Nutrition for Liver,

Gallbladder and
pancreas Diseases
WEINONA M. LIGASON,RND
 The Liver
•The most active organ in the Roles
body ◦Processes, stores, &
redistributes nutrients
◦Produces bile
◦Synthesizes protein
◦Detoxifies drugs & alcohol
◦Processes excess nitrogen
Diseases of the Liver
Hepatitis
Fatty liver
Cirrhosis
Hepatic Encephalopathy
Hepatitis
Liver inflammation
Results from any factor causing liver damage
◦ Viruses A, B, & C
◦ Excessive alcohol
◦ Exposure to certain drugs & toxic chemicals
◦ Some herbal remedies
 Types of Hepatitis
Hepatitis A
◦ Extremely contagious
◦ Most common
◦ Cause: fecal-oral
Hepatitis B
◦ Blood contact
◦ Sexual contact
◦ Vaccinations available
Hepatitis C
◦ Blood contact
◦ Major cause of chronic hepatitis
Hepatitis
Symptoms
◦Mild & chronic may be asymptomatic
◦Acute
◦ Fatigue, nausea, anorexia
◦ Pain in liver area
◦ Enlarged liver & jaundice
◦ Fever, headache
◦ Muscle weakness, skin rashes
◦ Elevated liver enzymes
Treatment
Supportive care, bed rest, nutritious diet
Hepatitis B & C need antiviral agents
Non-viral: anti-inflammatory &
immunosuppressant drugs
Fatty Liver
Accumulation of fat in the Associated with
liver ◦Obesity
Causes ◦Diabetes mellitus
◦Alcoholic liver disease ◦Marasmus & kwashiorkor
◦Exposure to drugs & toxic ◦Gastrointestinal bypass
metals surgery
◦Long-term TPN
Consequences of Fatty Liver
Liver enlargement
Inflammation
Fatigue
Abnormal liver enzyme levels
Increased triglycerides, cholesterol, & glucose
Treatment
Eliminate the cause
Lower lipid levels
Stop alcohol use
Change drug treatment
Lose weight
Control blood glucose
Cirrhosis
End-stage condition
Scarring/fibrosis
Irregular, nodular appearance
Impaired liver function - can lead to liver failure
Causes of Cirrhosis
Hepatitis C
Alcoholic liver disease
Bile duct blockages
All untreated types of chronic hepatitis
Drug-induced liver injury
Some inherited metabolic disorders
Symptoms of Cirrhosis
40% of people are Later symptoms
asymptomatic ◦Anemia
Initial symptoms ◦Blood clotting impairment
◦ Fatigue ◦Susceptibility to infection
◦ Weakness ◦Jaundice & fat
◦ Anorexia malabsorption
◦ Weight loss ◦Ascites & varices
Consequence of Cirrhosis
Portal Hypertension
◦ Scar tissue of liver impedes blood flow
◦ Causes a rise in pressure in the portal vein
◦ Blood is diverted to collaterals
◦ Collaterals become enlarged & engorged, forming varices, & may rupture
◦ Esophageal
◦ Gastric
Esophageal Varix
Consequence of Cirrhosis
Ascites
◦ Accumulation of fluid in the abdominal cavity
◦ Due to
◦ Portal hypertension
◦ Reduced albumin
◦ Altered kidney function
◦ Abdominal discomfort & early satiety
◦ Weight gain
Consequences of Cirrhosis
Hepatic encephalopathy oElevated blood ammonia
◦ Abnormal neurological oMalnutrition & wasting
functioning
◦ Amnesia, seizures, hepatic
coma
 Treatment of Cirrhosis
Individualize Drug therapy
Supportive care ◦Diuretics
◦Appropriate diet ◦Appetite stimulants
◦Avoidance of liver toxins ◦Laxatives & antibiotic
neomycin to reduce
Abstinence from alcohol ammonia
Liver transplant
Medical Nutrition Therapy Liver
Diseases
Energy
◦ BEE + stress factor
◦ 4-6 feedings/day
Protein
◦ High enough to maintain nitrogen balance
◦ 0.8-1.2 g/kg
CHO & fat
◦ Complex CHO
◦ May need to restrict fat with steatorrhea
Medical Nutrition Therapy
Sodium & Fluid
◦ With ascites, need to restrict fluid and sodium
Vitamins & minerals
◦ Multivitamin supplementation
◦ Liquid form if patient has varices
Enteral & parenteral
◦ Specialized enteral products high in kcalories
◦ Parenteral if patient has obstructions, bleeding, vomiting
Liver Transplantation
Only option when liver failure occurs
Hepatitis C & alcoholic liver disease account
for 40% of cases
Most patients are already malnourished
Liver Transplantation
Post-transplant concerns
◦Organ rejection
◦Infection
Immunosuppressive drugs affect nutrition status
Diet: increased protein & energy requirements
Gallbladder
The role of the gallbladder is to store bile, which is made by the liver.
Bile helps digest and break down fat.
Gallstones are made when the cholesterol in bile forms hard stones.
Your risk for developing gallbladder disease may increase if you:
 are a woman, are over the age of 60 take cholesterol-lowering medications,
are pregnant, take hormone replacement therapy, take birth control pills, are
overweight, have diabetes, have lost weight very quickly, fast (go without
eating for long periods of time)
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
 Gallbladder Disease
Consequences of gallstones Risk factors for gallstones
◦ Many asymptomatic ◦ Ethnicity
◦ Other symptoms—usually occur when gallstones ◦ Age & gender (most cases women)
block cystic duct ◦ Pregnancy
◦ Steady & severe pain ◦ Obesity & weight loss
◦ Nausea, vomiting, bloating ◦ Other risk factors
◦ Symptoms mainly occur after meals, especially fatty ◦ Long-term TPN
foods ◦ Medications
◦ High TG levels
Complications
◦ Cholecystitis Treatment
◦ Low fat diet
◦ Peritonitis
◦ Cholecystectomy
◦ Blockage of common bile duct
◦ Non-surgical
◦ Infection
◦ Capsule urso-deoxycholic acid (cholesterol production; used on small
stones)
◦ Shock-wave lithotripsy (used on few and larger stones)
PANCREATITIS
 Pancreatitis is a disease in which your
pancreas becomes inflamed.

The pancreas is a large gland behind your

stomach and next to your small intestine.

 Your pancreas does two main things:

It releases powerful digestive enzymes into
your small intestine to help you digest food.
NUTRITION THERAPY
Treatment :
In Acute Phase -----parenteral nutrition, later as patient tolerates
clear liquid oral diet mainly CHOs as they have less stimulatory effect
on pancreatic secretion.
 As recovery progresses, small frequent feedings of CHO and
proteins with little fat or fiber is given.
The fat is restricted.
The patient is gradually returned to less restricted diet as tolerated.
For Chronic Pancreatitis the goal of nutrition therapy
are to reduce steatorrhea, to minimize pain and to
avoid attacks by:
• Limiting Fat to the maximum amount the patient can
tolerate without causing steatorrhea ,to or pain---usually 50
g/day or less.
• Provide liberal quantities of CHOs and proteins.
Nutrition in Practice
Alcohol in Health &
Disease

© 2007 THOMSON - WADSWORTH

Alcohol
Primary cause of liver Moderate alcohol
disease ◦Can help with heart
Can be toxic to brain, GI disease
tract, & pancreas ◦Middle-aged & older adults
Abuse leads to nutrient ◦Increases HDLs
deficiencies ◦Reduces tendency for
blood clotting
Dietary Guidelines
Women, 1 drink/day
Men, 2 drinks/day
One drink
◦ 12 oz beer
◦ 5 oz wine
◦ 10 oz wine cooler
◦ 1½ oz of 80 proof spirits
One drink =
Contraindicated
Pregnant & lactating
Children & adolescents
Those with potential medication interactions
Those unable to voluntarily stop
Activities requiring attention & coordination
Alcohol in the Body
Supplies 7 kilocalories/gram
Liver is the site of most metabolism
Suppresses glycogen storage & glucose availability
Suppresses breakdown of fat
Can inhibit protein synthesis
Alcohol & the Brain
Is a CNS depressant In excess
◦ Impairs judgment
◦Can cause sedation ◦ Reduces inhibitions
◦Slow reaction time ◦ Impairs speech & motor
◦Relieve anxiety function
Extremely high levels
◦ Coma
◦ Respiratory depression
◦ Death
Long-Term Consequences
Liver disease
Damaged GI tract
Damaged pancreas
Can raise heart attack risk
Alcohol & Nutrition Status
Heavy drinking can increase medication potency
Problematic with
◦Sedatives
◦Blood glucose-lowering medications
Can reduce drug absorption