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