased excretion of nutrients Available at: http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=79921. Accessed on February 13, 2010. (11) Preventable disease caused after years of excessive consumption of alcohol Most common liver disease in the US About 20 million people in the US have some degree of alcoholic liver disease In 2006, it was reported 13,050 cases of alcoholic liver disease deaths Alcoholic Liver Disease progress in three stages: Fatty Liver (also called steatosis) Alcoholic Hepatitis Alcoholic Cirrhosis Genetic factors (predisposition for alcohol abuse) Personal susceptibility to alcohol-induced liver disease (availability to alcohol, social acceptability of alcohol use) Toxicity of alcohol to the liver Most common alcoholic liver disease Affects 10 to 24% of the US population Occurs after acute alcohol ingestion Marked by the excessive accumulation of fat inside the liver cells (mainly triglycerides) In the presence of ethanol, long-chain fatty acids in diet have a greater tendency than medium-chain fatty acids to promote fatty liver Reversible with alcohol abstinence Enlargement of the liver Abdominal discomfort (15) Available at: http://www.livers.org.nz/images/LIVER/Fatty_change.jpg. Accessed on February 13, 2010. Acute form of alcoholic liver disease that occur with the consumption of a large quantity of alcohol over a period of time Characterized by inflammation and more severe injury of the liver Destruction of hepatic cells and scarring (15) Available at: http://atlas.kennesaw.edu/~dmurphy3/imageSRI. JPG. Accessed on February 13, 2010. Fever Jaundice Increased white blood cells count Enlarged and tender liver Spider-like veins in the skin Accumulation of fluids in the abdominal cavity The 11th leading cause of death in the US Final stage of alcoholic liver disease Condition in which the liver slowly deteriorate in consequence of chronic injury Alcoholic Cirrhosis destroys normal liver tissue producing scar in the liver Scar tissue is formed because of injury or long-term disease Scar tissue replaces healthy tissue but it cannot work as properly as healthy tissues Scar tissue block the normal flow of blood through the liver Scarring from cirrhosis is irreversible Can be life-treating but can also be controlled with proper treatments About 5% of individuals with cirrhosis will also develop liver cancer Weakness Fatigue Nausea Vomiting Ascites Loss of appetite Weight loss Abdominal pain Itching Available at: http://protectyourliver.com/images/liver_damage.gif. Accessed on February 13, 2010. (17) Available at: http://www.cwu.edu/~bergmane/images/Normal%20Liver,%20Fatty%20Liver,%20and%20Cirrhosis.GIF. Accessed on February 13, 2010. (18) Enlarged liver Liver cancer Accumulation of fluids in the abdomen Kidney failure Increased white blood cell count High blood pressure in the liver Spider-like veins in the skin Fever Jaundice (yellowing of the skin and eyes) Enlarged spleen Confusion Dry mouth Excessive thirst Development of insulin resistance Induced Wernicke-Korsakoff Induced Beri-beri disease Lifestyle and medical history related to alcohol Blood test: INR, bilirubin, creatinine X rays, magnetic resonance imaging and ultrasound images Liver biopsy (most accurate) Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis. Accessed on February 13, 2010. (20) NI-1.4 Inadequate energy intake Empty calories from alcohol reduce appetite and food intake NI-5.2 Malnutrition Malnutrition and nutrient deficiencies are common among alcoholics because of the decreased dietary intake, malabsorption, alterations in metabolism of nutrients, decreased storage and increased losses of nutrients NI-5.9.1 Inadequate vitamin intake Folic acid, thiamin and vitamin B6 deficit is common ALD patients because of their inability to absorb these vitamins from foods, which can lead to decreased serum folate and induced-beri beri NI-5.7.1 Inadequate protein intake Protein energy malnourishment aggravates ALD NC-1.4 Altered GI function Impaired oxidation of triglycerides Nutrition support is essential for improvement Malnourished alcoholics should be recommended a high-calorie, well-balanced and nutritious diet, rich in complex carbohydrates, dietary fiber and protein Calories: 35-40 kcal/kg body weight based on adequate weight rather than current weight Protein, CHO and fat recommendations: Alcoholic Hepatitis 1.5-2 g protein/kg body weight High carbohydrate 30-35 g/kg body weight Moderate fat Alcoholic Cirrhosis 1-2 g protein/kg body weight High carbohydrate 30-35 g/kg body weight Moderate fat Personalized meal plan Eat 4 to 6 small meals a day instead of 3 large ones Adequate fluid intake Vitamin and mineral supplementation (especially thiamin, folate and vitamin B6) When possible liquid supplements should be administered orally or via enteral tube feedings Strict abstinence from alcohol is necessary for the liver to recover NOT Recommended Foods/Beverages Recommended Foods/Beverages Fresh vegetables and fruits Whole-wheat grains Lean meat Health snacks: nuts, cheese, yogurt, wholegrain crackers, sunflower seeds Drink 8 glasses of fluids each day Avoid foods that are high in sodium, such as canned soups, canned vegetables, processed meats and cheeses, condiments, and snack foods Avoid foods that can cause food borne illnesses such as unpasteurized or raw milk, raw or undercooked meat, raw or undercooked eggs , unwashed fresh fruits and vegetables, unpasteurized fruit and vegetable juices and cider and all raw vegetable sprouts Foods prepared with alcohol Foods and beverages containing caffeine Foods high in sugar Meal Menu Breakfast ½ cup oatmeal with 1tsp of brown sugar 1 cup of soymilk 2 slices whole wheat toast with1tsp margarine and 1tsp of strawberry jam 1 egg Morning Snack 6 oz yogurt with 2 tbs granola Lunch 1 cup low-sodium chicken noodle soup 2 slices of whole wheat bread 3oz of lean turkey 1 tsp of mayonnaise 4 baby carrots 1 banana 1 cup of soymilk Afternoon Snack 1 cup of liquid high-calorie supplement (such as Boost or Ensure) 5 whole wheat, no-salt-added crackers Dinner 4 oz pork tenderloin 1 small baked sweet potato with 2 teaspoons margarine ½ cup stir-fried broccoli, pea pods, onion, and mushrooms ½ cup mixed fresh fruit Evening Snack 2 cookies Available at: http://www.womenfitness.net/wfimgank7/balance_diet.jpg. Accessed on February 13, 2010. Medications Liver transplant (most alcoholics do not qualify for transplant) Social support Psychotherapy Exercise Available at: http://www.providence.org/resources/everett/GroupTh erapy.jpg Accessed on February 13, 2010. (26) Liver function tests Prothrombin Test Bilirubin Test Hepatitis markers Blood counts Protein levels Vitamin and mineral levels Hemogram Hemoglobin Hematocrit Platelet count Blood Chemistry Liver Enzymes Gamma glutamyl transferase, gamma glutamyl transpeptidase (GGT) Serum glutamyicoxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) Toxicology Blood alcohol content Glucose Blood urea nitrogen (BUN) Creatinine Albumin Total protein Serum folate Triglycerides Urinalysis Bilirubin Ketones There is not enough evidence to support the effectiveness of medications in the treatment of ALD Patients with cirrhosis are more sensitive to medications Some examples of medications used are: Pentoxifylline Corticosteroid (alcoholic hepatitis) Diuretic edema Oral antibiotics prevent infections Beta-blocker or nitrate portal hypertension Medication Pentoxifylline Corticosteroid Diuretic Beta-blocker or nitrate Nutritional Interaction/Monitoring Recommendation •No caffeine •Take with food •Fluid needs may increase •Weight and appetite may decrease •Should be consumed with food or milk to decrease GI distress •Sodium intake should decrease •Adequate potassium, protein, Ca, Phos, Zn, Fol, Vits A,B6,C,D should be consumed •Take on an empty stomach or with milk •Some diuretics cause loss of potassium, calcium and magnesium •Monitor glucose levels, weight, blood pressure •Take with food •Alcohol should be avoided 1) Popper H. Liver: structure and function. Am Jour Med Scien.1958;235:121. 2) MedlinePlus. Liver diseases. Available at: http://www.nlm.nih.gov/medlineplus/liverdiseases.html. Accessed on February 13, 2010. 3) Brookmoller J, Roots I. Assessment of liver metabolic function: Clinical implications. Clin Pharmacokinet. 1994;27(3):216-248. 4) American Liver Foundation. Alcohol-induced liver disease. Available at: http://www.liverfoundation.org/education/info/alcohol/. Accessed on February 11, 2010. 5) National Institute in Drug Abuse. Alcohol. Available at: http://www.drugabuse.gov/drugpages/alcohol.html. Accessed on February 12, 2010. 6) New Jersey City University. Available at: web.njcu.edu/dept/counselingcenter. Accessed on February 13, 2010. 7) National Institute on Alcohol Abuse and Alcoholism. Alcohol alert. Available at: http://pubs.niaaa.nih.gov/publications/aa22.htm. Accessed on February 12, 2010. 8)Tan HH, Virmani S, Martin P. Controversies in the management of alcoholic liver disease. Mount Sinai Jour Med. 2009;76:484-498. 9) Alcohol affects seniors differently. Available at: http://50somethinginfo.blogspot.com/2009/07/alcohol-affects-seniors-differently.html. Accessed on February 13, 2010. 10) American Dietetic Association. Nutrition care manual: Alcoholism. Available at: http://www.nutritioncaremanual.org/content.cfm?heading_id=11426. Accessed on February 13,2010. 11) American Dietetic Association. Available at: http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=7992. Accessed on February 13, 2010. 12)Stickel F, Hoehn B, Schuppan D, Seitz HK. Nutritional therapy in alcoholic liver disease. Aliment Pharmacol Ther. 2003;18:357-373. 13) American Gastroenterological Association. Liver transplantation is effective in alcoholic liver disease. Available at: http://www.gastro.org/wmspage.cfm?parm1=8439. Accessed on February 13, 2010. 14) ) American Liver Foundation. Fatty-liver. Available at: http://www.liverfoundation.org/education/info/fattyliver/. Accessed on February 11, 2010 15) Liver photos. Available at: http://www.livers.org.nz/images/LIVER/Fatty_change.jpg. Accessed February 13,2010. 16) National Institute of Diabetes and Digestive and Kidney Diseases. Cirrhosis. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/. Accessed on February 10, 2010. 17) National Digestive Disease Clearinghouse. Nonalcoholic Steatohepatitis. Available at: http://protectyourliver.com/images/liver_damage.gif. Accessed on February 13, 2010. 18) Nutrition soup. Available at: http://www.cwu.edu/~bergmane/images/Normal%20Liver,%20Fatty%20Liver,%20and%20Cirrhosis.GIF. Accessed on February 13, 2010. 19) Baker H, Frank O, Zetterman RK, Rajan KS, Hove W, Leevy CM. Inability of chronic alcoholics with liver disease to use food as a source of folate, thiamin and vitamin B6. Am Jour Clin Nutr. 1975; 28:1377-1380. 20) National Digestive Disease Clearinghouse. Cirrhosis. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis. Accessed on February 13, 2010. 21)Bunout D,Gattás V, Iturriaga H, Pérez C, Pereda T, Ugarte G. Nutrition status of alcoholic patients: it’s possible relationship to alcoholic liver damage. Am Jour Clin Nutr. 1983;38:469-473. 22) American Dietetic Association. International dietetic and nutrition terminology (IDNT) reference manual: Standardized language for the nutrition care process. 2009. 23) MedlinePlus. Alcoholic liver disease. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000281.htm. Accessed on February 10,2010. 24) Healthy liver diet. Available at: http://www.womenfitness.net/wfimgank7/balance_diet.jpg. Accessed on February 13, 2010. 25) Center for Disease Control and Prevention. Alcohol use. Available at: http://www.cdc.gov/nchs/fastats/alcohol.htm. Accessed on February 13, 2010. 26) Support group. Available at: http://www.providence.org/resources/everett/GroupTherapy.jpg Accessed on February 13, 2010. 27) Burke PK, Roche-Dudek M, Roche-Klemma K. Roche dietitians: Drug-nutrient Resource. 2003. 28) Barposter. Available at: : http://barposter.com/images/oupost.jpg. Accessed on February 13, 2010. Alcohol and your liver http://medicalnewstoday.healthology.com/hy brid/hybridautodetect.aspx?content_id=2600&focus_handl e=cirrhosis&brand_name=medicalnewstoday