Nutritional Consideration in Liver�Disease

By the end of this unit the students will be able to:
• Define key terms
• List the functions of liver
• Identify liver diseases
• Describe the role of diet in the management of gall stone
• Discuss the role of diet management of liver disease, especially hepatitis, cirrhosis, encephalopathy.
• Discuss current beliefs and practices related to diet in liver disease in the community.
• Identify the role of nurse in dietary management of liver disease

1. UNIT VI: Nutritional Consideration in Liver Disease Course Code :01204 KIRAN WARIS MScN , BScN Assistant Professor T-A Cheema Institute Bwp

2. Objectives: By the end of this unit the students will be able to: • Define key terms • List the functions of liver • Identify liver diseases • Describe the role of diet in the management of gall stone • Discuss the role of diet management of liver disease, especially hepatitis, cirrhosis, encephalopathy. • Discuss current beliefs and practices related to diet in liver disease in the community. • Identify the role of nurse in dietary management of liver disease.

3. Key terms Scarring : The replacement of healthy liver tissue with scar tissue  Fibrosis : Another term for scarring of the liver  End-stage liver disease : A term for cirrhosis because it occurs after other stages of liver damage  Hepatitis B and C : Viruses that can cause cirrhosis  Fatty liver : A condition that can lead to cirrhosis, caused by obesity and diabetes  Jaundice : A yellowing of the skin and eyes caused by cirrhosis  Hepatic encephalopathy : Confusion, disorientation, and mood changes caused by cirrhosis  Motor dysfunction : Twitching, tremors, or lapses in muscle control caused by cirrhosis  Child-Pugh score : A score that indicates how sick the liver is  INR : A test that checks how fast blood clots  MRI : An imaging test that can be used to look for liver problems 

4. Function of liver • Metabolizes CHO, proteins, fat • Synthesizes plasma proteins • Stores vitamins and minerals • Forms blood clotting factors • Detoxifies drugs & toxins

5. Cont….. • Produces & excretes bile • Phagocytic activities • Acts as reservoir for blood volume

6. Diseases of the Liver Viral hepatitis Non-viral hepatitis Acute and Chronic Liver Diseases Alcoholic liver disease, alcoholic hepatitis, and cirrhosis Cholestatic liver diseases Other liver diseases

7. End-Stage Liver Disease • Malnutrition • Portal hypertension with varices • Ascites • Hepatic encephalopathy • Glucose alterations • Fat malabsorption------Steatorrhea • Thrombocytopenia with anemia • Cachexia

8. Severe Malnutrition and Ascites

9. Non invasive - LFT's — Enzymes — Proteins — Prothrombin time — CBC Diagnostic Tests - non-invasive • ALT, AST, ALP • serum & urinary bilirubin • serum albumin & proteins • Prothrombin time • platelet count

10. • Vitamin A • Vitamin D • Vitamin E • Vitamin K • Vitamin B 6 • Vitamin B 12 • Folic acid/Folate • Niacin/Nicotinic acid • Thiamin Vitamin/Mineral Deficits in Severe Hepatic Failure • Zinc • Magnesium • Iron • Potassium • Phosphorus

11. Dietary factors that may increase risk include: Cholesterol, saturated fat, refined sugar, and possibly legumes. Obesity is also a risk factor for gallstones Dietary management of Gallstones

12. polyunsaturated fat ( e,g fish,walnuts,plant oil, egg yolk peanut, butter, avocados), monounsaturated fat , fiber, caffeine and vegetable. Dietary factors that may prevent the development of gallstones include

13. Nutritional supplements that might help prevent gallstones include vitamin C, and iron. • In addition, plant terpenes ( Rowachol ) has been used with some success to dissolve gallstones. • The gallbladder flush is a folk remedy said to promote the passage of gallstones. Dietary management in Gall stones cont...

14. A regimen called a "gallbladder flush" or "liver flush" is a popular remedy in alternative medicine. In this treatment, often self-administered, the patient drinks four glasses of pure apple juice and eats five apples per day for five days, then fasts briefly, takes magnesium and then drinks large quantities of lemon juice mixed with olive oil before bed. Dietary management in Gall stones cont...

15. • The next morning, they painlessly pass a number of green and brown pebbles from the biliary system. • Apples are a source of pectin, which has been shown to sequester bile and facilitate its elimination in the stool CONT…….

16. • Dietary management in Liver Disease In people with badly damaged livers, proteins are not properly processed. Waste products may build up and affect the brain. Dietary changes for liver disease may involve: Cutting down the amount of protein you eat. This will help limit the buildup of toxic waste products.

17. Increasing your intake of carbohydrates. • Take vitamins. • Limiting your salt intake. Salt in the diet may worsen fluid build up and swelling in the liver . CONT…….

18. Eat large amounts of carbohydrate foods. Carbohydrates should be the major source of calories in this diet. • Eat a moderate intake of fat, as prescribed by the health care provider. The increased carbohydrates and fat help prevent protein breakdown in the liver. • Have about 1 gram of protein per kilogram of body weight or less depending upon the severity of liver problem CONT…….

19. Take vitamin supplements, especially B-complex vitamins. • Reduce the amount of salt you consume (typically less than 1500 milligrams per day) as it may worsen fluid buildup and swelling in the liver. CONT…….

20. Provide empathy and understanding and works with the patients (and their family/carers) particularly those with chronic liver disease. Support patients (and families/carers) in the understanding of their condition through Patient education and health promotion. Role of Nurse in liver Disease

21. CONT….. Undertake a comprehensive clinical assessment including risk profiling and follow up with appropriate action, including referral to specialists, for relevant acute and chronic health care conditions. • Assess, in collaboration with the patients (family/carers), their health care needs, taking into account the impact of their age, vulnerability, their lifestyle, cultural and ethnic background.

22. CONT….. Develops and evaluates a self-management plan with the patient who has predisposing factors to liver disease. •Works alongside and with the patient(and families/carers)to address the psychological and social impact of their condition. • Provides specific diagnostic/treatment options safely. •Use early warning tools/approaches to identify the patient's changing and deteriorating condition, and take appropriate action.