liver, gallbladder, exocrine pancreas -...
TRANSCRIPT
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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