Liver, Gallbladder, Exocrine Pancreas KNH 406

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1 Liver, Gallbladder, Exocrine Pancreas KNH 406

2 2007 Thomson - Wadsworth

3 LIVER Anatomy - functions With disease blood flow becomes obstructed Bile All bile drains into common hepatic duct

4 Liver Bile complex aqueous solution Components of bile must remain in ratio Bile salts, cholesterol, lecithin, bilirubin 12 hours of bile

5 Liver Bile Bile is expelled from gallbladder 2 functions: Emulsifying agent Absorption Daily rate is controlled by enterohepatic circulation

6

7 Jaundice Jaundice - yellowish tint to body tissues Normal plasma concentration Skin appears yellowish Hemolytic Obstructive

8 Liver function tests Laboratory Values and Procedures Non-invasive screening for liver function Allow recognition of type of liver disease Assessment of severity

9

10

11 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

12 Pathophysiology of the Liver Fatty Liver - Etiology Lipid accumulation Steatosis Increased availability and decreased degradation of fatty acids Treat cause of fatty liver

13 Pathophysiology of the Liver Fatty Liver - Etiology Steatohepatitis inflammation If alcohol not present NASH NAFLD progresses to cirrhosis and hepatic carcinoma

14 2007 Thomson - Wadsworth

15 2007 Thomson - Wadsworth

16 Pathophysiology of the Liver Alcoholism - Nutrition Implications Significant caloric contributions Irregular eating habits Decreased appetite Kcal derived from ethanol

17 Pathophysiology of the Liver Alcoholism Malnutrition PEM Vitamin deficiency Major cause of liver damage

18 Pathophysiology of the Liver Alcoholism - vitamin and mineral deficiencies Folate Thiamin Low plasma pyridoxine Vitamin C Vitamin D

19 Pathophysiology of the Liver Alcoholism - vitamin and mineral deficiencies Vitamin K Vitamin A Interaction between vitamin A and zinc Iron Calcium Potassium Recommend multivitamin

20 Pathophysiology of the Liver Alcoholism nutritional effects Imbalanced diet Maldigestion and malabsorption Increased catabolism of visceral protein Increased excretion of vitamins

21 2007 Thomson - Wadsworth

22 Pathophysiology of the Liver Hepatitis Nutrition Therapy Spare liver and provide nutrients Adequate rest, fluids, good nutrition Increase dietary intake Small, frequent meals

23 Pathophysiology of the Liver Hepatitis Nutrition Therapy Adequate protein 30-40% of kcal from fat Supplemental vitamin K Potassium and sodium

24 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

25 Pathophysiology of the Liver Cirrhosis - chronic liver disease in which healthy tissue is replaced by scar tissue Most common causes Steatosis is first stage

26 2007 Thomson - Wadsworth

27 Pathophysiology of the Liver Cirrhosis ascites: nutrition therapy Encourage oral proteins/ supplements Restricting salt Restricting fluid Adequate kcal Diuretics

28

29 Pathophysiology of the Liver Cirrhosis hepatic encephalopathy Treatment depends on type Treatments Dietary protein restriction Monitor serum potassium level Correct hypoglycemia, vitamin deficiencies

30 2007 Thomson - Wadsworth

31 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

32 Pathophysiology of the Liver Liver Transplant Nutrition Therapy Individualized Pretransplant Kcal/protein Normalize macro- and micronutrients Normalize blood sugar

33 Pathophysiology of the Liver Liver Transplant Nutrition Therapy Posttransplant Regualr diet Other nutrients individualized based on immunosuppressant drug regimen Provide DRI for vitamins

34 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

35 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

36 Pathophysiology of the Liver CF Nutrition Therapy Vitamin A Vitamin E Vitamin D 2-4 µg/dl/day Vitamin K mg/daily EFA supplementation

37 The Gallbladder Stores, concentrates and secretes bile Removal of water and electrolytes increasing concentration Storage Control of delivery of bile salts to duodenum

38 2007 Thomson - Wadsworth

39 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

40 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

41 The Gallbladder Cholelithiasis Nutrition Therapy Chronic condition Low fat Weight reduction Adjust pro and CHO Water-soluble forms

42 The Gallbladder Cholelithiasis Nutrition Therapy Postoperative Cholecystectomy Oral feedings resumed Advance as tolerated to regular diet Manage digestive symptoms

43 The Pancreas Pancreas exocrine function produces and secretes digestive enzymes through duct system

44 2007 Thomson - Wadsworth

45 2007 Thomson - Wadsworth

46 The Pancreas Pancreatitis - nutrition therapy Provide minimal stimulation Severe attacks Less severe Small, frequent meals

47 The Pancreas Pancreatitis - Nutrition Support for Acute Provide adequate kcal & protein Enteral preferred method Maintain gut integrity Less costly

48 The Pancreas Pancreatitis - Nutrition Support for Acute Enteral support Initiate feeding 25 ml/hour Nearly fat-free elemental formulas Advance to oral diet

49 The Pancreas Pancreatitis - Nutrition Support for Acute Parenteral Mixed fuel Intralipid

50 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

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