MNT for Individuals II

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Author:
rpeders
ID:
197837
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MNT for Individuals II
Updated:
2013-02-05 09:17:33
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Review Dietetic exam
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Liver, pancreas, gallbladder
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  1. Function of Liver
    -Store and release blood, filters toxic elements, metabolizes and store nutrients, regulates fluid and electrolyte balance
  2. ALP Alkaline phosphatase
    Increased: liver or bone disease

    Decreased: scurvy or malnutrition
  3. LDH Lactic Acid Dehydrogenase
    Increased: hepatitis, myocardial infarction, muscle malignancies
  4. AST, SGOT, Aspartate amino transferase
    Increase: Hepatitis

    Decreased: Uncontrolled diabetes with acidosis
  5. ALT, SGPT, alanine aminotransferase
    Increased: liver disease
  6. Enzymes in liver disease?
    -All 4 (ALP, LDG, AST, ALT) are elevated

    *SGOT is decreased in uncontrolled diabetes.
  7. Acute Viral Hepatitis
    • -Inflammation, necrosis, jaundice, anorexia, nausea, fatigue
    • *Jaundice occurs when bile ducts are blocked*
  8. HAV
    Fecal-Oral transmission of hepatitis
  9. HBV
    Sexually transmitted hepatitis
  10. HCV
    Blood to blood contact hepatitis
  11. Treatment for Hepatitis
    • -Increase fluids to prevent dehydration
    • -Care for varices
    • -50-55% CHo to replenish liver glycogen and spare protein
    • -moderate to liberal fat intake if tolerated, limit fat is steatorrhea
    • -small, frequent feedings bc of anorexia
    • -encourage coffee (antioxidant)
    • -multivit with B complex, C, K, zinc
  12. Cirrhosis
    • -Damaged liver tissue is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries. Blood flow through liver is disrupted.
    • -Poor intake leads to deficincies
    • -Protein deficiencies lead to ascites, fatty liver, impaired blood clotting
  13. When/Why does ascites occur?
    • -Normally due to cirrhosis
    • -Fluid build up in peritoneal cavity
    • -Occurs when blood cannot leave the liver
    •   -Overgrowth blocks blood flow out of liver into vena cava, leaving pressure in the liver (can hold extra liter of blood). When too much pressure, the blood volume forces fluid to sweat through the liver into the peritoneal cavity. The fluid is mostly plasma, with a high osmolar laod--pulling in more fluid to dilute.
    • -low serum albumin may be due to dilution factor
  14. Esophageal Varices
    • -Occur when blood cannot enter the liver
    • -Due to portal hypertension
    • -Increased pressure forced blood back into collateral veins that offer less resistance
  15. Diet for Cirrhosis
    • -High Protein (.8-1 g/kg, in stress at least 1.5 g/kg)
    • -High Cal (25-35 cals/kg, est by dry weight, or 1.2-1.5 X BEE)
    • -Moderate to low fat 25-40%, MCT oil if needed. Fat is preferred fuel in cirrhosis, include omega-3
    • -Low fib if varices, low sodium if edema
    • -restrict fluid to 1-1.5L/day if hyponaturemia
    • -B complex
  16. Alcoholic Liver Disease
    • -Alcohol is converted to acetaldehyde and excess hydrogen which disrupts liver metabolism
    • -Hydrogen replaces fat as fuel in Krebs cycle so fat accumulates in the liver and blood
  17. Malnutrition with Alcoholic Liver Disease
    • -Malnutrition (replacement of alcohol with food)
    • -Alcohol interferes with absorption of thiamin, b12, vit c, folic acid (inflammation of GI tract)
    • -need more b vit to metabolize alc
    • -need more mg, excreted after alcohol consumption
  18. Wernicke-Korsakoff Syndrome
    a brain disorder due to thiamine deficiency. Symptoms of Wernicke's encephalopathy: Confusion; Loss of muscle coordination (ataxia) Leg tremor.
  19. Hepatic Failure (ESLD)
    • -decreased to 25%
    • -apathy, drowsiness, confusion, encephalopathy, coma
    • -Mod-high protien (1-1.5)
    • -30-35 cals/kg, 30-35% cals from fat
    • -Include BCAA(leucine, isoleucine, valine)
    • -Lactulose (laxative-removes nitrogen)
    • -Neomycin (antibiotic)
  20. Gallbladder disease
    • Cholecystitis: inflammation of the gallbladder
    • -Infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones (cholelithiasis)

    • Treatment:
    • -Low fat diet, 30-45 grams
    • -cholecystectomy: bile now secreted from liver directly into the intestine
  21. Acute Pancreatitis
    • -put pancreas at rest, withhold feedings, fluid IVs
    • -progress slowly, low fat
    • -elemental (pre-digestd) enteral nutrition into jejunum
  22. Chronic Pancreatitis
    • -Provide oral pancreatic enzymes with meals and snacks
    • -Add MCT oil to dishes, jams, jellies bc they don't need lipases
    • -max fat tolerated
    • -antacids
    • -avoid large meals with fatty foods, alcohol
  23. PERT
    Pancreatic Enzyme Replacement Therapy
  24. Cystic Fibrosis
    • Disease of exocrine glands-thick mucus that obstructs glands and ducts
    • -chronic pulmonary disease
    • -high perspiration-decreased electrolytes
  25. Treating Cystic Fibrosis
    • -Cal/Pro
    • -may need 110-200% of normal energy needs
    • -Pro: 15-20%
    • -CHO: 45-55%
    • -Liberal fat (35-40%)
    • -vits a-e
  26. CVD, CAD, IHD (ischemic heart disease)
    • Hypertension >140/90
    • -Obesity is leading cause
    • want 120/80
    • -Management: thiazide diuretics, restrict salt, weight loss, alcohol, PA
    • DASH diet
  27. Mediterranean Diet
    • -may help in reducing hypertension
    • -rich in ALA, high in monounsaturated fats
    • -resveratrol in skin of grapes may lower blood pressure
  28. Atherosclerosis
    • -Accumulation of lipids in large arteries
    • -
  29. Metabolic Syndrome
    • 3 or more risk factors are linked to insulin resistance, increases risk for coronary events
    • -hypertension >130/85
    • -elevated TG >150
    • -fasting serum glucose >110
    • -low HDL <40 men, <50 women
    • -waist measurements >102 men, >88cm women
  30. National Cholesterol Education Program (NCEP); National Heart, Lung and Blood Institute
    • LDL: <100=optimal
    • Total Cholesterol: <200 desirable
    • HDL: <40 (m) & <50 (f) are low
    • *High homocysteine levels are independent risk factors for CHD
  31. TLC Diet (Adult Treatment Panel III)
    • -up to 35% of cals from fat, <7% from saturated fat
    • -25-30 grams fiber (half soluble)
    • -stanols and sterols inhibit cholesterol absorption (2-3g/day)
    • -Prevent weight gain
    • -Increase PA to at least 30 mins/day
  32. Heart Failure
    • -weakened heart fails to maintain adequate output, reduces bloow flow so held in tissue (edema); dyspenea
    • -decreased blood flow to kidneys causes increase secr in hormones that hold in sodium and fluid
  33. Treatment for heart failure
    • 1. digitalis increases strengeth of heart contraction
    • 2. diuretics
    • 3. diet: low sodium (2-3g), DASH diet, FR
    • 4. 1.2 g pro/kg
    • 5. Check thiamine status

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