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Which vein brings blood full of nutrients from the digestive tract to the liver, before it enters the systemic circulation?
Hepatic Portal Vein
Which organ can regenerate itself?
Which organ secrets the enzyme trypsin?
Which organ does not secrete digestive enzymes?
What organ secretes bile acids?
What hormones secreted by the pancreas are
- involved in blood glucose regulation?
- Insulin & Glucagon
Which endocrine gastrointestinal regulatory peptide stimulates GALLBLADDER CONTRACTION and pancreatic secretions in response to peptides, amino acids, and fatty acids in the duodenum and jejunum.
Which endocrine gastrointestinal regulatory peptide stimulates biliary and pancreatic BICARB SECRETIONS in response to acid in the duodenum?
What are liver cells called?
Which autosomal recessive congenital metabolic disorder is characterized by progressive decline of lung and pancreas function due to ABNORMAL exocrine BODY SECRETIONS plugging up passageways, such as bronchi, pancreatic and bile ducts, and intestines?
What is hepatomegaly?
What is hepatitis?
Acute or chronic inflammation of the liver
What is steatosis?
excessive fat deposition in cells(liver)- fatty liver
What is Cirrhosis?
Irreversible destruction of the liver with scaring, loss of cell function, and signs and symptoms of liver failure, including jaundice, portal hypertension, and ascites.
What is Bilirubin?
A reddish yellow pigment formed during the catabolism of hemoglobin from red blood cells, and is excreted in bile.
What is Jaundice?
A yellowish coloration of the skin and body tissues due to abnormally elevated concentrations of bilirubin in blood and tissues.
What is Encephalopathy?
A disorder producing alteration of brain structure and degeneration of mental function.
What is Wernicke’s encephalopathy?
Inflammation of the brain with hemorrhage due to thiamin deficiency that produces alteration of brain structure and degeneration of mental function, especially seen in severe alcoholism.
What is Cholelithiasis?
The presence of cholesterol stone(s) in the gallbladder or a bile duct.
What is Cholestasis?
A condition of bile flow arrest or failure.
What is Cholecystitis?
Inflammation of the gallbladder.
What is Cholecystectomy?
The removal of the gallbladder by surgery.
What is Hemochromatosis?
An inherited disorder of iron metabolism causing excess iron absorption and deposition in tissues and organs, including the skin, joints, pancreas, liver, and heart.
What is Pancreatitis?
Inflammation of the pancreas due to cell damage.
What is Pancreatectomy?
Removal of part or all of the pancreatic tissue by surgery.
What may trigger the formation of gall stones?
- 1. Bile supersaturation with cholesterol (due to an increase of free cholesterol, a reduction of bile acids, and/or a reduction of phospholipids in bile)
- 2. Stasis of the gallbladder (cholestasis)
What factors and disease conditions are associated with an increased risk of the formation of cholelithiasis?
- Increasing age
- Female sex esp. 40 yrs
- Rapid Wt. loss
- Cystic fibrosis
What factors are commonly involved in the pathogenesis of hepatitis?
- Viral infection
- Toxic agents: alcohol, drugs, etc.
- Hemochromatosis (increased body iron)
- Nonalcoholic steatohepatitis (possibly induced by diabetes mellitus and/or obesity)
What is the most frequent etiology for chronic liver disease?
What are the clinical manifestations of hepatitis?
- Abdominal pain
- Reduced liver function
- Elevated serum bilirubin concentration
What are the complications of hepatitis?
- Fulminant liver failure (liver failure with severe encephalopathy and liver cell necrosis)
- Renal failure
- Cerebral edema
- Hemodynamic instability
- Severe hypoglycemia
What are the clinical manifestations of cirrhosis include:
- Portal hypertension
- Fatigue, malaise, weakness
- Nausea, vomiting
- Weight loss
- Overall decline of the health status and nutritional status
- Failure to thrive (in a child)
- Hepatic encephalopathy and reduced mental functions
- Diabetes mellitus
What are the S&S of end-stage liver failure?
- Liver function is diminished to 25% of less
- Hepatic encephalopathy
- Liver shrinks, losing cell function
- Condition is irreversible
Explain the purpose of nutrition care in liver disease?
- -Support and maintain a normal nutritional status, including protein-energy and micronutrient status, using nutrition support if required
- -Prevent complications, including malnutrition, and worsening of metabolic abnormalities associated with hepatic disorders
- -Favor regeneration of the hepatic tissue
- -Help support normal growth in children and adolescents
Why are clients with liver disease at risk of protein-energy malnutrition?
- Altered macronutrient metabolism
- Maldigestion and malabsorption
- Reduced oral intake
Which biochemical data may help identify the presence of liver disease?
- aspartate aminotransferase (AST)
- alanine aminotransferase (ALT)
- alkaline phosphatase (ALP)
- γ-glutamyl transferase (GGT)
- Blood albumin concentration
What other biochemical measures are useful in assessing the nutritional status of clients with liver disease?
- Hemoglobin and Hematacrit:Anemia? Ability to produce PRO
- Mean Corpuscular Volume: High if you have a folicin def
What is the main dietary recommendation for postcholecystectomy?
- A fat-restricted diet (25–50 g fat) in the first weeks/months and then a regular diet that is low in fat, as tolerated.
- If the clients experience steatorrhea postcholecystectomy, it is helpful to avoid fat, lactose-containing foods, spices, and foods causing a fast intestinal transit or abdominal discomfort (e.g., dried beans, cabbage, dried peas). It is also helpful to have small, frequent meals and to increase the intake of fluids and soluble fiber.
How is alcoholic liver disease managed?
- The role of diet therapy is to provide adequate nutrition and nutrition support as required to maintain or improve the nutritional status.
- Drugs-corticosteroids to reduce liver inflammation.
- Liver transplantation may be required.
What diet is recommended for liver disorders such as hepatitis, cirrhosis, and billary disease?
- The diet recommended for liver disorders has to be individualized for each client depending on the type of liver disease and its severity.
- Usual: High-PRO,CHO,Kcals,Vitamins and Minerals
Which clients with liver disease are especially susceptible to fat maldigestion and, therefore, may require a fat-restricted diet?
- Reduced bile flow
- Biliary tract obstruction
When are fluid and sodium restrictions necessary in clients with liver disease?
Clients with liver disease who have edema or ascites are likely to require fluid and sodium restrictions to help reduce the excess accumulation of body fluids.
What vitamins and minerals may need to be supplemented in clients with liver disease due to a suboptimal status and possible deficiency?
- The following vitamins and minerals may need to be supplemented in clients with liver disease:
- 1.Water-soluble vitamins (particularly in alcoholic clients), especially
- -Folate/folic acid
- -Thiamin (vitamin B1)
- -Pyridoxine (vitamin B6)
- -Ascorbic acid
- -Cobalamin (Vitamin B12)
- 2. Fat-soluble vitamins if there is fat malabsorption and steatorrhea
- 3.Trace elements if they are deficient
- 4. Exceptions Include:
- No excess manganese and copper in clients having biliary obstruction
- No iron supplementation in clients having hemochromatosis or hemosiderosis
What is Lactulose?
A synthetic nonabsorbable disaccharide used in the treatment if hepatic encephalopathy. That acts as a nonabsorbable fiber and is metabolized to lactate by bacteria in the colon. It acts as a laxative and favors ammonia and nitrogen excretion in the feces.
What are the S&S of acute pancreatitis?
- Inflammation of the pancreas
- Several blood abnormalities
- Decreased lipase
- Increased AST (damaged cells)
- Increased BG due to inflammation
What is the most sever complication of acute pancreatitis?
- Fulminant pancreatic inflammation,
- which can progress to necrotizing pancreatitis with liberation of pancreatic enzymes.
What is the MNT for clients with Chronic pancreatitis?
- -Complete abstinence from alcohol intake to reduce abdominal pain and promote healing
- -Maintenance of body weight and lean body mass
- High Energy: about 25–30 kcal/kg/day)
- Pro: 1.0–1.5 g kg/day
- CHO: 40%–60% of energy
How can symptoms be managed if a patient has chronic pancreatitis?
- -A low-fat diet (~30 % of energy as fat), or fat-restricted diet if there is steatorrhea
- -Oral pancreatic enzyme replacement therapy to reduce protein and fat maldigestion
- -Semi-elemental diet with MCT if required due to significant malabsorption
- -Restoration of nutritional status with vitamin and mineral supplementation and nutrition support as needed
What is the MNT for patients with acute pancreatitis?
- -Intravenous fluids and electrolytes
- -Enteral nutrition in the jejunum (e.g., nasojejunal feeding tube) often required
- -Parenteral nutrition if required due to complications and/or prolonged healing
- -Oral intake restarted when the inflammation is resolved
Recurrent insults followed by repair of the liver tissue can cause fibrosis and scarring. It also involves an irreversible distortion of hepatocyte structure, usually occurring after long-term liver dysfunction.
What is the effect of long-term alcohol abuse on the liver?
Hepatitis & Cirrhosis
Describe how hepatic steatosis may progress to cirrhosis.
The liver does not have the proper time to heal and regenerate. This can be be caused due malnutrition or not following proper MNT.
Differentiate between hepatitis A, B, C, D, and E.
- A-(virus) Transmitted by the fecal-oral route from contaminated drinking water, food sewage
- B- (virus) Transmitted via blood, blood products, semen and saliva
- C- Inflammation by a virus
- D- (virus) serum Hep
- E- Inflammation of liver- contaminated water
What are the functions of the liver it CHO metabolism?
- Galactose and fructose from digestion are converted to glucose
- Stores gluc and glycogen (glycogenesis) and then returns it to glucose when the blood level of glucose is low
- Synthesis of Fat from CHO
- Produces new gluc (gluconeogenesis) from precursors (lactic acid, intermediates in the TCA cycle)
What are the functions of the liver from PRO?
- Transamination and oxidative deamination to convert AMINO ACIDS to substrates that are utilized as energy and glucose production or the sunthesis of nonessential amino acids.
- Detoxify AMMONIA by converting it to urea for the kidney to excrete
- Synthesis of vital BODY PRO (albumin, transferrin, and lipoproteins).
What is urea made and excreted?
Made in the LIVER and excreted in the KIDNEY
What is the function of the liver for Fat?
- FATTY ACIDS from diet and adipose tissue are converted in the liver to acetyl-CoA by the process of beta-oxidation to produce energy.
- Ketone bodies are also produces
How is hepatic encephalopathy treated?
- Decrease PRO in diet (.6-.8g/kg)
- Lactulose - laxative that binds N for excretion in feces
What are the clinical manifestations of severe alcoholism?
- Fatty Liver
- NAD used to metabolize alcohol
- Cant make lipoproteins to transfer FA out
- alcohol is toxic to pancreas
- deficiency of folate and paradoxiene
What mineral my affect symptoms in alcoholics?
- Zinc (Deficiency)
- Alcohol dehydrogenase is a zinc dependent enzyme
What diet therapy is recommended for the management of CF?
- Supplementation of pancreatic enzymes
- Increased vitamins and minerals
What is the main blood PRO and and is synthesized in the liver?
What complications are associated with cirrhosis?
- Hypoglycemia (IGT)
What are the dietary recommendations for clients with mild chronic cholecystitis with symptomatic gallstones?
- The gallbladder contracts when you eat fat so decrease the amount of fat to <35% of calories, restrict but do not eliminate fat and distribute throughout the day
- foods that are gas forming
What is Bile?
- Bile is a complex solution needed to emulsify fat for digestion
- Made from chol in the liver
- Bile is a way to excrete minerals via the intestinal tract
- Bile is MADE in the LIVER and STORED in the GALLBLADDER
What is the function of the liver for vitamins?
- Storage, activation, and transport of V&M
- Stores are fat-soluble vitamins in addition to zinc, iron, copper, magnesium, and vitamin B12
What vitamin is involved in the synthesis if PT for blood clotting?
What is the protective function of the liver?
- Primarily metabolized in the liver by ADH
- Metabolism of excessive ETOH can cause excess NADH causing metabolic disturbances
- Not enough NAD presnet to digest normally, liver gives priority to alcohol because it is directly toxic
What are the metabolic disturbances that too much NADH can cause?
What effect does excess ETOH have on the liver?
- Depress the TCA cycle because of a lack of NAD
- Decrease in FA oxidation and accumulation of triclycerides in the liver (fatty liver)
What is the kcalorie value of alcohol?
.8 x proof x ounces = Calories
What are the vitamin and mineral deficiencies involved in Alcoholism?
- Thiamin (wet and dry beriberi, Wernicke-Korsakoff syndrome)
- Low plasma pyridoxine
- Vitamin C
- Vitamin D
- Vitamin K (clotting factors)
- Vitamin A ( night blindness)
- Calcium (bone density and bone mass)
- Potassium (hypokalemia)
What are the three progressive stages of alcoholic liver disease?
- 1.Hepatic steatosis (fatty liver)
- 2.Alcoholic hepatitis
What is Fatty Liver?
- Yellow discoloration of the liver due to fatty degeneration of the liver parenchymal cells
- Hepatomegaly is the most common sign
- Dark urine
- Elevated AST and ALT
- >5% lipid accumulation
What is Jaundice?
- Refers to the yellowish tint to the body tissues including the skin
What is hepatitis?
Widespread inflammation of the liver with a variety of etiologies
What is Chronic Hepatitis? Common S&S? Lab tests?
- Continued inflammation with abnormal liver function tests persisting for more than 6 mos
- Common S&S: Anorexia, N/V, right upper quadrant abd pain, dark urine, fever and jaundice
- Bilirubin, alkaline phosphatase and serum AST are generally elevated
What are the typical Nutritional Treatment recommendations for Hepatitis (exact amounts)?
- 30-35 Kcals/kg
- 3000 kcals
- 1-1.2 g PRO/kg
- 30-40% Kcals from fat
- 50-55% CHO
- Supplement with Vitamin K
What are the complications of Cirrhosis?
- portal hypertension
- Hepatic encephalopathy
What is portal hypertension?
Increased pressure within the liver from the disrupted architecture of the cells causing an increase in BP
What is the treatment for portal hypertension?
- Increase oral PRO
- Decrease Salt (<2g/day)
- Decrease Fluid
- Adequate Kcals and energy
What is the nutrition care plan for liver disease?
- Energy: 30-35 kcal/kg
- Fat: 25-40% of kcals as tolerated
- PRO: 1g/kg with hepatitis (DRY WEIGHT)
- V&M supplements
- Fluid restriction
- Low Na
- Soft foods