Medical Nutrition Therapy in Liver, Pancreas and Gallbladder diseases

liver

receives nutrients from the digestive tract and processes them for distribution throughout the body

biliary system

includes the gallbladder, which stores and secretes bile; and bile ducts, which conduct bile from liver to the gallbladder and from gallbladder to the intestine

gallbladder

stores the bile

bile duct

conduct bile from liver to the gallbladder and from gallbladder to the intestine

hepatic vein

returns blood from the liver to the heart

hepatic artery

supplies oxygen-rich blood from the heart to the liver

portal vein

carries nutrient-rich blood from the digestive tract to the liver

GI tract veins

transport absorbed nutrients to the portal vein

Fatty liver

Accumulation of triglycerides in liver

(also called as hepatic steatosis)

Failure of the liver to metabolize fat due to inflammation, hepatic injury or poor fat transport, insulin resistance, & increased fat synthesis

Accounts for an increase of 5-40% of the body weight

Insulin resistance and fatty liver

insulin resistance promotes fat accumulation in the liver by stimulating fatty acid synthesis, inhibiting fatty acid oxidation, and blocking VLDL secretion into the bloodstream

Lipotropic factors

substances that have the ability to remove and prevent fatty deposits in the body. These nutrients essentially perform the task of breaking down and transporting fat from the liver. They are important because they can help the liver function better as well as get rid of toxins. Examples are choline, carnitine and inositol

Hepatitis

Inflammation of the liver caused by alcohol, infection, parasites, drugs and some supplements

ascites

greek origin (askos) and means bag or sac

it is the collection of fluid in the peritoneal cavity

Liver Cirrhosis

Chronic inflammation of the liver replaced with fibrous tissues

Portal hypertension

increased blood pressure due to obstructed blood flow to the liver

Ascites

accumulation of fluids in the abdominal cavity

Esophageal varices

distended blood vessels due to obstruction

Collateral formation

blood vessels that develop when the blood flow to the liver is obstructed

Hyperammonemia

elevated ammonia in the blood

Biliary stasis

condition where bile cannot flow from the liver to the duodenum

Postnecrotic

complication of hepatitis

Laennec’s

types of liver cirrhosis, if induced by alcohol

Biliary cirrhosis

types of cirrhosis, diseases of the bile duct

Obstructive cirrhosis

obstruction of the bile duct

cardiac cirrhosis

complication of heart failure

toxic

exposure to chemical, poisons

Idiopathic

when causes are unknown

Hepatic coma

Also called portal systemic encephalopathy

Liver malfunction characterized by confusion, apathy and neurological dysfunction, fecal odor of breath, flapping tremor (allows the muscles to flap like wings), anemia and hepatorenal syndrome

ETIOLOGY: Severe liver damage marked by accumulation of ammonia in blood due to inability of the liver to convert ammonia to urea

proteins

GENERAL RULE for liver disorders, they are restricted to?

calcium magnesium vit d

deficiencies need to be controlled because of steatorrhea losses and inability to release vit. D for activation.

zinc

this loses are also associated with liver disease

Pancreatitis

Inflammation of the pancreatic tissues due to inadequate supply of blood

or obstruction to the flow of pancreatic juices

Etiology: alcohol, biliary obstruction and inflammation

Cystic fibrosis

Rare genetic disease

Accumulation of mucus in the bronchi, pancreas, liver and intestines, causing damage and malfunction of the organs and biliary cirrhosis

Gallbladder

Concentrates and stores bile produced by the liver until the bile is needed for fat digestion

Disorders that obstruct the liver’s release of bile can damage the liver. Disorders of the biliary system—the gallbladder and bile ducts—result in the formation of gallstones

gallstones

stones that form in the gallbladder from crystalline deposits of cholesterol or bilirubin

Cholecystitis

inflammation of the gallbladder

Cholelithiasis

presence or formation of gallstones in the gallbladder or bile ducts

Cholecystolithiasis

presence of Choledocholithiasisgallstones in the gallbladder

Choledocholithiasis

occurrence of stone in biliary tree (cystic duct, hepatic duct, common bile duct)

Cholangitis

inflammation of the bile ducts

Cholesterol Gallstones

• 80% of the cases

• the cholesterol in bile precipitates out of solution and forms small crystals, which eventually combine to form stones

• the bile concentrate thickens and forms a sludge that cannot be easily expelled by gallbladder contraction

Pigment Gallstones

• 10 to 25% of cases

• primarily made up of the calcium salt of bilirubin (calcium bilirubinate)

• result of bacterial infection, which alters bilirubin and causes it to precipitate out of bile and form stones

• Others: result from excessive red blood cell breakdown, leading to an abnormal accumulation of bilirubin

• soft and easily crushed

cholecystectomy

surgical removal of the gallbladder

laparoscopic

procedures that use a laparoscope for internal examination or surgery

narrow surgical telescope

shock-wave lithotripsy

nonsurgical procedure that uses high-amplitude sound waves to fragment gallstone

Biliary Dyskinesia

Abnormal bile flow due to increased (spastic) or decreased contraction of the gallbladder (atonic)

Jaundice

Yellow discoloration of the eyes and skin due to overflow of bile into general circulation

Hepatic

obstruction, type of jaundice

hemolytic

rapid breakdown of bilirubin, type of jaundice

• vit E supplementation

infectious

impaired excretion, type of jaundice

• high protein, kcal adequate to maintain DBW, low fat