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21 Cards in this Set
- Front
- Back
Liver Disease
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12th leading cause of death in the US
Malnutrition common in liver disease |
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Primary Cause of Severe Liver Disease in Adults
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Hepatisis C
Alcoholism- Affects both nutritional status and liver function. |
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Five functions of the Liver
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1. Carb, protein, and lipid metabolism
2. Detoxification of endo-exogenous substances 3. Vitamin storage 4. Synthesis of plasma proteins - Albumin - Prealbumin - Clotting proteins Bile and cholesterol synthesis |
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Four Signs of Liver Dysfunction
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1. Fatty Liver
- Alcoholic - NAFLD 2. Jaundice: bilirubin increases in the blood 3. Decreased plasma proteins - Albumin, clotting factors 4. Elavated Serum Enzymes - ALT- Alanine transaminase - AST- Aspartine transaminase |
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Fatty Liver Cause
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Alcoholic liver disease
Exposure to drugs and toxic metals Obesity, DM, kwashiorkor and marasmus Post Gastrointestinal Surgery Long-term parenteral nutrition |
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Fatty Liver Consequences 5
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Liver enlargement
Inflammation Fatigue Liver Damage/failure Abnormal liver enzymes/lipids |
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Fatty Liver Treatment
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Elimination of causing factors
- Alcohol abuse - Drug therapies Weight loss BG control Reduction in blood lipid levels |
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Hepatitis
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Inflammation of the liver
Due to viral infection (Hep C most common) Hep C will progress to cirrhosis and liver failure DIETARY TREATMENT Eliminate EtOH Vitamin/mineral supplementation |
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Cirrhosis
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Destruction of livers cells leading to impaired liver function
Scarring becomes extensive as the disease progresses Eventually leads to liver failure |
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Complications of Cirrhosis
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Jaundice
Fatigue Bruising and bleeding Low bone mass Increased blood NH3 Decrease albumin synthesis Increase aldosterone Malnutrition and wasting |
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Portal Hypertension
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Decrease blood flow through protal vein
- Increased BP in portal vein - Enlarged veins (varices) ASCITES Decreased Alb and aldosterone |
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Ascites Defintion and Causes
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Accumulation of fluid in abdominal cavity
1. Portal HTN 2. Water retention due to altered kidney function 3. Decreased alb sysnthesis by the liver Treatment: Sodium restrictions and diuretics (if Na lower retrict fluids 1-1.5L) |
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Hepatic Encephalopathy (Hepatic Coma)
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Neuropsycological disorder due to severe liver disease
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Hepatic Coma Symptoms
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Mood swings
Flapping tremors Memory Loss Coma |
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Hepatic Encephalopathy Causes
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DISTURBED NITROGEN BALANCE METABOLISM
Hyperammononemia due to inability to remove NH3 from the blood - Action of bacteria on unabsorbed protein in the colon - Amino acid catabolism Decreased branched chain amino acids Altered uptake leads to decrease NT production in the brain |
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Hepatic Encephalopathy Treatment
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Lactulose or anti-biotics
Protein restrictions if needed (40-60g/day) may increase to 1.2-1/5g/kg as tolerated. Give Branch chain amino acids |
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Malnutrition and Wasting
PEM |
PEM: protein-energy malnutrition
Consume less food due to reduced appetite, fatigue, or gastrointestinal symptoms Fat Malabsorption Unable to meet high energy needs |
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Cirrhosis Medical Nutritional Therapy
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Energy: May range from 20-75% above basal energy expenditure depending
Based on desirable weight or dry weight (weight without ascites) Protein 1-1.5g/kg |
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Treatment of Cirrhosis
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Vitamin and mineral supplementation
If steatorrhea occurs use fat soluable vitamins in a water soluable form. CAUTION: Vit A toxicity can occur at lower intake levels in liver disease and alcoholism. Large doses of niacin can cause liver damage |
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Liver Transplants
Post-transplantation Concerns |
Immunosupressive drugs are given to prevent rejections which can lead to infection
- Antibiotics and antivirals often prescribed - Food saftey measures used |
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Liver Transplant
Side Effects of Immunosuppressives |
N & V
Hyperglycemia and DM Electrolyte and fluid imbalance Alteration in taste HTN, Hyperlipidemia, osteoporosis, and protein catabolism High kcal, high protein, enteral supplementation if nessecary. |