A

1. Nutritional Consideration in
Liver
Disease
PRESENTED BY
ABDULLAH
MSN SCHOLAR

2. Objectives:
By the end of this unit the students will be able to:
• Define key terms
• List the functions of liver
• Identify liver diseases
• Describe the role of diet in the management of gall stone
• Discuss the role of diet management of liver disease, especially
hepatitis, cirrhosis, encephalopathy.
• Discuss current beliefs and practices related to diet in liver disease in
the community.
• Identify the role of nurse in dietary management of liver disease.

3. Function of liver
 • Metabolizes CHO, proteins, fat
• Synthesizes plasma proteins
• Stores vitamins and minerals
• Forms blood clotting factors
• Detoxifies drugs & toxins

4. Cont…..
• Produces & excretes bile
• Phagocytic activities
• Acts as reservoir for blood volume

5. Diseases of the Liver
• Viral hepatitis
• Non-viral hepatitis
• Acute and Chronic Liver Diseases
• Alcoholic liver disease, alcoholic hepatitis, and
cirrhosis
• Cholestatic liver diseases
• Other liver diseases

6. End-Stage Liver Disease
• Malnutrition
• Portal hypertension with varices
• Ascites
• Hepatic encephalopathy
• Glucose alterations
• Fat malabsorption------Steatorrhea
• Thrombocytopenia with anemia
• Cachexia

7. Severe Malnutrition and Ascites

8. Diagnostic Tests - non-invasive
Non invasive - LFT's
— Enzymes
— Proteins
— Prothrombin time
— CBC
• t ALT, AST, ALP
• t serum & urinary bilirubin
• i serum albumin & proteins
• t Prothrombin time
• i platelet count

9. • Vitamin A
• Vitamin D
• Vitamin E
• Vitamin K
• Vitamin B6
• Vitamin B12
• Folic acid/Folate
• Niacin/Nicotinic acid
• Thiamin
Vitamin/Mineral Deficits in Severe Hepatic Failure
• Zinc
• Magnesium
• Iron
• Potassium
• Phosphorus

10. Dietary factors that may increase risk include:
•Cholesterol, saturated fat, refined sugar, and
possibly legumes.
•Obesity is also a risk factor for gallstones
Dietary management of Gallstones

11. Dietary factors that may prevent the development
of gallstones include
•polyunsaturated fat ( e,g fish,walnuts,plant oil,
egg yolk peanut, butter, avocados),
monounsaturated fat , fiber, caffeine and
vegetable.

12. Dietary management in Gall stones cont...
Nutritional supplements that might help prevent gallstones
include vitamin C, and iron.
• In addition, plant terpenes (Rowachol) has been used
with some success to dissolve gallstones.
• The gallbladder flush is a folk remedy said to promote
the passage of gallstones.

13. Dietary management in Gall stones cont...
•A regimen called a "gallbladder flush" or "liver flush"
is a popular remedy in alternative medicine.
•• In this treatment, often self-administered, the
patient drinks four glasses of pure apple juice and eats
five apples per day for five days, then fasts briefly,
takes magnesium and then drinks large quantities of
lemon juice mixed with olive oil before bed.

14. CONT…….
• The next morning, they painlessly pass a number of
green and brown pebbles from the biliary system.
• Apples are a source of pectin, which has been
shown to sequester bile and facilitate its elimination in
the stool

15. •
Dietary management in Liver Disease
• In people with badly damaged livers, proteins are not
properly processed. Waste products may build up
and affect the brain.
• Dietary changes for liver disease may involve:
• Cutting down the amount of protein you eat. This
will help limit the buildup of toxic waste products.

16. CONT…….
Increasing your intake of carbohydrates.
• Take vitamins.
• Limiting your salt intake. Salt in the diet may worsen
fluid build up and swelling in the liver.

17. CONT…….
Eat large amounts of carbohydrate foods. Carbohydrates
should be the major source of calories in this diet.
• Eat a moderate intake of fat, as prescribed by the health
care provider. The increased carbohydrates and fat help
prevent protein breakdown in the liver.
• Have about 1 gram of protein per kilogram of body
weight or less depending upon the severity of liver problem

18. CONT…….
Take vitamin supplements, especially B-complex
vitamins.
• Reduce the amount of salt you consume (typically
less than 1500 milligrams per day) as it may worsen fluid
buildup and swelling in the liver.

19. Role of Nurse in liver Disease
Provide empathy and understanding and works with the
patients (and their family/carers) particularly those with
chronic liver disease.
Support patients (and families/carers) in the
understanding of their condition through Patient
education and health promotion.

20. CONT…..
Undertake a comprehensive clinical assessment including risk
profiling and follow up with appropriate action, including
referral to specialists, for relevant acute and chronic health
care conditions.
• Assess, in collaboration with the patients (family/carers),
their health care needs, taking into account the impact of their
age, vulnerability, their lifestyle, cultural and ethnic
background.

21. CONT…..
Develops and evaluates a self-management plan with the patient who
has predisposing factors to liver disease.
• Works alongside and with the patient(and
• families/carers)to address the psychological and social impact of
their condition.
• Provides specific diagnostic/treatment options safely.
• Use early warning tools/approaches to identify the patient's
changing and deteriorating condition, and take appropriate action.