This document discusses liver diseases and their dietary management. It covers the functions of the liver, liver cirrhosis, hepatitis, and their symptoms. For dietary management of liver diseases, the key objectives are to relieve symptoms, aid liver regeneration, and prevent further damage. A high carbohydrate and protein diet is recommended, with moderate fat and supplementation of vitamins and minerals. Foods to include are sugars, cereals, milk, eggs, fruits and vegetables while excluding fried, fatty, strongly flavored foods and alcohol.

1. LIVER DISEASES

2. Introduction
1. Any condition that damages the liver and
prevents it from functioning well.
2. If liver doesn’t work properly, it will affect
your whole body.
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3. FUNCTIONS OF LIVER
1. Carbohydrate metabolism
a) Liver cells stores energy in the form of glycogen and release it as glucose when
required.
b) In the absence of CHO, the proteins are converted to glucose in liver.
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4. 2. Fat metabolism
a. Synthesis of TRG’s and phospholipids.
b. Liver synthesizes lipoproteins.
c. It synthesizes cholesterol and converts 80% into bile and conjugated
bile salts and the remainder is transported in the form of lipoproteins.
d. Oxidation of fatty acids to acetyl CoA to give energy.
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5. 3. Protein metabolism
a) Liver removes the nitrogen from amino acids (deamination) which is
then used as an energy source or converted to CHO and fats.
b) Converts ammonia to urea (a waste product of protein breakdown).
c) Site of most plasma protein synthesis
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6. 4. Minerals and Vitamin metabolism
a) Liver is a store house of iron, zinc and copper etc.
b) Liver is a store house of all fat soluble vitamins.
c) Converts carotene to retinol.
d) Converts vitamin d to its active form 1,25-dihydroxycholrcalciferol.
e) It synthesizes heparin (anticoagulant) which prevents intra-vascular
coagulation of blood.
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7. 1. Liver cirrhosis

8. 1. Cirrhosis is characterized by abnormal structure and
function of the liver.
2. It is the final stage of liver injury and degeneration.
3. Lives cirrhosis is the end result of hepato- cellular injury
where in fibrous connective lines replaces functional live
cells.
4. It is a serious form of end stage liver disease where in the
liver looses major of its functional capacity.
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9. SYMPTOMS OF LIVER CIRRHOSIS
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1. GI disturbances (anorexia, nausea, vomiting, abdominal
pain and distension ).
2. Electrolyte and fluid imbalance
3. Weight loss and muscles wasting
4. Abnormal serum amino acid levels
5. Fatty infiltration of the liver
6. Severe jaundice
7. Hepatic encephalopathy /hepatic coma
8. Ascites (accumulation of fluid in abdominal cavity
9. High drug sensitivity
10. Chronic inflammation of the liver
11. Fibrosis of the liver
12. Necrosis (death of tissues)

10. “
AETIOLOGY OF LIVER
CIRRHOSIS
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1) Neglected acute/ chronic hepatitis
2) Alcoholism associated with
malnutrition
3) Virus and toxins
4) Prolonged biliary stasis
5) Metabolic disorder e.g. Wilson’s
disease

11. ⬩ 1) Ascites (to the accumulation of massive quantities of fluid in the peritoneal cavity of the
abdomen. This may be due to:-
⬩ a) Portal hypertension (elevated pressures in the portal venous system (a major vein that leads to
the liver)
⬩ b) Hypoalbuminamia (a fall in colloidal osmotic pressure due to inadequacy of serum albumin)
⬩ 2) Oesophagealvarices :- it relate to a state of varicose (dilated) veins in the oesophagus and
upper part of the stomach which develop as a consequences of portal hypertension.
COMPLICATIONS IN LIVER CIRRHOSIS
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12. OESOPHAGEAL VARICES ⬩ ASCITIS
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13. 3. Hepatic coma
• It is a brain and nervous system damage that occurs as a complication of liver disorders that reduce liver functioning.
• Characterized by:
a) Mild confusion
b) Depression
c) Decreased attention
d) Slowing of activity to perform mental tasks
e) Irritability
f) Disorders of sleep pattern
g) Drowsiness
h) Lethargy
i) Speech disorientation or disorder:- Dysarthria (incomprehensive speech)
j) Coma (finally):- Day-night reversal. Tremor (involuntary muscle movement)
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14. Diet management
for liver cirrhosis
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15. A high carbohydrate, protein and low fat recommended to cirrhosis
patient along with vitamin and mineral supplements
1) Energy :- emphasis should
be on improving the total intake
. An intake of 25 to 35 kcal./kg
estimated dry food weight
should be used in calculations to
prevent overfeeding.
2) Protein :- A protein intake high enough to maintain N2
balance and to prevent hepatic coma.
a) In cirrhosis without encephalopathy a protein requirement
1g/kg of dry wgt/ day is advised.
b) To promote N2 accumulation or positive balance, atleast 1.2 to
1.5 g/kg daily is needed.
c) Protein intake is restricted to 0.5 g/kg day if there are signs of
impending coma.
d) In case of stress such as alcoholic hepatitis, infection ,GI
bleeding severs ascites , atleast 1.5g/kg 1 day should be given .
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16. 3)Carbohydrates:-
carbohydrate content is
kept adequate (300-
400g/kg day) for its
protein sparing effects.
4) Fat :- Steatorrhoea
or fatty infiltration of
liver may be seen in
cirrhosis patient, thus a
modulate intake with
the substitution of
MCT are effective in
reducing
malabsorption of fats.
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5) Vitamins :- supplements with vitamins is desired to replenish lives stores and repair tissue damage
especially if the patient has anorexia
6) Minerals :- Ca, Mg and Zn are important as serum level tend to malabsorption associated with
steatorrhoea.
Restriction of Na is essential if oedema and ascites are present . Sodium restriction up to 500mg/kg day is
seen with ascites but generally relaxed to 2g/day with diuretics.
7) Fiber:- reduction in fiber content is necessary in advanced cirrhosis to prevent dangers, of hemorrhage
from esophageal varices. Hence liquid and soft diet and small meals are emphasized.
8) Fluid :- need not to be severely limited of Na restriction is effects in correcting oedema and ascites ( not
more than 1500ml/ day .
Restriction of fluid intake (800-1000ml/day) is required for patients with hypernatremia (serum sodium
<125mEq/L).

18. Hepatitis
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19. 1. Hepatitis is an infectious disease characterised by inflammation and
degeneration of the liver cells.
2. Viral hepatitis is more common.
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Hepatitis
Viral hepatitis
Drug induced
hepatitis

20. Aetiology of hepatitis
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Viral hepatitis
1. Hepatitis A virus (HAV) /infective hepatitis: It is extremely contagious and is the most common
cause of acute viral hepatitis which is transmitted by a virus via faecal-oral route through
contaminated food and water.
2. Hepatitis B virus (HBV)/serum hepatitis: it is transmitted through parenteral route or poorly
sterilized needles through blood and blood products contaminated with virus. Open cuts,
wounds, sexual contact and saliva of the infected person contribute to its transmission.

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3. Hepatitis D virus: It is a chronic form of hepatitis which is dependent on the HBV for survival and
propagation in humans. It may be a co-infection (occurring at the same time as HBV) or a super infection
(super imposing itself on the HBV carrier state).
4. Hepatitis E virus: it is an acute form which is transmitted via the oral-feacal route.
DRUG INDUCED HEPATITIS
It may be due to a reaction to certain drug like sulfa or penicillin or the effect of toxic chemicals like carbon
tetrachloride, heroin, alcohol or marijuana.

22. Symptoms of hepatitis
1. Anorexia
2. Fatigue
3. Nausea
4. Vomiting
5. Diarrhoea
6. Fever
7. Abdominal discomfort
8. Weight loss
9. Jaundice
10.Tenderness of liver
11. Enlargement of liver
12.Dark urine
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23. JAUNDICE (SYMPTOM OF HEPATITIS)
1. Jaundice is a condition in which yellow tinge appears on the
skin, mucous membrane and eyes.
2. Symptoms: yellow coloured skin, dark urine, clay coloured
stools, abdominal pain, itchiness, nausea and vomiting.
3. Causes: high bilirubin concentration in blood, liver problem,
obstruction of bile duct, gall stones, pancreatic tumor etc.
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25. Dietary management
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26. Main objectives for dietary management
1. To relieve symptoms
2. To aid in regeneration of the liver disease
3. To prevent further liver damage
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27. 1. ENERGY:
A high energy intake is needed to promote weight gain and ensure
maximum protein utilization. Due to bed rest, the actual daily
requirements of energy are reduced. The energy intake may be
incresead to 20-30 percent more than normal intake.
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28. 2. Protein :
A high protein diet is required to promote regeneration of the liver cell and
prevent fatty infiltration of liver. The damaged liver may not be able to tolerate
high protein load because the conversion of ammonia to urea gets affected.
Depending on the extent of liver damage , there is a need to adjust protein.
Protein with high biological value are recommended.
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29. 3. Carbohydrates:
High carbohydrate diet is recommended to provide bulk of energy,
to build up glycogen stores in the liver as a protection against fatty
infiltration as well as for protein sparing action. Simple
carbohydrates like glucose, sugar, honey, fruits, fruit juices and
starches like cereals and root vegetables.
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30. ⬩ 4. FATS:
⬩ Liver diseases affects the digestion and absorption of fats
because bile secretion is altered. Moderate amounts of fats are
recommended to increase palatability of food and decrease the
bulk of diet. For severe cases of liver damage, fats are
restricted to 20-30g/day. For mild to moderate conditions, 40-
50g total fat per day is recommended.
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31. ⬩ 5. Vitamins and minerals:
Minerals should be provided in appropriate amounts specially
calcium and iron. Vitamins A, K etc. levels are lowered due to
decreased intake and impaired fat absorption. The requirements
of vitamin B-complex is also increased due to increased energy
metabolism and higher amounts of vitamin C are required for
tissue healing.
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32. FOODS
⬩ FOODS TO BE INCLUDED
1. Sugar
2. Glucose
3. Honey
4. Cereals and pulses
5. Milk and milk products
6. Eggs
7. Fruits and vegetables
⬩ FOODS TO BE EXCLUDED
1. Fried and fatty foods
2. Fats and oils
3. Nuts and oilseeds
4. Strongly flavoured vegetables
5. Alcohol
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