Accessory GI Organs (Liver, Pancreas, Gallbladder)

food doesn’t travel through liver and pancreas but…

if you don’t have them your food can’t be digestible or absorbed

liver and gallbladder jobs

liver makes bile, gallbladder stores bile

what does the pancreas make?

insulin

pancreatic enzymes

lipase, protease, amylase

lipase

breaks down lipids

protease

breaks down proteins

amylase

breaks down carbs

liver disorders

viral hepatitis, nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), cirrhosis

liver functions

regulation of blood glucose, bile production, vitamin absorption, detoxification of alcohol and drugs, amino acid breakdown, cholesterol management, RBC recycling and regulation of blood composition

regulation of blood glucose

stores glycogen

bile production

needed for digestion of fats

vitamin absorption

A, D, E, K, and B12

amino acid breakdown

oncotic pressure (albumin), blood clotting (prothrombin and fibrinogen)

prothrombin turns into…

thrombin which helps us clot

where is prothrombin made?

in the liver

viral hepatitis

causes inflammation of liver due to infection or injury

viral hepatitis symptoms

lack of appetite, zinc deficiency (no taste), jaundice, dark urine

A nurse is caring for a client with hepatitis. The client has no complaints of nausea or vomiting. Which food selection should the nurse offer to this client?

A. Egg Sandwich

B. Saltine Crackers

C. Tortilla Chips and salsa

D. Cheddar cheese popcorn

A. Egg Sandwich

hepatic steatosis

reversible

steatohepatitis (NASH)

reversible

liver cirrhosis

irreversible

Nonalcoholic Fatty Liver Disease (NAFLD)

excess fat builds up in liver, leading to inflammation or scarring

NAFLD Nutrition Therapy

eliminate alcohol, limit saturated fats and simple sugars, whole carbs instead of refined carbs

progression to NASH

most severe form of fatty liver, chance for liver cancer is very high, reversible but needs to be detected prior to scarring

cirrhosis complications

portal HTN, esophageal varices, ascites, encephalopathy, jaundice, hemorrhoids, spider veins

portal HTN

increased pressure in portal vein

esophageal varices

medical emergency, fatal if ruptures

cirrhosis nutritional therapy macros

high calorie, high plant based protein, no alcohol

positive nitrogen balance

anabolic

negative nitrogen balance

catabolic

cirrhosis nutritional therapy micros

restrict sodium to help w edema and ascites, promote water soluble vitamins

coping w fluid restriction

lemons for dry mouth, oral hygiene, take meds w applesauce

A client with cirrhosis has developed esophageal varices. Which food choices indicate the client understands the necessary modifications needed? Select all that apply

A. Gelatin

B. Bananas

C. Tortilla chips

D. Raw carrot sticks

E. Oatmeal with honey

A. Gelatin, B. Bananas, E. Oatmeal with honey

Which dietary recommendation is appropriate for a client with fatty liver disease?

A. Limit protein

B. Eliminate alcohol

C. Eliminate crunchy foods

D. Limit soft foods

B. Eliminate alcohol

galbladder

stores bile then releases it for digestion, activates release for pancreatic enzymes

gallbladder disorders

cholelithiasis, choledocholithiasis, cholecystitis

cholelithiasis

gall stones

choledocholithiasis

gallstone in common bile duct

cholecystitis

inflamed gallbladder

gallbladder disorders risk factors

female, high fat diet, obesity, sedentary lifestyle

gallbladder nutrition therapy acute episode

NPO (allows for rest)

gallbladder nutrition therapy postop

clear liquid diet → regular diet as tolerated

gallbladder nutrition therapy fatty foods

low fat diet might be recommended if pt cannot tolerate fatty foods, used to be required postop, but liver is still making bile so pts can tolerate fat in diet

pancreatitis chronic

typically associated w alcohol

pancreatitis nutrition therapy

enteral feedings within 24 to 48 hrs., low fat formula (hydrolyzed), jejunum

why the jejunum for pancreatitis enteral feedings?

have to get past gallbladder to give it a rest

pancreatitis complications and nutrition

malabsorption of fats and proteins, six small meals a day, ABSOLUTELY NO ALCOHOL