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1、Nutritional Management of Liver Disease,Review the functions of the liver Review diseases of the liver Major complications of liver disease Nutritional features of end stage liver disease Nutritional management of end stage liver disease Nutritional response to hepatic transplantation Nutritional ma
2、nagement of non alcoholic fatty liver disease (NAFLD) Hepatitis C,Functions of the Liver,Major role of the liver is the regulation of solutes in the blood that affect the functions of other organs for example: the brain, heart, muscle and kidneysStrategically placed such that all blood passing from
3、the small intestine must travel through the liver,Functions of the Liver,Storage and metabolism of macronutrients such as protein, carbohydrates and lipidsMetabolism of micronutrients vitamins and mineralsMetabolism and excretion of drugs and toxins endogenous and exogenous,Role of the Liver in Nutr
4、ient Metabolism,Storage and metabolism of macronutrients such as protein, carbohydrates and lipidsCarbohydrate Storage of carbohydrate as glycogen Gluconeogenesis Glycogenolysis,Role of the Liver in Nutrient Metabolism,Protein Synthesis of serum proteins e.g. albuminSynthesis of blood clotting facto
5、rs Formation of urea from ammonia Oxidation of amino acids Deamination or transamination of amino acids,Role of the Liver in Nutrient Metabolism,Fat Hydrolysis of triglycerides, cholesterol and phospholipids to fatty acids and glycerolFormation of lipoproteinsKetogenesis,Role of the Liver in Nutrien
6、t Metabolism,Fat Fat storageCholesterol synthesis Production of bile necessary for digestion of dietary fat,Role of the Liver in Nutrient Metabolism,Vitamins Site of the enzymatic steps in the activation of vitamins : thiaminepyridoxinefolic acidvitamin D(25 hydroxycholecalciferol)Site of the synthe
7、sis of carrier proteins for vitamins: A, B12, E,Role of the Liver in Nutrient Metabolism,Storage site for fat soluble vitamins A, D, E, K, B12Minerals Storage site for copper iron and zinc,Diseases of the Liver,HepatitisInflammation of hepatocytes ReversiblePrecipitants include: Viral infections suc
8、h as hepatitis A, B, C Drugs such as paracetamolSome herbal preparationsAlcohol,Fatty Liver:Infiltration of the liver by fatPossible causes include:alcoholobesitytype 2 diabetes mellitushyperlipidaemiasudden rapid weight gain hepatitis CTPN,NAFLD (Non Alcoholic Fatty Liver Disease),Resembles alcohol
9、 induced fatty liverOccurs in people who do not abuse alcoholHas the potential to progress to cirrhosis and liver failure,Non Alcoholic Fatty Liver Disease (NAFLD),Simple steatosis Steatohepatitis (NASH) Fibrosing steatohepatitis Cirrhosis,Non Alcoholic Fatty Liver Disease (NAFLD),Risk Factors inclu
10、de: Overweight Obesity Central Obesity,Non Alcoholic Fatty Liver Disease (NAFLD),Factors involved in the development of NAFLD: Lifestyle : Weight gain Weight loss Reduced activity Childhood and adult obesity Type 2 diabetes,Non Alcoholic Fatty Liver Disease (NAFLD),The major underlying risk factor f
11、or the development of NAFLD is insulin resistance,NAFLD (Non Alcoholic Fatty Liver Disease),Prevalence of obesity in patients with NAFLD reported between 30% and 100%Prevalence of type 2 diabetes in patients with NAFLD reported between 10% and 75%Prevalence of hyperlipidaemia in patients with NAFLD
12、reported between 20% and 92%,NAFLD - Symptoms,Often asymptomatic of liver disease at time of diagnosisFatigue or malaise and/or a feeling of fullness or discomfort on the right side of the abdomen,NAFLD - Symptoms,Mild to moderate elevation of the enzymes:aspartate amino transferasealanine amino tra
13、nsferase Diagnosis confirmed on biopsy,Cirrhosis Refers to chronic scarring of the liverClearly delineated nodules form within the liver which contain connective tissueThis leads to a significant reduction in liver function,Fulminant Hepatic Failure Sudden massive necrosis of hepatocytesThe patient
14、rapidly becomes encephalopathic and comatosedCauses may be viral or a reaction to a drug such as paracetamol, sulphathiazone or some herbal remedies,Autoimmune liver diseases Diseases of the biliary tract and include primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC)PSC often o
15、ccurs in association with ulcerative colitisSerum cholesterol levels may be elevated and unresponsive to medication or dietary manipulation,Alcoholic liver disease,Alcohol is toxic to the liverCaused by chronic alcohol abuse All stages of the disease process hepatitis, fatty liver fibrosis and cirrh
16、osis,Alcoholic liver disease,Cessation of alcohol may result in recovery in the early stages of liver diseaseCessation of alcohol in patient with cirrhosis may result in an improvement in liver function and may also result in a slowing down of the disease progression,Wilsons Disease,Copper storage d
17、iseaseMay result in cirrhosis if untreatedFirst presentation often in adults who present with cirrhosis,Wilsons Disease,If detected in childhood management involves penecillamine which acts to bind Cu in the GITValue of dietary Cu restriction debatable in children; of no value in adults in the presence of cirrhosis,
