nhhc chapter 19 ppt

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition andLiver Diseases

Chapter 19


Introduction

• Liver– Most metabolically active organ in the body

• Produces most of the proteins circulating in plasma• Produces bile: emulsifies fat during digestion• Detoxifies drugs and alcohol• Processes excess nitrogen: excreted as urea

• What is the difficulty in early diagnosis of liver disease?


Fatty Liver and Hepatitis

• Fatty liver– Amount of fat produced in the liver or picked

up from the blood• Exceeds the amount the liver can use or export to

the blood via lipoproteins– Causes

• Metabolism defects, drugs and toxins, excessive alcohol intake, etc.


Fatty Liver and Hepatitis (cont’d.)

• Consequences of fatty liver– Asymptomatic for many– Steatohepatitis: inflammation– Hepatomegaly: liver enlargement– Fatigue– More serious conditions

• Cirrhosis, liver failure, or liver cancer



• Treatment of fatty liver– Eliminate causative factors

• Discontinue alcohol or drug use; lower blood lipid levels; weight reduction; etc.

• Hepatitis: liver inflammation– Causes

• Specific viral infections (A, B, C, D, and E)• Excessive alcohol intake, drugs and toxic

chemicals, herbal products, etc.



• Viral hepatitis– Features (Table 19-1)– Hepatitis A virus (HAV)

• Primarily spread via fecal-oral transmission– Hepatitis B virus (HBV)

• Transmission: infected blood or needles, sexual contact with an infected person, or mother to infant during childbirth



• Viral hepatitis– Hepatitis C virus (HCV)

• Spread via infected blood or needles• Not readily spread by sexual contact or childbirth

• Symptoms of hepatitis– Onset of acute hepatitis

• Fatigue, malaise, nausea, anorexia, and pain in the liver area



• Symptoms of hepatitis– Jaundice– Fever, muscle weakness, joint pain, and skin

rashes– Elevated ALT and AST serum levels

• Treatment of hepatitis– Supportive care: bed rest and diet– What substances should be avoided?



• Nutrition therapy for hepatitis– Most individuals: no dietary changes required– Nutritional support as needed

• Small, frequent meals; adequate protein and energy to replenish nutrient stores; electrolyte replacement; oral supplements; etc.


Cirrhosis

• Late stage of liver disease– Extensive scarring replaces healthy liver

tissue– Impaired liver function and liver failure

• What are the chief causes of cirrhosis in the United States?


Cirrhosis (cont’d.)

• Consequences of cirrhosis– Metabolic disturbances

• Anemia; bruise easily; susceptible to infections– Bile obstruction

• Jaundice, fat malabsorption, and pruritis (itchy skin)– Fluid accumulation

• Blood vessels and body tissues– Clinical effects of liver cirrhosis (Figure 19-1)



• Portal hypertension– Rise in blood pressure due to:

• Increased portal blood coupled with resistance to blood flow within the liver

• Collateral vessels– Blood vessels that enlarge or newly form

• Allow an alternative pathway for diverted blood



• Varices: abnormally dilated blood vessels– Esophageal and gastric

• Vulnerable to rupture• Bleeding may be fatal

• Ascites– Large accumulation of fluid in the abdominal

cavity• Critical state of liver damage



• Hepatic encephalopathy– Abnormal neurological functioning– Indications

• Adverse changes in personality, behavior, mood, mental ability, and motor functions

– Fully reversible with treatment– Exact etiology unknown

• What are current theories surrounding hepatic encephalopathy?



• Elevated blood ammonia levels– Advanced disease

• Liver unable to process the ammonia sufficiently– Ammonia-laden blood bypasses the liver via

collateral vessels• Reaches the general blood circulation and thereby,

brain tissue



• Protein-energy malnutrition (PEM)– Some degree of wasting– Possible causes of malnutrition (Table 19-4)

• Reduced nutrient intake; malabsorption or nutrient losses; altered metabolism or increased nutrient needs



• Treatment of cirrhosis– Objective: correct the underlying cause of

disease; prevent or treat complications– Supportive care

• Appropriate diet • Avoidance of liver toxins

– Medications: treat complications of cirrhosis• Be aware of diet-drug interactions (listed in text)



• Nutrition therapy for cirrhosis (Table 19-5)– Customized to each patient’s needs– Energy

• 35 to 40 kcal/kg body weight per day• Four to six small meals• “How To” Help the Cirrhosis Patient Eat Enough

Food



• Nutrition therapy for cirrhosis– Protein

• 0.8 to 1.2 grams of protein per kilogram of body weight per day

– Carbohydrates• Patients with insulin resistance: medications or

insulin required– Fat

• Special considerations with fat malabsorption



• Nutrition therapy for cirrhosis– Sodium and fluid

• What restrictions are necessary to control ascites?– Vitamins and minerals

• Deficiencies common: nutrient supplementation often necessary

– Safe food practices• Minimize foodborne illnesses



• Nutrition therapy for cirrhosis– Enteral and parenteral nutrition support

• Infused overnight: supplement to oral intakes• Replace oral feedings entirely• Feeding formulas: dependent on conditions, e.g.,

ascites or fluid restrictions• Parenteral feedings: patients unable to tolerate

enteral feedings– Case Study – Man with Cirrhosis


Liver Transplantation

• Overview– Most transplants needed for:

• Chronic hepatitis C and alcoholic liver disease– Five year survival rate of transplant recipients

• 54 to 81 percent

• Nutrition status of transplant patients– What attributes to the difficulty in assessing

nutrition status in transplant candidates?


Liver Transplantation (cont’d.)

• Posttransplantation concerns– Immediate concerns

• Organ rejection and infection: immunosuppressive drugs raise the risk of infection

• Antibiotics and antiviral medications also given• In what ways do immunosuppressive drugs affect

nutrition status?– Stress of surgery

• Increases protein and energy requirements

nhhc chapter 19 ppt

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