In which abdominopelvic quadrant is the pancreas located?
LLQ
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?
liver
which organ secretes the enzyme trypsin?
pancreas
these organs secrete digestive enzymes, with the exception of
E. liver
what organ secretes bile acids?
c. liver
Describe the composition of pancreatic juice
water, bicarbonate and digestive enzymes
What hormones secreted by the pancreas are involved in blood glucose regulation?
insulin and 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?
cholecystokinin
which endocrine gastrointestinal regulatory peptide stimulates biliary and pancreatic bicarbonate secretion in response to acid in the duodenum?
secretin
what are liver cells called?
hepatocytes
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?
cystic fibrosis
hepatomegaly
enlargement of the liver
hepatitis
an acute or chronic inflammation of the liver due to liver cell injury
liver steatosis
fatty liver or abnormal and excessive accumulation of fat in hepatocytes causing degeneration and enlargement of the liver tissue
cirrhosis
a chronic and irreversible cellular destruction of the liver with scarring and fibrosis causing nodular architecture distortion, loss of cell function, and signs and symptoms of liver failure, including jaundice, portal hypertension, and ascites
bilirubin
a reddish yellow pigment formed during the catabolism of hemoglobin from red blood cells, and is excreted in bile.
jaundice
a yellowish coloration of the skin and body tissues due to abnormally elevated concentrations of bilirubin in blood and tissues
encephalopathy
a disorder producing alteration of brain structure and degeneration of mental function
wernicke's encephalopathy
an inflammation of the brain with hemmorrhage due to thiamin deficiency produces alteration of brain structure and degeneration of mental function, especially seen in severe alcoholism
lithiasis
the production of calculi or stony concretions in the body
cholelithiasis
the presence of cholesterol stone(s) in the gallbladder or bile duct
cholecyst
a synonym for gallbladder
gallstone
a lithiasis in the gallbladder or a bile duct
cholelith
a synonym for gallstone
cholecystolithiasis
a condition characterized by the presence of gallstone(s) in the gallbladder
cholestasis
a condition of bile flow arrest or failure
cholecystitis
an inflammation of the gallbladder
cholecystectomy
the removal of the gallbladder
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
pancreatitis
an inflammation of the pancreas due to cell damage
pancreatectomy
a removal of part or all of the pancreatic tissue by surgery
What may trigger the formation of gallstones?
-bile supersaturation with cholesterol
- stasis (lack of contraction) of the gallbladder
What factors and disease conditions are associated with an increased risk for the formation of cholelithiasis?
-increasing age
-femal sex
-estrogens
-pregnancy
-diabetes
-obesity
-prolonged fasting
-cystic fibrosis
-rapid weight loss
-total parenteral nutrition
What factors are commonly involved in the pathogenesis of hepatitis?
-viral infection
-toxic agents: alcohol, drugs, etc.
- alcoholism
-hemochromatosis
-ischemia
What is the most frequent etiology for chronic liver disease?
alcohol
What are clinical manifestations of hepatitis?
-fever
-malaise
-fatigue
-anorexia
-abdominal pain
-reduced liver function
-elevated serum bilirubin concentration
What are the complications of hepatitis?
-liver failure
- renal failure
-cerebral edema
-hemodynamic instability
-severe hypoglycemia
-immunosuppression
-cirrhosis
What are the clinical manifestations of cirrhosis?
-jaundice
-portal hypertension
-ascites
- fatigue, malaise, weakness
-anorexia
-nausea and vomiting
-steatorrhea
-overall decline of the health and nutritional status
-failure to thrive
-hepatic encephalopathy and reduced mental functions
-diabetes mellitus
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 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
-anorexia
-nausea & vomting
-maldigestion and malabsorption
-reduced oral intake
What is the best method to determine the energy needs of clients with liver disease?
-indirect calorimety
-CO2 / O2 exchange
-one liter oxygen = 4 calories
Which biochemical data may help identify the presence of liver disease?
-AST
-ALT
- (ALP) alkaline phosphatase
- blood albumin concentration
-BUN
-PT time
-serum ammonia (increased in liver failure and hepatic encephalopathy)
- WBC
- C-reactive protein
-blood glucose
-blood lipid profile
What other biochemical measures are useful in assessing the nutritional status of clients with liver disease?
- blood albumin concentration
-blood thyroxine-binding prealbumin concentration
-blood transferrin concentration
-total lymphocyte count
-blood hemoglobin concentration
-serum osmolarity
-serum electrolyte concentrations
-Hgb
-Hct
-MCV
-MCHC
-serum folate
-serum B12
serum thiamin
-serum Vitamin C
What is the main dietary recommendation postcholecystectomy?
- a fat restrticted diet (25-50g) in the first weeks/months and then a regular diet that is low in fat, as tolerated.
How is alcoholic liver disease managed?
with a mulitdisciplinary approach supporting the client and promising abstinence. The role of diet therapy is to provide adequate nutrition and nutrition support as required to maintain or improve the nutritional status.
What diet is recommended for liver disorders such as hepatitis, cirrhosis, and biliray disease?
-has to be individualized for each client depending on the type of liver disease and its severity
-energy needs are usually increased due to infection, metabolic stress, surgery, and weight loss.
- supplemental nutrition help may be needed if the client cannot maintain a healthy nutrition status
Which clients with liver disease are especially susceptable to fat maldigestion and, and therefore, may require a fat-restricted diet?
-cirrhosis
-reduced bile flow
-biliray tract obstruction
-alcoholism
-cholecystectomy
When are fluid and sodium restrictions necessary in clients with liver disease?
-clients with edema or ascites
Which vitamins and minerals may need to be supplemented in clients with liver disease due to suboptimal status and possible deficiency?
- folate
-thiamin
-B6-Vitamin C
- B12-fat soluble vitamins (if steatorrhea)
_________ is a synthetic nonabsorbable disaccharide used in the treatment of hepatic encephalopathy. It 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.
lactulose
Give the signs and symptoms of acute pancreatitis.
-acute abdominal pain in the LUQ
-N & V
-anorexia
- hematologic abnormalities including:
- increased blood amylase
-increased blood lipase
- elevated WBC
-lowered blood calcium
-elevated AST
-elevated BUN
-decreased Hct
-elevated blood glucose
-elevated blood triglyceride
Describe the most severe complications of acture pancreatitis.
fulminant pancreatic inflammation which progresses to necrotizing pancreatitis with liberation of the pancreatic enzymes, which can burn other tissues in the abdominal cavity
What is medical nutrition therapy for clients with chronic pancreatitis?
-complete abstinence from alcohol
-maintainence of body weight
- high energy diet (25-30 kcals/kg/day)
-1.0 - 1.5 g protein/kg/day
- 40-60% of energy from CHO
- fat restricted if steatorrhea is present
-enzyme replacement therapy to reduce protein and fat maldigestion
-MCT oil
-restoration of nutrtional status with vitamin and mineral supplementation and nutrition support as needed
What is the medical nutrition therapy for clients with acute pancreatitis?
-NPO
-intravenous fluids and electrolytes
-enteral nutrition in the jejunum
-parenteral nutrition if required due to complications
-oral intake restarted when the inflammation is resolved
recurrent insults followed by repair of the liver tissue can cuase fibrosis and scarring known as _______, which involved an irreversible distortion of hepatocyte structure, usually occuring after long-term liver dysfunction.
cirrhosis
What is the effect of long-term alcohol abuse on the liver?
the liver stores fat (fatty liver), hepatitis, cirrhosis
Describe how hepatic steatosis may progress to cirrhosis.
fat builds up, the liver cells enlarge, which can regenerate if drinking ceases, but it can lead to hepatitis and cirrhosis if drinking continues
Differentiate between hepatitis A, B, C, D, E
Hepatitis A: infectious virus, transferred via feces
Hepatitis B: virus, transferred via blood, needles, body fluid
Hepatitis C: virus, transfered via blood products
Hepatitis D: virus serum hepatitis
Hepatitis E: virus, transfered by contaminated water
What is biliary cirrhosis?
irreversible destruction of the liver tissue, obstruction of bile duct, bile builds up in the liver
explain how advanced liver disease alters the metabolism of carbohydrate.
decreased blood glucose, decreases glycogen storage capacity, increases fat build-up due to the lack of ability to convert CHO to fat, and convert glucose to glycogen and glycogen to useable glucose.
explain how advanced liver disease alters the metabolism of Protein
increases ammonia in the blood because the liver is needed to remove nitrogen from proteins and it helps make body proteins that serve many functions throughout the body including enzymes
How is hepatic encephalopathy treated?
-lactulose which consumes some of the ammonia in the blood and excretes it with the feces
-decrease protein intake
What are clinical manifestations of severe alcoholism?
-fatty liver
-gastritis
-pancreatitis
-deficiencies: thiamin, folate, B6, Vitamin C
What diet therapy is recommended for the management of cystic fibrosis?
-enzyme replacement therapy
-increase energy, protein
-mineral and vitamin supplement
________ is synthesized by the liver and is the main blood protein. Therefore it can be used as a marker of liver function. Decreased _________ concentration in the blood is seen in liver disease. However, it is not a sensitive marker as its half-life is 12 to 18 days and it is not specific as other factors can alter its concentration including malnutrition, fluid status, inflammation & pregnancy.
albumin
These conditions are associated with cholelithiasis formation except...
a. cystic fibrosis
b. menopause
c. rapid weight loss
d. ileal resection
e. prolonged fasting
b. menopause
disease-specific nutrition support formulas like Nutrihep and other hepatology formulas are usually lower in _________
aromatic amino acids
What are the dietary recommendations for clients with mild chronic cholecystitis with symptomatic gallstones?
-decreased fat diet (less than 30% kilocalories)
- evenly distributed fat throughout the day
- avoid gas-forming food (individual tolerances)
What are the dietary recommendations for clients with acute cholecystitis with symptomatic gallstones awaiting an emergency cholecystectomy by laparoscopy?
