NURS 345 - Nutrition for Disorders of the Liver, Gallbladder & Pancreas

viral hepatitis

inflammation of the liver caused by infectious mononucleosis, cirrhosis, toxic chemicals, and/or a viral infection

fecal-oral route

transmission of hepatitis A:

hepatitis A

type of hepatitis: often caused by poor hand washing or stool precautions. common in areas of poor sanitation

hepatitis A

type of hepatitis: vaccine available, recommended for people at risk

hepatitis A

type of hepatitis: rapid onset, within 4-6 weeks

hepatitis A and B

type of hepatitis: adequate diet without alcohol is recommended

through contaminated blood and sexual contact, and perinatally

transmission of hepatitis B:

hepatitis B

type of hepatitis: routine vaccination available for children and at-risk groups

hepatitis B

type of hepatitis: onset slow, approximately 12 weeks

through blood, saliva, or semen

transmission of hepatitis C:

hepatitis C

type of hepatitis: onset slow, approximately 8 weeks

10-40 years

progression from hepatitis C virus (HCV) to cirrhosis may take _____

hepatitis C and D

type of hepatitis: no dietary recommendations

hepatitis D

type of hepatitis: occurs only in an individual with hepatitis B virus coinfection or superinfection

hepatitis D

type of hepatitis: found throughout the world, but prevalent in Mediterranean basin, Middle East, Amazon basin, Samoa, China, Japan, Taiwan and Myanmar

hepatitis D

type of hepatitis: risk factor is intravenous drug use

intravenous drug use

risk factor of hepatitis D:

oral-fecal route

transmission of hepatitis E:

hepatitis E

type of hepatitis: risk factors are travel in tropical climates, inadequate sanitation, and poor personal hygiene

hepatitis E

type of hepatitis: avoid drinking water or other beverages that can be contaminated, avoid uncooked fruits and vegetables (!!!)

drinking water or other beverages that can be contaminated, uncooked fruits and vegetables

what should be avoided with hepatitis E?

initially liquid diet, then progress to small, frequent feedings high in calories and high in quality protein as tolerated

diet for patients with hepatitis:

steatorrhea

with hepatitis, fats should be limited only if _____ is present

B complex (especially thiamine and vitamin B12), vitamin K, vitamin C, and zinc

what vitamins should be supplemented with hepatitis?

nonalcoholic fatty liver disease (NAFLD)

the buildup of extra fat in the liver that is not caused by alcohol

nonalcoholic fatty liver disease (NAFLD)

highly prevalent (15-45%) in western societies

nonalcoholic fatty liver disease (NAFLD)

develops in people who are overweight or obese; who have diabetes, high cholesterol levels, elevated triglyceride levels, or poor eating habits; or who experience rapid weight loss

hepatic fibrosis

develops in 10-25% of cases of nonalcoholic fatty liver disease, and leads to cirrhosis, end-stage liver disease, or liver cancer

cirrhosis

caused by a buildup of fibrous connective tissue as a result of alcohol abuse, hepatitis, biliary disorders, chronic autoimmune diseases, metabolic disorders, or chronic use of hepatotoxic drugs

portal hypertension, esophageal varices, ascites, hepatic encephalopathy

complications of cirrhosis:

portal hypertension

complication of cirrhosis: increased pressure in portal vein

esophageal varices

complication of cirrhosis: enlarged blood vessels that bulge into the lumen of the esophagus

if ruptured, may be fatal

ascites

complication of cirrhosis: accumulation of fluid in the abdominal cavity

hepatic encephalopathy

complication of cirrhosis: brain damage resulting from toxic ammonia buildup

can result in hepatic coma

dietary restriction of sodium and sometimes fluids

treatment of ascites:

antibiotic therapy, lactulose, neomycin

treatment of hepatic encephalopathy:

using their DRY weight

how should the nurse calculate protein requirements for a patient with cirrhosis?

branched-chain amino acid based formula with restricted aromatic amino acids if protein sensitive

nutrition therapy for patients with hepatic encephalopathy from cirrhosis:

folate, vitamin B12, and thiamine

water soluble vitamins should be supplemented in patients with cirrhosis, with emphasis on _____

protein catabolism

patients with cirrhosis should eat foods high in kilocalories to prevent _____

enough kilocalories and protein to decrease protein catabolism and correct nutritional deficiencies

nutrition therapy before liver transplantation:

- total parenteral nutrition (TPN) or tube feeding may be necessary

- use ideal (desirable) weight rather than actual weight because of ascites, edema, or excess fluid

- kilocalories and protein must be adequate for hypercatabolic stresses

- provide between-meal feedings, supplements, or both

nutrition therapy 4-8 weeks after liver transplantation:

- eat a healthy, well-balanced diet

- prevent excessive weight gain, hypertension, hyperlipidemia, and diabetes

long-term nutrition therapy after liver transplantation:

- high-fat diet

- women: multiparity

- oral contraceptive or estrogen use

- obesity

- sedentary lifestyle

- rapid weight loss, very low-calorie diets

- older age

causes and predisposing factors of gallbladder disorders:

mild pain in mid-epigastrium after eating, colic attack (pain radiating to right upper quadrant and right subscapular area)

symptoms of cholelithiasis:

pain, tenderness, fever, fat intolerance, nausea, heartburn, jaundice, steatorrhea

symptoms of cholecystitis:

avoid foods that cause discomfort, follow low-fat diet

nutrition therapy for pain control for patients with gallbladder disorders:

start with clear liquids and progress to regular diet

postoperative nutrition therapy for patients with gallbladder disorders:

low-fat diet, individual tolerances vary

diet for patients with gallbladder disorders:

pancreatitis

inflammatory process characterized by decreased production of digestive enzymes and bicarbonate

excess alcohol consumption, gallbladder disease, or genetics

pancreatitis is caused by:

chronic pain, diabetes mellitus

consequences of pancreatitis:

autodigestion of the pancreas by enzymes, severe pain and elevated serum enzyme levels, malabsorption of fats and proteins

symptoms and complications of pancreatitis:

pancreatitis

affected patients may be malnourished because of protein and fat malabsorption → nutritional support is needed

minimize pancreatic secretions

the goal of nutrition therapy for patients with pancreatitis is to:

low-fat elemental formula

when enteral feeding is appropriate for patients with pancreatitis , a _____ formula is recommended

jejunum

position of an enteral feeding tube for patients with pancreatitis should be positioned in the _____ to allow for feeding with minimal stimulation of the pancreas

peripheral parenteral nutrition (PPN)

type of parenteral nutrition that may be used in non-stressed individuals with pancreatitis who are on NPO status for less than 10 days

central parenteral nutrition (CPN)

type of parenteral nutrition that may be used for those patients with pancreatitis who are on NPO status longer than 5-7 days

pancreatitis

medium-chain triglyceride (MCT) oils may be used for patients with _____

enzyme replacement

may be necessary for patients with pancreatitis to control malabsorption