1. © 2007 Thomson - Wadsworth Chapter 19 Nutrition and Liver Diseases

2. © 2007 Thomson - Wadsworth The Liver The most active organ in the body Liver disease Progresses slowly Fatty liver Hepatitis Roles Processes, stores, & redistributes nutrients Produces bile Synthesizes protein Detoxifies drugs & alcohol Processes excess nitrogen

3. © 2007 Thomson - Wadsworth Fatty Liver Accumulation of fat in the liver Causes Alcoholic liver disease Exposure to drugs & toxic metals Associated with Obesity Diabetes mellitus Marasmus & kwashiorkor Gastrointestinal bypass surgery Long-term TPN

4. © 2007 Thomson - Wadsworth Consequences of Fatty Liver Liver enlargement Inflammation Fatigue Abnormal liver enzyme levels Increased triglycerides, cholesterol, & glucose

5. © 2007 Thomson - Wadsworth Treatment Eliminate the cause Lower lipid levels Stop alcohol use Change drug treatment Lose weight Control blood glucose

6. © 2007 Thomson - Wadsworth Hepatitis Liver inflammation Results from any factor causing liver damage Viruses A, B, & C Excessive alcohol Exposure to certain drugs & toxic chemicals Some herbal remedies

7. © 2007 Thomson - Wadsworth Types of Hepatitis Hepatitis A Extremely contagious Most common Cause: fecal-oral Hepatitis B Blood contact Sexual contact Vaccinations available Hepatitis C Blood contact Major cause of chronic hepatitis

8. © 2007 Thomson - Wadsworth Hepatitis Symptoms Mild & chronic may be asymptomatic Acute Fatigue, nausea, anorexia Pain in liver area Enlarged liver & jaundice Fever, headache Muscle weakness, skin rashes Elevated liver enzymes

9. © 2007 Thomson - Wadsworth Treatment Supportive care, bed rest, nutritious diet Hepatitis B & C need antiviral agents Non-viral: anti- inflammatory & immunosuppressant drugs

10. © 2007 Thomson - Wadsworth Cirrhosis End-stage condition Scarring/fibrosis Irregular, nodular appearance Impaired liver function - can lead to liver failure

11. © 2007 Thomson - Wadsworth Causes of Cirrhosis Hepatitis C Alcoholic liver disease Bile duct blockages All untreated types of chronic hepatitis Drug-induced liver injury Some inherited metabolic disorders

12. © 2007 Thomson - Wadsworth Symptoms of Cirrhosis 40% of people are asymptomatic Initial symptoms Fatigue Weakness Anorexia Weight loss Later symptoms Anemia Blood clotting impairment Susceptibility to infection Jaundice & fat malabsorption Ascites & varices

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14. Consequence of Cirrhosis Portal Hypertension Scar tissue of liver impedes blood flow Causes a rise in pressure in the portal vein Blood is diverted to collaterals Collaterals become enlarged & engorged, forming varices, & may rupture Esophageal Gastric

15. © 2007 Thomson - Wadsworth Esophageal Varix

16. © 2007 Thomson - Wadsworth Consequence of Cirrhosis Ascites Accumulation of fluid in the abdominal cavity Due to Portal hypertension Reduced albumin Altered kidney function Abdominal discomfort & early satiety Weight gain

17. © 2007 Thomson - Wadsworth Consequences of Cirrhosis Hepatic encephalopathy Abnormal neurological functioning Amnesia, seizures, hepatic coma Elevated blood ammonia Malnutrition & wasting

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20. Treatment of Cirrhosis Individualize Supportive care Appropriate diet Avoidance of liver toxins Abstinence from alcohol Liver transplant Drug therapy Diuretics Appetite stimulants Laxatives & antibiotic neomycin to reduce ammonia

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22. Medical Nutrition Therapy Energy BEE + stress factor 4-6 feedings/day Protein High enough to maintain nitrogen balance 0.8-1.2 g/kg CHO & fat Complex CHO May need to restrict fat with steatorrhea

23. © 2007 Thomson - Wadsworth Medical Nutrition Therapy Sodium & Fluid With ascites, need to restrict fluid and sodium Vitamins & minerals Multivitamin supplementation Liquid form if patient has varices Enteral & parenteral Specialized enteral products high in kcalories Parenteral if patient has obstructions, bleeding, vomiting

24. © 2007 Thomson - Wadsworth Liver Transplantation Only option when liver failure occurs Hepatitis C & alcoholic liver disease account for 40% of cases Most patients are already malnourished

25. © 2007 Thomson - Wadsworth Liver Transplantation Post-transplant concerns Organ rejection Infection Immunosuppressive drugs affect nutrition status Diet: increased protein & energy requirements

26. © 2007 Thomson - Wadsworth Nutrition in Practice Alcohol in Health & Disease

27. © 2007 Thomson - Wadsworth Alcohol Primary cause of liver disease Can be toxic to brain, GI tract, & pancreas Abuse leads to nutrient deficiencies Moderate alcohol Can help with heart disease Middle-aged & older adults Increases HDLs Reduces tendency for blood clotting

28. © 2007 Thomson - Wadsworth Dietary Guidelines Women, 1 drink/day Men, 2 drinks/day One drink 12 oz beer 5 oz wine 10 oz wine cooler 1½ oz of 80 proof spirits

29. © 2007 Thomson - Wadsworth One drink =

30. © 2007 Thomson - Wadsworth Contraindicated Pregnant & lactating Children & adolescents Those with potential medication interactions Those unable to voluntarily stop Activities requiring attention & coordination

31. © 2007 Thomson - Wadsworth Alcohol in the Body Supplies 7 kilocalories/gram Liver is the site of most metabolism Suppresses glycogen storage & glucose availability Suppresses breakdown of fat Can inhibit protein synthesis

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33. Alcohol & the Brain Is a CNS depressant Can cause sedation Slow reaction time Relieve anxiety In excess Impairs judgment Reduces inhibitions Impairs speech & motor function Extremely high levels Coma Respiratory depression Death

34. © 2007 Thomson - Wadsworth Long-Term Consequences Liver disease Damaged GI tract Damaged pancreas Can raise heart attack risk

35. © 2007 Thomson - Wadsworth Alcohol & Nutrition Status Can displace essential nutrients Can cause deficiencies of Vitamin A Thiamin Folate

36. © 2007 Thomson - Wadsworth Alcohol & Medication Heavy drinking can increase medication potency Problematic with Sedatives Blood glucose-lowering medications Can reduce drug absorption