The document discusses various liver diseases and their associated medical nutrition therapy (MNT). It covers viral hepatitis types A through E, liver cirrhosis, portal hypertension, and hepatic encephalopathy. For viral hepatitis, the MNT focuses on adequate protein and calorie intake, avoiding alcohol and hepatotoxic substances. For cirrhosis, portal hypertension, and encephalopathy, the MNT emphasizes sodium, fluid, and protein restrictions depending on the condition. Enteral nutrition is also recommended to support liver function and overall health when managing liver diseases.

1. •Irsa Ali
•Nimra Maheen
•Liver Diseases and
Their Medical Nutrition
Therapy

2. Liver:-
THE LIVER IS A VITAL ORGAN
THAT PERFORMS MANY
IMPORTANT FUNCTIONS IN
THE BODY.
FUNCTIONS OF THE LIVER: •METABOLISM OF NUTRIENTS •DETOXIFICATION OF
HARMFUL SUBSTANCES
•PRODUCTION OF BILE
•STORAGE OF VITAMINS AND
MINERALS
•PRODUCTION OF BLOOD
CLOTTING FACTORS

3. Liver function tests (LFTs)
LFTs are a group of blood
tests that can provide
information about the health
of the liver and help
diagnose liver disorders.
Some common LFTs include:
•Alanine aminotransferase
(ALT)
•Aspartate aminotransferase
(AST)
•Alkaline phosphatase(ALP)
•Total bilirubin •Albumin •Prothrombin time (PT)

4. Viral hepatitis:-
•Viral hepatitis is a type of
liver disorder caused by a viral
infection.
•There are several types of
viral hepatitis, including
hepatitis A, B, C, D, and E. Each
type of viral hepatitis is caused
by a different virus and has its
own unique characteristics

5. Viral hepatitis:-
•Hepatitis A:
It is usually transmitted through contaminated food or water and causes an acute infection.
•Hepatitis B:
It is transmitted through blood, semen, or other body fluids and can cause both acute and chronic
liver infection.
•Hepatitis C:
It is also transmitted through blood and can cause both acute and chronic liver infections.

6. •Hepatitis D:
It is a rare form of viral hepatitis that only occurs in people who are already
infected with hepatitis B. Hepatitis D can cause acute and chronic liver infections
and can lead to serious complications.
•Hepatitis E:
It is transmitted through contaminated food or water and is most common in
developing countries. It usually causes an acute infection and does not usually
cause chronic liver disease.

7. MNT for viral hepatitis
Here are some general guidelines for MNT for viral hepatitis:
•Adequate protein intake
•Avoidance of alcohol
•Moderate fat intake
•Avoidance of hepatotoxic drugs and supplements
•Adequate calorie intake
•Hydration
•Individualized recommendations

8. Diet planing:-
It is important for people with viral hepatitis to follow a balanced and healthy diet to support liver function and overall health. Here are some
drink and food recipe ideas for viral hepatitis patient
•Breakfast:
Oatmeal/ Scrambled eggs/ Fruit salad
•Lunch:
Grilled chicken salad/ Lentil and vegetable soup
•Dinner:
Baked salmon/ Grilled chicken with sautéed veggies
•Snack:-
Apple slices with almond butter/ Greek yogurt with friuts / Fruit smoothie/fruit salad

9. Liver Cirrhosis
•Cirrhosis occurs as a s result of excessive alcohol intake,
most common viral hepatitis, obstruction of the bile ducts,
and exposure to certain drugs or toxic substances. It is also
found in highly malnourished children.
• Liver cirrhosis is a chronic disease in which there is
considerable damage to its cells with infiltration by fats and
fibrosis.
• Symptoms include loss of appetite nausea, vomiting and
weight loss, giving an emaciated appearance.

10. Diet:
•Patients with cirrhosis
require a balanced diet
providing 2000-3,000
calories a day to allow the
liver cells to regenerate.
Thus the diet recommended
is a high-calorie, adequate
protein diet with vitamin
and mineral supplements.
Too much protein will result
in an increased amount of
ammonia in the blood, and
too little protein can reduce
healing of the liver.

11. Portal Hypertension
• Portal hypertension is one of the most serious complications
of advanced liver disease. Scar tissue in your liver (cirrhosis)
compresses the blood vessels running through it and reduces
their blood flow

12. Symptoms of portal hypertension
•Blood in vomit.
•Blood in poop.
•Bloated stomach with rapid weight gain (from fluid).
•Swelling in your legs and feet (edema).
•Mental confusion or disorientation.

13. MNT for portal HTN
•Sodium restriction •Protein intake •Fluid restriction
•Adequate calorie
intake
•Avoid alcohol
•Vitamin and mineral
supplements
•Fiber intake

14. Hepatic Encephalopathy
•Hepatic encephalopathy is a nervous system disorder brought
on by severe liver disease. When the liver doesn’t work
properly, toxins build up in the blood. These toxins can travel to
the brain and affect brain function

15. Types of hepatic
encephalopathy
•There are three types of hepatic
encephalopathy:
•Type A is brought on by acute liver
failure (without underlying chronic liver
disease).
•Type B occurs in some people who have a
shunt that connects two veins inside the liver
without underlying liver disease.
•Type C results from chronic liver disease and
scarring (cirrhosis)

16. SYMPTOMS
•Anxiety or irritability. •Cognitive impairment
(confused thinking or
judgment).
•Coordination
or balance problems.
•Difficulty concentrating
or short attention span.

17. MNT for encephalopathy
•Protein should be severely
restricted (18–20g/day)
sometimes even 0 per day.
Maintenance of nitrogen
balance is difficult.
• Intravenous feeding may be
used in some cases.
Hypertonic dextrose solution
with 37–50% BCAA and low in
AAA should be administered.
•Alfa Keto analogs of BCAA
can also be given. All measures
to reduce ammonia
(previously mentioned) should
be taken.
• Fat solution containing 75%
medium-chain triglycerides
and 25% long chain
triglycerides may be better
utilized.
• Attention to electrolyte
balance as well as acid-base
status is equally important.
• Supplements of water and
fat-soluble vitamins should be
given. The patient should be
shifted to enteral feeding as
soon as possible.
•Enteral nutrition maintains
intestinal membrane integrity
thus preventing bacterial
translocation and subsequent
multiple organ failure in
critically ill patients.