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70 Cards in this Set
- Front
- Back
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True or False: The liver is the largest solid organ in the body. |
True |
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The ___ lobe is larger than the ____ lobe. |
Right, left |
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What is the lifespan of a hepatocyte? |
120 days |
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Normal hepatic function results in ____, ___, and ___ of a variety of products. |
clearance, detoxification, excretion |
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Normal hepatic function results in the ___ of materials for use in the liver and other parts of the body. |
synthesis |
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The liver synthesizes ___, _____, and _____ for local use. |
amino acids, transaminases, alkaline phosphatase |
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The liver synthesizes ___, ___, and ___ for release into the blood. |
urea, plasma proteins, lipoproteins |
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The liver synthesizes ___, ___, and ___ for release into bile. |
bile acids, cholesterol, phospholipids |
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In the liver ___, ___, ___, ___ and is stored. |
glycogen, vitamin B12, Fat soluble vitamins A, D, E, and K, and iron/ferritin. |
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What proteins are produced in the liver? |
Albumin Glycoproteins, transferrin Acute phase proteins, ceruloplasmin clotting factors |
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How does liver disease progress? |
Inflammation > Fibrosis > Scarring > Cirrhosis |
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Define cirrhosis |
chronic scarring and fibrosis |
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What are the causes of liver disease? |
1. Infections 2. Toxins 3. Metabolic Factors 4. Immunological Factors 5. Altered circulation 6. Biliary obstruction |
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What are the main infections that cause liver disease? |
Hepatitis A Hepatitis B Hepatitis C |
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How does Hepatitis A spread? |
by fecal-oral route? |
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How does Hepatitis B spread? |
Perinatal, blood, and sexual transmission |
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How does hepatitis C spread? |
blood borne transmission. |
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What is the major toxin cause of liver disease? |
Alcohol. Alcohol is directly toxic to hepatocytes |
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Alcohol is broken down by _____ and ____. |
alcohol dehydrogenase and MEOS |
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____ to ____ g/day for several years in men and ___ to __ g/day for several years in women, may lead to alcoholic liver disease. |
40-80g, 20-40g |
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What is a serving of alcohol? |
16gm or one 1.5 fl oz of 80 proof liquor, 5 fl oz of wine, and 12 oz of beer or wine cooler. |
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Define Alcoholic Steatosis |
May develop with short term alcohol use over days or chronic or chronic alcohol use. Characterized by fatty deposits in the liver Asymptomatic Reversible with abstinence With continued alcohol use, 20-30% develop alcoholic hepatitis or cirrhosis. |
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Define Alcoholic hepatitis |
Develops after years of alcohol abuse Clinical finds: Fever and tender hepatomegaly. Lab Findings: AST: ALT > 2:1 Both AST and ALT <300 |
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What is the possible cause of NAFLD? |
insulin resistance fails to suppress the lipolysis of adipose tissue and there is increased efflux of FFA from adipose tissue to the liver. |
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Insulin resistance ___ TG synthesis but ____ fatty acid oxidation, which leads to ___ accumulation in the liver. |
increases, inhibits, TG |
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____ is an extreme form of NAFLD. It is caused by ___ accumulation and ___. |
Nonalcoholic steatohepatitis (NASH), lipid, inflammation |
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What is "second hit" theory? |
An event the induces an inflammatory response. |
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What are the risk factors for NASH/NAFLD? |
Obesity DM2 Hyperlipidemia all of which lead to insulin resistance Other factors include: female sex, rapid weight loss, parenteral nutrition, medications. |
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With hepatic steatosis the liver becomes ___, ___, and ___ colored. |
inflamed, fatty, yellow. |
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What are the stages of NAFLD to cirrhosis? |
NAFLD > NASH > Cirrhosis |
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Define Liver cirrhosis |
Chronic liver damage from a variety of causes leading to scarring and liver failure. |
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What is the minimal toxic single dose for tylenol? |
7.5-10 g (adults) |
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What are the metabolic factors for alcoholic liver disease? |
Hemochromatosis and Wilson's Disease |
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Hemochromatosis is an ___ overload syndrome. |
iron |
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Hemochromatosis is due to a ____ |
genetic mutation |
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Iron deposition in the liver leads to ___ and eventually ____. |
scarring, cirrhosis. |
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Progression to cirrhosis in hemochromatosis can be prevented with ___ and _____. |
Phlebotomy and iron chelation therapy. |
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Wilson's Disease is a defect in __ excretion of ____. |
biliary, copper |
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Wilson's disease leads to fatty ___ > liver ___ and ___ > ____. |
inflammation, fibrosis, scarring, cirrhosis |
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Wilson's disease often present in ____ adults with concomitant neuropsychiatric disease. |
younger |
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What are a few examples of high copper foods. |
Oysters/shellfish whole grains beans nuts (brazil nuts, cashews potatoes Dark leafy greens dried fruits cocoa/chocolate black pepper yeast organ meats |
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What are the immunologic factors that cause liver disease? |
Autoimmune hepatitis Primary binary cirrhosis Primary Sclerosing Choloangitis |
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Hepatic fibrosis leads to ___ resistance to blood flow through the liver, which leads to ___ pressures in the portal vein and portal system |
increased, high |
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Varices are ___, ___ veins that occur as result of portal hypertensions. They are found in the ___, __and ___. |
large, dilated stomach, esophagus, rectum |
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Define ascites |
accumulation of fluid in the peritoneal space due to elevated hydrostatic pressure from portal hypertensions and from decreased plasma onoctic pressure from hypoalbunimeia |
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How do you treat ascites |
treatment is with paracentesis (removal of fluid), diuretic treatments, and dietary sodium restoration (2 g Na/day) |
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What is refractory ascites? |
that is ascites which cannot be mobilized by low sodium diet and maximal doses of diuretics |
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How is refractory ascites treated? |
TIPS or large volume paracentesis w/ albumin replacement. |
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What is a Transjugular Intrahepatic Portosystemic Shunts (TIPS) |
The radiologists puts a catheter into the jugular vein in the neck and threads it until it reaches to veins from the liver. Once in the liver, the catheter is inserted into the portal vein. Over the catheter, the radiologist will pass a mental spring called a stent, which will expand to create a channel between the two veins. Blood will then flow from the high-pressure portal vein into the low pressure liver vein. |
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Define Hepatic Encephalophathy |
The loss of brain function when a damaged liver doesn't remove toxins from the blood. |
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How many stages are their in Hepatic Encephalopathy? |
4 |
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What are some of the precipitants contributing to hepatic encephalopathy? |
Excess protein, surgery, TIPS, Gi bleeding, HCC, Infections, Diuretics, Alcohol, Low Potassium, Low plasma volume. |
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How is hepatic encephalopathy treated? |
1. Eliminate precipitating factors 2. PN Support 3. Lactulose or neomycin as medical treatment. |
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How does lactulose work? |
Lactulose reduces the amount of ammonia in the blood of patients with liver disease. It works by drawing ammonia from the blood into the colon where it is removed from the body |
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Patients with liver disease have been found to have ___ metabolism, ____, and ____. |
normal, hypo metabolism, hyper metabolism. |
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Energy requirements for patients with liver disease are ___ to ____ % of REE. |
120-140%. |
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Malnutrition is present in up to ___ % of liver disease patients. |
80% |
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Malnutrition is associated with increased risk of ____ bleeding, _____, spontaneous _______ |
variceal, refractory ascites, bacterial peritonitis. |
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What are some of the causes of malnutrition in liver disease patients? |
Anorexia, vomiting, diarrhea, taste changes, restrictive diets, early satiety, alcohol abuse. |
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Patients with liver disease can have metabolic abnormalities similar to ____ or ___. |
sepsis or trauma |
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After an overnight fast, the metabolism of patients with liver disease is comparable to a patients who have sustained a ____ hour ___ without compensatory decrease is REE. This results in _____ energy expenditure and loss of muscle and fat. |
72 hour, fast, increased |
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What are some other metabolic abnormalities that may lead to malnutrition? |
glucose intolerance, storage capacity. |
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What are some malabsorption/maldigestion causes of malnutrition in liver disease patients? |
Fat malabsorption, fat soluble vitamins, water soluble vitamin malabsorption, minerals |
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What are some reliable methods for nutritional assessment of liver disease? |
Tricep skin fold, mid arm muscle mass Hand grip dynamometer Nitrogen Balance Study (if Cr clearance > 50) Subjective Global Assessment/ Nutrition focused physical examination |
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It is common that individuals with encephalopathy do not device adequate ____. |
Protein
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What are the nutrition therapy recommendations for individuals with acute encephalopathy? |
Gradually increase protein to 1-1.5 g/kg/day Small frequent meals and bedtime snacks 30-35 kcals/kg vitamin and mineral supplementation Restrict sodiums/ fluid if there is ascites and edema present |
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What are the nutrition therapy recommendations for individuals with chronic encephalopathy? |
Once encephalopathy resolves gradually increase protein to normal levels Use enteral supplements Encourage branched chain amino acids Small frequent meals and bedtime snack 25-35 kcal Vitamin and mineral supplementation Restrict sodium/ fluid if ascites/ edema present |
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What is the nutrition therapy recommendations for those patients w/o encephalopathy. |
Do not restrict protein small frequent meals and bedtime snacks vitamin and mineral supplementation restrict sodium if ascites/edema present Restrict fluid if pt is hyponatremic. |
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Patients with liver disease are at high risk for ___ and ___ deficiencies and ____ deficiencies. |
fat and water soluble vitamins and mineral (zinc, selenium, iron) |
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What are the main priorities for NAFLD/NASH Diet? |
Limit saturated fat, manage diabetes, adequate protein. |
