Liver, Gallbladder, Exocrine Pancreas -...

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Liver, Gallbladder, Exocrine Pancreas KNH 406

Transcript of Liver, Gallbladder, Exocrine Pancreas -...

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Liver, Gallbladder, Exocrine

Pancreas

KNH 406

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© 2007 Thomson - Wadsworth

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LIVER

Anatomy - functions

With disease blood flow becomes obstructed

Bile

All bile drains into common hepatic duct

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Liver

Bile – complex aqueous solution

Components of bile must remain in ratio

Bile salts, cholesterol, lecithin, bilirubin

12 hours of bile

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Liver

Bile

Bile is expelled from gallbladder

2 functions:

Emulsifying agent

Absorption

Daily rate is controlled by enterohepatic circulation

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Jaundice

Jaundice - yellowish tint to body tissues

Normal plasma concentration

Skin appears yellowish

Hemolytic

Obstructive

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Laboratory Values and

Procedures Liver function tests

Non-invasive screening for liver function

Allow recognition of type of liver disease

Assessment of severity

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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

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Pathophysiology of the Liver

Fatty Liver - Etiology

Lipid accumulation

“Steatosis”

Increased availability and decreased degradation of fatty

acids

Treat cause of fatty liver

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Pathophysiology of the Liver

Fatty Liver - Etiology

Steatohepatitis – inflammation

If alcohol not present – NASH

NAFLD progresses to cirrhosis and hepatic carcinoma

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© 2007 Thomson - Wadsworth

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© 2007 Thomson - Wadsworth

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Pathophysiology of the Liver

Alcoholism - Nutrition Implications

Significant caloric contributions

Irregular eating habits

Decreased appetite

Kcal derived from ethanol

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Pathophysiology of the Liver

Alcoholism – Malnutrition

PEM

Vitamin deficiency

Major cause of liver damage

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Pathophysiology of the Liver

Alcoholism - vitamin and mineral deficiencies

Folate

Thiamin

Low plasma pyridoxine

Vitamin C

Vitamin D

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Pathophysiology of the Liver

Alcoholism - vitamin and mineral deficiencies

Vitamin K

Vitamin A

Interaction between vitamin A and zinc

Iron

Calcium

Potassium

Recommend multivitamin

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Pathophysiology of the Liver

Alcoholism – nutritional effects

Imbalanced diet

Maldigestion and malabsorption

Increased catabolism of visceral protein

Increased excretion of vitamins

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© 2007 Thomson - Wadsworth

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Pathophysiology of the Liver

Hepatitis – Nutrition Therapy

Spare liver and provide nutrients

Adequate rest, fluids, good nutrition

Increase dietary intake

Small, frequent meals

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Pathophysiology of the Liver

Hepatitis – Nutrition Therapy

Adequate protein

30-40% of kcal from fat

Supplemental vitamin K

Potassium and sodium

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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

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Pathophysiology of the Liver

Cirrhosis - chronic liver disease in which healthy tissue

is replaced by scar tissue

Most common causes

Steatosis is first stage

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© 2007 Thomson - Wadsworth

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Pathophysiology of the Liver

Cirrhosis – ascites: nutrition therapy

Encourage oral proteins/ supplements

Restricting salt

Restricting fluid

Adequate kcal

Diuretics

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Pathophysiology of the Liver

Cirrhosis – hepatic encephalopathy

Treatment depends on type

Treatments

Dietary protein restriction

Monitor serum potassium level

Correct hypoglycemia, vitamin deficiencies

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© 2007 Thomson - Wadsworth

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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

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Pathophysiology of the Liver

Liver Transplant – Nutrition Therapy

Individualized

Pretransplant

Kcal/protein

Normalize macro- and micronutrients

Normalize blood sugar

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Pathophysiology of the Liver

Liver Transplant – Nutrition Therapy

Posttransplant

Regualr diet

Other nutrients individualized based on immunosuppressant

drug regimen

Provide DRI for vitamins

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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

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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

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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

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The Gallbladder

Stores, concentrates and secretes bile

Removal of water and electrolytes – increasing

concentration

Storage

Control of delivery of bile salts to duodenum

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© 2007 Thomson - Wadsworth

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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

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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

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The Gallbladder

Cholelithiasis – Nutrition Therapy

Chronic condition

Low fat

Weight reduction

Adjust pro and CHO

Water-soluble forms

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The Gallbladder

Cholelithiasis – Nutrition Therapy

Postoperative Cholecystectomy

Oral feedings resumed

Advance as tolerated to regular diet

Manage digestive symptoms

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The Pancreas

Pancreas – exocrine function – produces and secretes

digestive enzymes through duct system

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© 2007 Thomson - Wadsworth

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© 2007 Thomson - Wadsworth

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The Pancreas

Pancreatitis - nutrition therapy

Provide minimal stimulation

Severe attacks

Less severe

Small, frequent meals

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The Pancreas

Pancreatitis - Nutrition Support for Acute

Provide adequate kcal & protein

Enteral preferred method

Maintain gut integrity

Less costly

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The Pancreas

Pancreatitis - Nutrition Support for Acute

Enteral support

Initiate feeding 25 mL/hour

Nearly fat-free elemental formulas

Advance to oral diet

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The Pancreas

Pancreatitis - Nutrition Support for Acute

Parenteral

Mixed fuel

Intralipid

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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