Chapter 18 Liver, Gallbladder, and Pancreas

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Chapter 18 Liver, Gallbladder, and Pancreas

• NURS 210 - 2005

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Medical Nutrition Therapy for Liver Problems

• Fatty liver
• Viral hepatitis
• Cirrhosis
• Liver transplantation

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Fatty Liver

• Triglyceride build up in the liver
• Can be reversed if causative agent is removed
• e.g., alcohol
• Diet therapy well-balanced diet

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Hepatitis A

• Cause Inflammation caused by virus hepatitis A
• Transmission Oral-fecal route
• Preventive measures
• Hand washing, sanitation
• Avoid contaminated food and water, uncooked
  shellfish
• Get vaccinations
• Food handling permits and inspections in
  restaurants
• Vaccination

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Medical Nutrition Therapy for Hepatitis

• High amount of fluids per day
• IVs (and bedrest)
• Clear liquid to full liquid diet
• Small frequent feedings
• High kcalories
• High-quality protein
• Moderate carbohydrate and fat
• Fats limited only if steatorrhea present
• Multiple vitamins
• No alcohol

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Medical Nutrition Therapy for Cirrhosis

• Group presentation
• Medical nutrition therapy
• Small frequent meals
• Kcalories and CHO high to prevent protein
  catabolism
• Vitamins and moderate protein and fat
• Fluids to balance intake and output
• Protein restricted if encephalopathy (from
  ammonia)
• Sodium and fluids restricted if edema or ascites
• See page 534 related to fluid restriction
• Avoid rough foods if esophageal varices

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Normal vs. Cirrhotic Liver Cells
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Medical Nutrition Therapyfor Liver
Transplantation

• Pretransplant
• Calories and protein to decrease protein
  catabolism and correct deficiencies
• Posttransplant 4-8 weeks
• TPN or tube feeding
• Between meal supplements when PO
• Long-term
• Healthy, well-balanced diet

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Medical Nutrition Therapyfor Gallbladder Problems

• Know terms
• Cholelithiasis
• Choledocholithiasis
• Cholecystitis
• Causes high fat diet or very low calorie diet
• Nutrition
• Avoid foods that cause pain
• Low fat diet
• Postoperative clear liquids to regular diet, low
  fat if needed

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Medical Nutrition Therapy for Problems of the
Pancreas

• Pancreatitis
• Autodigestion if enzymes leak
• Diabetes mellitus
• Discussed in Chapter 19
• Cystic fibrosis
• Thick secretions

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Medical Nutrition Therapy for Acute Pancreatitis

• Initial goal keep pancreas at rest
• Nothing by mouth (NPO)
• IVs for hydration
• Enteral feedings if below pancreatic duct
  low-fat elemental formulas
• Total parenteral nutrition (TPN)
• Guidelines when patient can eat
• Fat limited (MCT oil preferred)
• High protein and carbohydrates, six small meals
• Pancreatic enzyme replacement by mouth
• No alcohol

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Cystic Fibrosis

• Pathophysiology
• Autosomal recessive inherited disease of
  mucus-producting exocrine glands
• High levels of
• Sodium and chloride in saliva and tears
• Electrolytes in sweat
• Viscous secretions in
• Pancreas
• Bronchi
• Bile ducts
• Small intestine

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Medical Nutrition Therapyfor Cystic Fibrosis

• Kcalories based on
• BMR
• Activity
• Lung function
• Fat absorption
• Fat 30-40 of kcalories
• Multivitamins
• Pancreatic enzyme replacement
• With milk
• With supplemental fat or carbohydrate as needed

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Indications for Low Fat Diet

• Pancreatitis (with steatorrhea)
• Acute - NPO
• Chronic Not low fat, add enzymes vitamins
• Cystic fibrosis (with steatorrhea)
• Chronic Not low fat, add enzymes vitamins
• Cholelithiasis
• Low fat
• Coronary artery disease
• Low fat

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What have you learned?