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Chapter 19 Nutrition and Liver Diseases © 2007 Thomson - Wadsworth The Liver • The most active organ in the body • Liver disease Progresses slowly • Fatty liver • Hepatitis • Roles Processes, stores, & redistributes nutrients Produces bile Synthesizes protein Detoxifies drugs & alcohol Processes excess nitrogen © 2007 Thomson - Wadsworth Fatty Liver • Accumulation of fat in the liver • Causes Alcoholic liver disease Exposure to drugs & toxic metals • Associated with Obesity Diabetes mellitus Marasmus & kwashiorkor Gastrointestinal bypass surgery Long-term TPN © 2007 Thomson - Wadsworth Consequences of Fatty Liver • Liver enlargement • Inflammation • Fatigue • Abnormal liver enzyme levels • Increased triglycerides, cholesterol, & glucose © 2007 Thomson - Wadsworth Treatment • Eliminate the cause • Lower lipid levels • Stop alcohol use • Change drug treatment • Lose weight • Control blood glucose © 2007 Thomson - Wadsworth Hepatitis • Liver inflammation • Results from any factor causing liver damage Viruses A, B, & C Excessive alcohol Exposure to certain drugs & toxic chemicals Some herbal remedies © 2007 Thomson - Wadsworth Types of Hepatitis • Hepatitis A Extremely contagious Most common Cause: fecal-oral • Hepatitis B Blood contact Sexual contact Vaccinations available • Hepatitis C Blood contact Major cause of chronic hepatitis © 2007 Thomson - Wadsworth Hepatitis • Symptoms Mild & chronic may be asymptomatic Acute • Fatigue, nausea, anorexia • Pain in liver area • Enlarged liver & jaundice • Fever, headache • Muscle weakness, skin rashes • Elevated liver enzymes © 2007 Thomson - Wadsworth Treatment • Supportive care, bed rest, nutritious diet • Hepatitis B & C need antiviral agents • Non-viral: antiinflammatory & immunosuppressant drugs © 2007 Thomson - Wadsworth Cirrhosis • • • • End-stage condition Scarring/fibrosis Irregular, nodular appearance Impaired liver function - can lead to liver failure © 2007 Thomson - Wadsworth Causes of Cirrhosis • Hepatitis C • Alcoholic liver disease • Bile duct blockages • All untreated types of chronic hepatitis • Drug-induced liver injury • Some inherited metabolic disorders © 2007 Thomson - Wadsworth Symptoms of Cirrhosis • 40% of people are asymptomatic • Initial symptoms Fatigue Weakness Anorexia Weight loss • Later symptoms Anemia Blood clotting impairment Susceptibility to infection Jaundice & fat malabsorption Ascites & varices © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Consequence of Cirrhosis • Portal Hypertension Scar tissue of liver impedes blood flow Causes a rise in pressure in the portal vein Blood is diverted to collaterals Collaterals become enlarged & engorged, forming varices, & may rupture • Esophageal • Gastric © 2007 Thomson - Wadsworth Esophageal Varix © 2007 Thomson - Wadsworth Consequence of Cirrhosis • Ascites Accumulation of fluid in the abdominal cavity Due to • Portal hypertension • Reduced albumin • Altered kidney function Abdominal discomfort & early satiety Weight gain © 2007 Thomson - Wadsworth Consequences of Cirrhosis • Hepatic encephalopathy Abnormal neurological functioning Amnesia, seizures, hepatic coma • Elevated blood ammonia • Malnutrition & wasting © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Treatment of Cirrhosis • Individualize • Supportive care Appropriate diet Avoidance of liver toxins • Abstinence from alcohol • Liver transplant • Drug therapy Diuretics Appetite stimulants Laxatives & antibiotic neomycin to reduce ammonia © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Medical Nutrition Therapy • Energy BEE + stress factor 4-6 feedings/day • Protein High enough to maintain nitrogen balance 0.8-1.2 g/kg • CHO & fat Complex CHO May need to restrict fat with steatorrhea © 2007 Thomson - Wadsworth Medical Nutrition Therapy • Sodium & Fluid With ascites, need to restrict fluid and sodium • Vitamins & minerals Multivitamin supplementation Liquid form if patient has varices • Enteral & parenteral Specialized enteral products high in kcalories Parenteral if patient has obstructions, bleeding, vomiting © 2007 Thomson - Wadsworth Liver Transplantation • Only option when liver failure occurs • Hepatitis C & alcoholic liver disease account for 40% of cases • Most patients are already malnourished © 2007 Thomson - Wadsworth Liver Transplantation • Post-transplant concerns Organ rejection Infection • Immunosuppressive drugs affect nutrition status • Diet: increased protein & energy requirements © 2007 Thomson - Wadsworth Nutrition in Practice Alcohol in Health & Disease © 2007 Thomson - Wadsworth Alcohol • Primary cause of liver disease • Can be toxic to brain, GI tract, & pancreas • Abuse leads to nutrient deficiencies • Moderate alcohol Can help with heart disease Middle-aged & older adults Increases HDLs Reduces tendency for blood clotting © 2007 Thomson - Wadsworth Dietary Guidelines • Women, 1 drink/day • Men, 2 drinks/day • One drink 12 oz beer 5 oz wine 10 oz wine cooler 1½ oz of 80 proof spirits © 2007 Thomson - Wadsworth One drink = © 2007 Thomson - Wadsworth Contraindicated • Pregnant & lactating • Children & adolescents • Those with potential medication interactions • Those unable to voluntarily stop • Activities requiring attention & coordination © 2007 Thomson - Wadsworth Alcohol in the Body • Supplies 7 kilocalories/gram • Liver is the site of most metabolism • Suppresses glycogen storage & glucose availability • Suppresses breakdown of fat • Can inhibit protein synthesis © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Alcohol & the Brain • Is a CNS depressant • In excess Can cause sedation Slow reaction time Relieve anxiety Impairs judgment Reduces inhibitions Impairs speech & motor function • Extremely high levels Coma Respiratory depression Death © 2007 Thomson - Wadsworth Long-Term Consequences • Liver disease • Damaged GI tract • Damaged pancreas • Can raise heart attack risk © 2007 Thomson - Wadsworth Alcohol & Nutrition Status • Can displace essential nutrients • Can cause deficiencies of Vitamin A Thiamin Folate © 2007 Thomson - Wadsworth Alcohol & Medication • Heavy drinking can increase medication potency • Problematic with Sedatives Blood glucose-lowering medications • Can reduce drug absorption © 2007 Thomson - Wadsworth
