Liver

Accessory Organs

Liver

I Hepatitis
A. Inflammation of the liver
B. 5 types, A being least severe
1. A is associated with food/water contamination and is highly contagious
C. Symptoms
1. jaundice: yellowness in palms, eyes, beds of nails
2. dark urine
3. elevated liver enzymes
4. tender, enlarged liver
D. Hepatitis is mainly acute, but sometimes chronic
1. Chronic may lead to cancer, liver failure, hepatic coma, and death
E. Medical Nutrition Therapy
1. regular diet
2. high protein, high kcal (if malnourished)
3. small frequent feedings
a. anorexia and nausea is common
b. anytime nausea is a symptom, we give small frequent meals
4. nutritional supplements
a. ensure
b. boost

II Cirrhosis
A. Chronic liver failure where scar tissues replace liver cells and there is a permanent loss of function. (cirrhosis = orange. Liver can regenerate itself, but not with cirrhosis)
B. Causes
1. alcohol abuse
2. billiary tract obstruction (billiary duct carries bile from the gall bladder to the liver)
3. infection
C. Consequences
1. portal hypertension (portal vein in liver)
2. esophageal varices (blisters inside esophagus)
3. ascites (excess fluid in abdomen)
4. elevated blood ammonia levels
5. hepatic coma
a. very little liver function taking place
6. changes in judgement, mood, personality, regression
7. sweet, musky or pungent fecal odor
8. flapping tremor of outstretched hand
D. Medical nutrition therapy
1. Energy: adequate carb and fat to spare protein (35-45 kcal/kg BW)
a. The function of protein is to build and repair tissue, and to provide energy.
b. Sparing protein: If the pt doesn’t have enough liver function to metabolize protein, a small amount is given to keep the liver from having to work too hard. If the pt does not receive enough protein he will burn it from the muscles, which is not good either. It is just as bad to have too much protein as not enough protein. Protein metabolism needs liver function. Provide just enough protein to do protein’s work, but not as a form of energy. Have an adequate amount of fat and carbs for energy. (non-protein calories)
2. protein (1.0 – 1.5 gm/kg BW)
a. enough to regenerate the cells, but not increase ammonia
b. impending coma (40 – 60 gm/day) ONLY
c. coma
i. vegetable protein
ii. branch chain amino acids (b/c metabolized in muscle)
iii. no animal protein at all
3. Hepatic formula diet
4. sodium (2 grams)
a. to control ascites
5. fluids (1.0 – 1.5 liters/day)
a. restricted to control ascites
6. vitamins and mineral supplementation
E. Drug therapy
1. antibiotics: to limit growth of intestinal bacteria (bacteria produces ammonia that will be absorbed)
2. laxatives: to decrease transit time
3. diuretics: to reduce fluid retention