Downloaded 66 times
More Related Content
Similar to NHHC chapter 19 ppt
NHHC chapter 19 ppt
- 1. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Nutrition and Liver Diseases Chapter 19
- 2. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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?
- 3. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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.
- 4. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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
- 5. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Fatty Liver and Hepatitis (cont’d.) • 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.
- 6. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Fatty Liver and Hepatitis (cont’d.) • 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
- 7. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Fatty Liver and Hepatitis (cont’d.) • 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
- 8. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Fatty Liver and Hepatitis (cont’d.) • 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?
- 9. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Fatty Liver and Hepatitis (cont’d.) • 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.
- 10. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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?
- 11. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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)
- 12. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 13. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 14. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 15. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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?
- 16. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014
- 17. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 18. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 19. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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)
- 20. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 21. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 22. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 23. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 Cirrhosis (cont’d.) • 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
- 24. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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?
- 25. Nutrition for Healthand Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014 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