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Transcript
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