Mnt: Liver, Gallbladder, & Pancreatic Disorders

Front 1

the liver receives how much blood per minute?

Back 1

1500mL/min

Front 2

what percentage of liver function do we need to survive?

Back 2

10-20%

Front 3

T or F: the liver has the ability to regenerate.

Back 3

true

Front 4

The main functions of the liver:

Back 4

1. metabolism of CHO, PRO, & Fat
2. activation of vitamin D
3. storage of Fat Soluble Vitamins
4 it receives blood, filters it, and recirculates.
5. forms and excretes bile
6. converts carotene to vit. A
7. converts ammonia to urea

Front 5

the liver also secretes what fluid that is stored in the gallbladder, and is then released when fatty foods enter the duodenum?

Back 5

bile

Front 6

what is the main function of bile?

Back 6

to emulsify fats in the intestine and forms compounds with fatty acid to aid in absorption

Front 7

how does the liver metabolize CHO?

Back 7

1. Gluconeogenesis (from lactic acid, glycogenic amino acids)
2. Glycogenesis (stores glucose as glycogen)
3. Glycogenolysis

Front 8

how does the liver metabolize PRO?

Back 8

1. transamination
2. deamination
(includes synthesis of blood clotting proteins)

Front 9

how does the liver metabolize fat?

Back 9

1. fatty acids are converted thru B-oxidation for energy
2. Ketone formation
3. synthesis of TG, FA, and cholesterol

Front 10

what is bilirubin?

Back 10

a product from the destruction of RBC excreted in bile

Front 11

the four types of tests for liver function include:

Back 11

1. Hepatic Excretion: bilirubin & bile acid
2. Cholestasis Tests: alkaline phosphatases
3. Hepatic Proteins: albumin, prealbumin, PT
4. Hepatic Enzymes: ALT, AST

Front 12

What is hemochromatosis and what are the biomarkers?

Back 12

An inherited hepatic disorder where excess iron is absorbed in the gut
- Iron overload of 50-100x normal iron
- biomarker = ferritin

Front 13

what is Wilson's Disease?

Back 13

An inherited hepatic disorder of impaired copper excretion
- Cu accumulates in various tissues
- Biomarker: Copper

Front 14

Acute viral Hepatitis is...

Back 14

widespread liver inflammation caused by Hepatitis A, B, C, D and E

Front 15

What are the 4 symptom phases of acute viral hepatitis?

Back 15

1. fever, rash, arthritis, joint pain (physical)
2. N/V, fatigue, myalgia, anorexia (digestion)
3. Jaundice develops from bilirubin build up in blood
4. Convalescence (HBV recovery 15-50%, HAV 95%)

Front 16

What is Fulminant Hepatitis and what is it caused by?

Back 16

severe liver dysfunction with hepatic encephalopathy, without pre-existing liver disease

*Causes: viral hepatitis, chemical toxicities, wilson's disease, renal failure, sepsis, pancreatitis

Front 17

To be diagnosed with chronic hepatitis a patient must have had hepatitis for how long?

Back 17

6 months
OR

evidence of liver disease w/ unresolved inflammation

Front 18

MNT for Hepatitis
1. PRO
2. Kcals
3. Fat & CHO

Back 18

1. increased PRO (1.5g/kg)**
2. increased Kcals to 150% of DRI
3. fat ~25-30% + CHO ~55%

Front 19

What is Hepatic Steatosis?

Back 19

Fatty Liver
- Alcohol + Non-Alcohol Causes)

Front 20

Non-Alcoholic Fatty Liver Disease:
CAUSES

Back 20

drugs, obesity, DM, ileal bypass, malnutrition, dyslipidemia

Front 21

Non-Alcoholic Fatty Liver Disease:
SYPMTOMS

Back 21

malaise, weakness, heptomegaly,

Front 22

Non-Alcoholic Fatty Liver Disease:
MNT

Back 22

1. gradual weight loss**
2. balanced diet
3. focus on treating DM and Dyslipidemia**

Front 23

NON-Alcoholic Fatty Liver Disease:
The metabolism of ETOH results in what toxic by-product?

Back 23

Acetylaldehyde
-damages the mitcochondrial membrane structure & functions

Front 24

Alcoholic Liver Disease:
STAGES

Back 24

1. Steatosis
2. Hepatitis
3. Cirrhosis

Front 25

Stages of Alcoholic Liver Disease:
1. Steatosis

Back 25

Steatosis - accumulation of fat w/in liver
reversible w/ alcohol absitnence
- ^FA from adipose
- ^FA + TG synthesis
- decreased FA oxidation

Front 26

Stages of Alcoholic Liver Disease:
2. Hepatitis

Back 26

Alcoholic Hepatitis -
^ ALT, AST, Bilirubin
GI bleed -> anemia
N/V, diarrhea, wt. loss
abdominal pain, anorexia

Front 27

Stages of Alcoholic Liver Disease:
3. Cirrhosis

Back 27

- edema
- ascites: accumulation of fluid and serum PRO
- GI bleeding
- Steatorrhea
- PEM**
- FSV deficiencies
- Osteopenia
- fibrous nodules, muscle wasting, portal HTN

Front 28

Clinical Manifestations of Alcoholic Liver Disease:
External & Internal

Back 28

- External: alopecia, spider angioma, palmar erythmia, jaundice, bruising, muscle wasting, altered hair distribution, edema
- Internal: encephalopathy, portal hypertension, cirrhosis, tea colored urine, clay colored stool

Front 29

Assessment Challenges in Liver Disease:

Back 29

- edema masks BW and anthropometric measures
- serum proteins, lowered by hepatic synthesis

Front 30

MNT : Cirrhosis
ENERGY

Back 30

*Concerns: anorexia, N/V, dysgeusia, malabsorption, early satiety.
*Energy: varied, best in SFM
no complications: 120% REE
W/ complications: 150-175% REE

Front 31

MNT : Cirrhosis
CHO
PRO
FAT

Back 31

CHO normal 50-55%
FAT: 30-40kcals (lower to 25% w/ steatorrhea)
PRO: normal for no complications, 1.5g/kg complications

Front 32

MNT: Cirrhosis
Vitamins & Minerals

Back 32

FSV, thiamin, niacin, folate, B6, B12
Ca, Mg, Zn, Fe

Front 33

MNT for Liver Transplant:
pre-/early post transplant

Back 33

Kcals: 35-45
PRO: 1-1.5g
Na/d: 2-4g
Fluids: 1500mL
Ca + Vit. D

Front 34

MNT for Liver Transplant:
Long term

Back 34

avoid side effects of meds***
- wt. gain (30-35%)
- hyperlipidemia (fat <30%)
- HTN (2-4g Na/d)
- Osteopenia (Ca + Vit D)

Front 35

Cholestatic Liver Diseases:
PRIMARY BILIARY CIRRHOSIS (PBC)

Back 35

- immune mediated disease
- affects bile ducts
- 90% in women

Front 36

3 Gallbladder Diseases

Back 36

Cholestasis: lack of bile flow, caused by TPN
Cholelithiasis: gallstones
Cholecystitis: inflammation of gallbladder due to gallstone obstruction

Front 37

MNT: Gallbladder Diseases

Back 37

-Cholecystitis: avoid obesity, yo-yo diets, fasting,
low fat diet 30-45g/d

Front 38

Pancreatic Disease:
What is the function of the pancreas?

Back 38

glucose homestasis

Front 39

Tests for Pancreatic Function?

Back 39

- secretin stimulation test
- glucose tolerance test
- 72 hour stool fat test

Front 40

MNT: acute pancreatitis

Back 40

Sx: N/V, pain, hypermetabolism, steatorrhea, hypercatabolism, PEM, glucose intolerance

MNT: TPN or EN to Low Fat 40g/d diet in SFM +20% PRO
no ETOH

Front 41

MNT: chronic pancreatitis

Back 41

Sx: pains, N/V, azotorrhea, B12 malabsorption, PEM, DM

MNT: 20% PRO, 25%FAT, 55% CHO
B12 + FSV, no ETOH