The document discusses nutrition therapy for liver and gallbladder diseases. It begins by outlining the functions of the liver and describing common forms of liver damage including fatty liver and hepatitis. Hepatitis can be caused by viruses or toxins and causes inflammation of the liver. Cirrhosis is an end-stage condition involving liver scarring that impairs function and can lead to complications like ascites, portal hypertension, and hepatic encephalopathy. Gallbladder diseases like gallstones are also discussed. Nutrition therapy aims to support liver function, avoid further damage, and manage complications through dietary modification and supplementation.

1. Nutrition Therapy for Liver & Gallbladder Diseases

2. Objectives:
-understand nutritional modification in different
stages of liver diseases .
-discuss the importance of adequate nutritional
monitoring in end stage liver diseases
-support maintenance of as much normal liver
function as possible

3.  Metabolizes CHO, proteins, fat
 Synthesizes plasma proteins
 Stores vitamins and minerals
 Forms blood clotting factors
 Detoxifies drugs & toxins
 Produces & excretes bile
 Regulates hormone function
 Phagocytic activities
 Acts as reservoir for blood volume
Functions of the Liver

4. Liver Damage
1-Fatty Liver
Accumulation of fat in the liver,
Most common of liver disorders
Usually mild & reversible, but can progress to serious illness &
liver damage
Causes
Alcoholic liver disease
Exposure to drugs & toxic metals
Associated with
Obesity
Diabetes mellitus
Marasmus & kwashiorkor
Gastrointestinal bypass surgery
Long-term TPN

5. 2-Hepatitis
 Liver inflammation
 Results from any factor causing liver
damage
 Viruses A, B, & C
 Excessive alcohol
 Exposure to certain drugs & toxic
chemicals
 Some herbal remedies
© 2007 Thomson - Wadsworth

6. Types of viral Hepatitis
 Hepatitis A
 Extremely contagious
 Most common
 Cause: fecal-oral
 Hepatitis B
 Blood contact
 Sexual contact
 Vaccinations available
 Hepatitis C
 Blood contact
 Major cause of chronic hepatitis

7. Hepatitis
 Symptoms
 Mild & chronic may be asymptomatic
 Acute
 Fatigue, nausea, anorexia
 Pain in liver area
 Enlarged liver & jaundice
 Fever, headache
 Muscle weakness, skin rashes
 Elevated liver enzymes (ALT, AST)
© 2007 Thomson - Wadsworth

8. Acute Viral Hepatitis
Widespread inflammation of the liver
that is caused by hepatitis viruses A, B,
C, D and E
 Hep A: oral-fecal route
 Hep B and C: body fluids
 Hep D: occurs only in pts with Hep B
 Hep E: oral-fecal route; seen more often in
Asia, Africa, Mexico
Hasse JM et al. ASPEN Nutrition Support Practice Manual, 2nd edition, 2005

9. Hepatitis
 Treatment
 Supportive care; bed rest & appropriate diet
 Avoidance of substances that aggravate liver (alcohol, drugs or dietary
supplements that cause liver damage)
 Hepatitis A usually resolves without medications
 Hepatitis B & hepatitis C infections may require antiviral agents
 Nonviral forms: treated with anti-inflammatory & immunosuppressant
drugs
 Nutrition therapy
 May require high-kcalorie, high-protein diet to replenish nutrient stores
 Liquid supplements may improve nutrient intakes
 Small, frequent meals easier to tolerate for patients with anorexia or GI
discomfort
 Fluid & electrolyte replacement necessary in case of vomiting
 Sodium & fat restriction may be recommended
Nutrition & Diet Therapy, 7th Edition

10. •Lean meat & egg Wight
•Skim milk
•more fluid intake
•meals should be attractive and well cooked
• give boiled or grilled food
• more vegetable and fruit or high fiber diet .

11. Cirrhosis
Diffuse fibrotic bands of connective
tissue in response to inflammation
Distorts normal architecture and
function

12. Cirrhosis
 End-stage condition
 Scarring/fibrosis
 Irregular, nodular appearance
 Impaired liver function - can lead to liver failure
© 2007 Thomson - Wadsworth

13. Causes of Cirrhosis
 Hepatitis C
 Alcoholic liver disease
 Bile duct blockages
 All untreated types of chronic hepatitis
 Drug-induced liver injury
 Some inherited metabolic disorders
© 2007 Thomson - Wadsworth

14. Symptoms of Cirrhosis
 40% of people are
asymptomatic
 Initial symptoms
 Fatigue
 Weakness
 Anorexia
 Weight loss
 Later symptoms
 Anemia
 Blood clotting
impairment
 Susceptibility to
infection
 Jaundice & fat
malabsorption
 Ascites & varices
© 2007 Thomson - Wadsworth

15. Consequence of Cirrhosis
 Ascites
 Accumulation of fluid in the abdominal
cavity
 Due to
 Portal hypertension
 Reduced albumin
 Altered kidney function
 Abdominal discomfort & early satiety
 Weight gain
© 2007 Thomson - Wadsworth

16. Consequences of Cirrhosis
 Hepatic
encephalopathy
 Abnormal
neurological
functioning
 Amnesia, seizures,
hepatic coma
 Elevated blood ammonia
 Malnutrition & wasting
© 2007 Thomson - Wadsworth
•Diet in hepatic encephalopathy( failure) :-
-protein free diet
-adequate energy
-laxative
If the pt recover from the hepatic failure protein should be
given gradually with skim milk

17. Treatment of Cirrhosis
 Individualized according to disease severity & complications
 Supportive care
 Appropriate diet
 Avoidance of liver toxins
 Abstinence from alcohol
 Drug therapy
 Medications for portal hypertension, varices
 Diuretics
 Appetite stimulants
 Medications to reduce or control blood ammonia levels
 Nutrition therapy
 Customized for each patient’s needs
 Avoidance of substances that can cause further liver damage
 Enteral & Parenteral nutrition support as indicated
Nutrition & Diet Therapy, 7th Edition

18. Nutrition & Diet Therapy, 7th Edition

19. © 2007 Thomson - Wadsworth

20. Medical Nutrition Therapy
 Sodium & Fluid
 With ascites, need to restrict fluid and
sodium
 Vitamins & minerals
 Multivitamin supplementation
 Liquid form if patient has varices
 Enteral & parenteral
 Specialized enteral products high in
kcalories
 Parenteral if patient has obstructions,
bleeding, vomiting
© 2007 Thomson - Wadsworth

21. IV. Gallbladder Disease
 Gallstones (cholelithiasis)
 Gallbladder stores the bile made by the
liver
 Disorders of gall bladder & bile ducts
result in formation of gallstones
 Results from excessive concentration &
crystallization
 Two Types
 1. Cholesterol gallstones: majority of
cases of gallstones; composed primarily
of cholesterol; precipitation of
cholesterol out of solution eventually
forms stones
 2. Pigment gallstones: composed
mainly of calcium salt of bilirubin;
often result of bacterial infection
Nutrition & Diet Therapy, 7th Edition
Bile: solution of bile
salts, cholesterol,
proteins, phospholipids
& bilirubin

22. Gallbladder Disease
 Consequences of gallstones
 Many asymptomatic
 Other symptoms—usually occur
when gallstones block cystic duct
 Steady & severe pain
 Nausea, vomiting, bloating
 Symptoms mainly occur after meals,
especially fatty foods
 Complications
 Cholecystitis
 Peritonitis
 Blockage of common bile duct
 Infection
 Risk factors for gallstones
 Ethnicity
 Age & gender
 Pregnancy
 Obesity & weight loss
 Other risk factors
 Long-term TPN
 Medications
 High TG levels
 Treatment
 Low fat diet
 Cholecystectomy
 Non-surgical
 Capsule urso-deoxycholic acid
(cholesterol production; used on
small stones)
 Shock-wave lithotripsy (used on
few and larger stones)
Nutrition & Diet Therapy, 7th Edition

23. Jaundice
 Inability of liver to conjugate
bilirubin
 Bilirubin- bile pigment from
breakdown of Hb from RBC’s
by macrophages
 Skin & sclera – jaundice
 Excreted in urine – tea colored
urine
 Blocked from flow into
intestines – clay colored stools
Hyperbilirubinemia >1.2mg/dl

24. II. Cirrhosis
 End-stage condition resulting from
chronic liver disease
 Gradual destruction of liver tissue,
leading to scarring
 Progressive disease results in
increased scarring, few areas of
healthy tissue
 Impairs liver function & can lead to
liver failure
 Causes
 Alcohol abuse & hepatitis C
infection most common causes
 Chronic hepatitis
 Drug-induced
 Inherited disorders
 Bile duct blockages
 Consequences
 Initial disease: mild or
asymptomatic, fatigue,
weakness, anorexia, weight loss
 Later disease: decline in liver
function, anemia, impaired
blood clotting, increased
susceptibility to infection,
jaundice, fat malabsorption
 Advanced disease: disruption of
kidney & lung function
 Altered liver enzymes, bilirubin
levels
 Lowered albumin levels,
extended clotting times
 Elevated blood ammonia levels
Nutrition & Diet Therapy, 7th Edition

25. Cirrhosis
 Consequences (con’t)
 Portal hypertension
 Scarred tissue of cirrhotic liver impairs
blood flow through liver
 Resistance to blood flow increases
pressure in portal vein: portal
hypertension
 Collaterals & gastroesophageal varices
 Collateral circulation-smaller blood
vessels enlarge to allow alternative
pathway for blood flow because (in GI
tract & near abdominal wall)
 As a result, varices form (collaterals
become enlarged & engorged with
blood)
 Ruptured esophageal or gastric varices
can result in massive bleeding, often
fatal
 Ascites
 Accumulation of fluid in the
abdominal cavity; indicates critical
stage of liver damage
 Thought to be consequence of
portal hypertension, reduced
albumin synthesis & altered kidney
function
 Hepatic encephalopathy:
characterized by abnormal
neurological functioning
 Changes in personality, mental
abilities & motor function
 Amnesia, seizures
 Hepatic coma
 Elevated blood ammonia levels
 Malnutrition & wasting
Nutrition & Diet Therapy, 7th Edition