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Transcript of Liver, Gallbladder, Exocrine Pancreas - Weeblymedicalnutri ... The Gallbladder Cholelithiasis...

  • Liver, Gallbladder, Exocrine

    Pancreas

    KNH 406

  • © 2007 Thomson - Wadsworth

  • LIVER

     Anatomy - functions

     With disease blood flow becomes obstructed

     Bile

     All bile drains into common hepatic duct

  • Liver

     Bile – complex aqueous solution

     Components of bile must remain in ratio

     Bile salts, cholesterol, lecithin, bilirubin

     12 hours of bile

  • Liver

     Bile

     Bile is expelled from gallbladder

     2 functions:

     Emulsifying agent

     Absorption

     Daily rate is controlled by enterohepatic circulation

  • Jaundice

     Jaundice - yellowish tint to body tissues

     Normal plasma concentration

     Skin appears yellowish

     Hemolytic

     Obstructive

  • Laboratory Values and

    Procedures  Liver function tests

     Non-invasive screening for liver function

     Allow recognition of type of liver disease

     Assessment of severity

  • Pathophysiology of the Liver

     Alcoholism

     Chronic consumption

     Alcoholic liver disease (ALD)

     Dependency may be evident as tolerance

     Ethanol rapidly and completely absorbed

     Cannot be stored

  • Pathophysiology of the Liver

     Fatty Liver - Etiology

     Lipid accumulation

     “Steatosis”

     Increased availability and decreased degradation of fatty

    acids

     Treat cause of fatty liver

  • Pathophysiology of the Liver

     Fatty Liver - Etiology

     Steatohepatitis – inflammation

     If alcohol not present – NASH

     NAFLD progresses to cirrhosis and hepatic carcinoma

  • © 2007 Thomson - Wadsworth

  • © 2007 Thomson - Wadsworth

  • Pathophysiology of the Liver

     Alcoholism - Nutrition Implications

     Significant caloric contributions

     Irregular eating habits

     Decreased appetite

     Kcal derived from ethanol

  • Pathophysiology of the Liver

     Alcoholism – Malnutrition

     PEM

     Vitamin deficiency

     Major cause of liver damage

  • Pathophysiology of the Liver

     Alcoholism - vitamin and mineral deficiencies

     Folate

     Thiamin

     Low plasma pyridoxine

     Vitamin C

     Vitamin D

  • Pathophysiology of the Liver

     Alcoholism - vitamin and mineral deficiencies

     Vitamin K

     Vitamin A

     Interaction between vitamin A and zinc

     Iron

     Calcium

     Potassium

     Recommend multivitamin

  • Pathophysiology of the Liver

     Alcoholism – nutritional effects

     Imbalanced diet

     Maldigestion and malabsorption

     Increased catabolism of visceral protein

     Increased excretion of vitamins

  • © 2007 Thomson - Wadsworth

  • Pathophysiology of the Liver

     Hepatitis – Nutrition Therapy

     Spare liver and provide nutrients

     Adequate rest, fluids, good nutrition

     Increase dietary intake

     Small, frequent meals

  • Pathophysiology of the Liver

     Hepatitis – Nutrition Therapy

     Adequate protein

     30-40% of kcal from fat

     Supplemental vitamin K

     Potassium and sodium

  • Pathophysiology of the Liver

     Alcoholic Hepatitis - Treatment/ Nutrition

    Therapy

     Abstention from alcohol

     Treatment of withdrawal symptoms

     Correction of nutritional deficiencies

     Multivitamin

     Multimineral

     Adequate kcal and protein

  • Pathophysiology of the Liver

     Cirrhosis - chronic liver disease in which healthy tissue

    is replaced by scar tissue

     Most common causes

     Steatosis is first stage

  • © 2007 Thomson - Wadsworth

  • Pathophysiology of the Liver

     Cirrhosis – ascites: nutrition therapy

     Encourage oral proteins/ supplements

     Restricting salt

     Restricting fluid

     Adequate kcal

     Diuretics

  • Pathophysiology of the Liver

     Cirrhosis – hepatic encephalopathy

     Treatment depends on type

     Treatments

     Dietary protein restriction

     Monitor serum potassium level

     Correct hypoglycemia, vitamin deficiencies

  • © 2007 Thomson - Wadsworth

  • Pathophysiology of the Liver

     Liver transplant – considered in cases where effects of

    disease have higher potential mortality than transplant

     With alcoholism - six months abstinence

     Psychological and nutritional evaluations

  • Pathophysiology of the Liver

     Liver Transplant – Nutrition Therapy

     Individualized

     Pretransplant

     Kcal/protein

     Normalize macro- and micronutrients

     Normalize blood sugar

  • Pathophysiology of the Liver

     Liver Transplant – Nutrition Therapy

     Posttransplant

     Regualr diet

     Other nutrients individualized based on immunosuppressant

    drug regimen

     Provide DRI for vitamins

  • Pathophysiology of the Liver

     Cystic fibrosis-associated liver disease (CFALD)

     Mutated gene codes

     Cl is prevented from leaving cell

     Mucus thickens, cilia cannot function

     infections

  • Pathophysiology of the Liver

     CF – Nutrition Therapy

     Counseling on risks

     Kcal needs increase

     May need MCT

     Do not restrict protein

     Assess status of fat-soluble vitamins

     Pancreatic enzyme supplements

  • Pathophysiology of the Liver

     CF – Nutrition Therapy

     Vitamin A

     Vitamin E

     Vitamin D – 2-4 µg/dL/day

     Vitamin K – 2.5-10 mg/daily

     EFA supplementation

  • The Gallbladder

     Stores, concentrates and secretes bile

     Removal of water and electrolytes – increasing

    concentration

     Storage

     Control of delivery of bile salts to duodenum

  • © 2007 Thomson - Wadsworth

  • The Gallbladder

     Cholelithiasis – Nutrition Therapy

     Assess alcohol intake

     Increase complex CHO

     Assess vitamin C intake

     ? Low-fat diet

     Counsel on lifestyle habits

     Plain, simple foods best tolerated

  • The Gallbladder

     Cholelithiasis – Nutrition Therapy

     Acute attack

     NPO

     Parenteral nutrition as needed

     Advance as tolerated to liquids

     Limited amounts of fats

     Progress to regular diet

  • The Gallbladder

     Cholelithiasis – Nutrition Therapy

     Chronic condition

     Low fat

     Weight reduction

     Adjust pro and CHO

     Water-soluble forms

  • The Gallbladder

     Cholelithiasis – Nutrition Therapy

     Postoperative Cholecystectomy

     Oral feedings resumed

     Advance as tolerated to regular diet

     Manage digestive symptoms

  • The Pancreas

     Pancreas – exocrine function – produces and secretes

    digestive enzymes through duct system

  • © 2007 Thomson - Wadsworth

  • © 2007 Thomson - Wadsworth

  • The Pancreas

     Pancreatitis - nutrition therapy

     Provide minimal stimulation

     Severe attacks

     Less severe

     Small, frequent meals

  • The Pancreas

     Pancreatitis - Nutrition Support for Acute

     Provide adequate kcal & protein

     Enteral preferred method

     Maintain gut integrity

     Less costly

  • The Pancreas

     Pancreatitis - Nutrition Support for Acute

     Enteral support

     Initiate feeding 25 mL/hour

     Nearly fat-free elemental formulas

     Advance to oral diet

  • The Pancreas

     Pancreatitis - Nutrition Support for Acute

     Parenteral

     Mixed fuel

     Intralipid

  • The Pancreas

     Pancreatitis - Insufficiency  Frequent, small meals

     Pancreatic enzymes

     Alcohol, coffee, tea, spices

     MCT may be added

     Monitor fat and water-soluble vitamins

     Medical management of pH

     Treat with insulin if indicated