Liver is an organ meat. It comes from the body's largest internal organ, found in the bellies of all animals with backbones. Among hundreds of other functions, the liver filters blood and removes toxins. It also makes bile, a substance that helps digest fats and get rid of waste.

1. Nutrition Therapy for Liver
& Gallbladder Diseases

2. OBJECTIVES
• Describe the role of diet management
of liver disease, especially hepatitis,
cirrhosis.
• Discuss current beliefs and practices
related to diet in liver disease in the
community.
• Describe the role of diet in the
management of gall stone
• Identify the role of the nurse in dietary
management of liver disease

4. Functions of Liver
• Liver—most active organ in body
– Receives & processes nutrients absorbed by
small intestine
– Makes bile for fat emulsification
– Synthesizes most proteins circulating in
plasma
– Detoxifies drugs & alcohols
– Processes excess nitrogen for excretion as
urea
• Liver damage or disease can profoundly
affect health & nutritional status

5. I. Fatty Liver & Hepatitis
• Most common of liver disorders
• Usually mild & reversible, but
can progress to serious illness
& liver damage

6. Fatty Liver
• Accumulation of fat in liver
tissue; represents
imbalance between fat
synthesized from the blood
& the amount exported to
the blood via LDL
• Causes are unclear, but
associated with:
– Alcoholic liver disease
– Result of exposure to
drugs & toxic materials
– Associated with obesity,
diabetes mellitus, diseases
of malnutrition
– May follow gastrointestinal
bypass surgery or long-
term TPN
• Consequences
– Liver enlargement
(hepatomegaly),
inflammation, fatigue
– Abnormal levels of liver
enzymes
– Increased levels of
triglycerides, cholesterol,
glucose
– Liver damage & failure
• Treatment
– Elimination of factors
causing it
– Weight reduction
– Control of blood glucose
levels

7. Hepatitis
• Inflammation of liver,
resulting from damage
to liver tissue
• Cause often infection
with specific viruses
(A, B, C)
• Usual transmission
– Blood contact with
infected persons
– Ingestion of
contaminated food or
water
– Excessive alcohol intake
or exposure to certain
drugs & toxic chemicals
• Symptoms
– Effects depend on cause
& severity of disease
– Fatigue
– Nausea, anorexia
– Pain in liver area
– Liver enlargement
– Jaundice
– Fever
– Headache, muscle
weakness
– Skin rashes
– Elevation of liver
enzymes (ALT, AST)

8. Hepatitis
• Treatment
– Supportive care; bed rest & appropriate diet
– Avoidance of substances that aggravate liver (alcohol,
drugs or dietary supplements that cause liver damage-
chaparral, germander, ma huang, saw palmetto and jin bu
huan)
– Hepatitis A usually resolves without medications
– Hepatitis B & hepatitis C infections may require antiviral
agents
– Nonviral forms: treated with anti-inflammatory &
immunosuppressant drugs

9. • 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

10. 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

13. Nutritional Assessment of patients
with ESLD
 Weight?
 Weight history?
 Descriptive history of wasting?
 Intake?
 Appetite?

14. 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

16. III. Liver Transplantation
• Liver failure (resulting from acute or chronic liver
disease) may require transplantation as only
treatment option
• Most common result of hepatitis C infection or
alcoholic liver disease
• Nutrition status of transplant patients
– Usually associated with malnutrition (common with
advanced liver disease)
– Correction of malnutrition prior to surgery can help
speed recovery
– Associated deficiencies: vitamins B6, B12, C, thiamin,
niacin, folate, fat-soluble vitamins, calcium, magnesium,
phosphorus, potassium, zinc

17. 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
Bile: solution of bile
salts, cholesterol,
proteins, phospholipids
& bilirubin

18. 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

19. • Risk factors for gallstones
– Ethnicity,Age & gender, Pregnancy,Obesity & weight loss
– Other risk factors
• Long-term TPN
• Medications
• High TG levels
• dietary Treatment
– Low fat diet

20. Role of nurse
• Nurse demonstrate an in-depth
knowledge and understanding of the
role of nutrition and its importance in
liver disease.