MNT for Individuals II

-Store and release blood, filters toxic elements, metabolizes and store nutrients, regulates fluid and electrolyte balance

Increased: liver or bone disease

Decreased: scurvy or malnutrition

Increased: hepatitis, myocardial infarction, muscle malignancies

Increase: Hepatitis

Decreased: Uncontrolled diabetes with acidosis

Increased: liver disease

-All 4 (ALP, LDG, AST, ALT) are elevated

*SGOT is decreased in uncontrolled diabetes.

• -Inflammation, necrosis, jaundice, anorexia, nausea, fatigue
• *Jaundice occurs when bile ducts are blocked*

Fecal-Oral transmission of hepatitis

Sexually transmitted hepatitis

Blood to blood contact hepatitis

• -Increase fluids to prevent dehydration
• -Care for varices
• -50-55% CHo to replenish liver glycogen and spare protein
• -moderate to liberal fat intake if tolerated, limit fat is steatorrhea
• -small, frequent feedings bc of anorexia
• -encourage coffee (antioxidant)
• -multivit with B complex, C, K, zinc

• -Damaged liver tissue is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries. Blood flow through liver is disrupted.
• -Poor intake leads to deficincies
• -Protein deficiencies lead to ascites, fatty liver, impaired blood clotting

• -Normally due to cirrhosis
• -Fluid build up in peritoneal cavity
• -Occurs when blood cannot leave the liver
•   -Overgrowth blocks blood flow out of liver into vena cava, leaving pressure in the liver (can hold extra liter of blood). When too much pressure, the blood volume forces fluid to sweat through the liver into the peritoneal cavity. The fluid is mostly plasma, with a high osmolar laod--pulling in more fluid to dilute.
• -low serum albumin may be due to dilution factor

• -Occur when blood cannot enter the liver
• -Due to portal hypertension
• -Increased pressure forced blood back into collateral veins that offer less resistance

• -High Protein (.8-1 g/kg, in stress at least 1.5 g/kg)
• -High Cal (25-35 cals/kg, est by dry weight, or 1.2-1.5 X BEE)
• -Moderate to low fat 25-40%, MCT oil if needed. Fat is preferred fuel in cirrhosis, include omega-3
• -Low fib if varices, low sodium if edema
• -restrict fluid to 1-1.5L/day if hyponaturemia
• -B complex

• -Alcohol is converted to acetaldehyde and excess hydrogen which disrupts liver metabolism
• -Hydrogen replaces fat as fuel in Krebs cycle so fat accumulates in the liver and blood

• -Malnutrition (replacement of alcohol with food)
• -Alcohol interferes with absorption of thiamin, b12, vit c, folic acid (inflammation of GI tract)
• -need more b vit to metabolize alc
• -need more mg, excreted after alcohol consumption

a brain disorder due to thiamine deficiency. Symptoms of Wernicke's encephalopathy: Confusion; Loss of muscle coordination (ataxia) Leg tremor.

• -decreased to 25%
• -apathy, drowsiness, confusion, encephalopathy, coma
• -Mod-high protien (1-1.5)
• -30-35 cals/kg, 30-35% cals from fat
• -Include BCAA(leucine, isoleucine, valine)
• -Lactulose (laxative-removes nitrogen)
• -Neomycin (antibiotic)

• Cholecystitis: inflammation of the gallbladder
• -Infection causes excess water to be absorbed causing cholesterol to precipitate out leading to gallstones (cholelithiasis)

• Treatment:
• -Low fat diet, 30-45 grams
• -cholecystectomy: bile now secreted from liver directly into the intestine

• -put pancreas at rest, withhold feedings, fluid IVs
• -progress slowly, low fat
• -elemental (pre-digestd) enteral nutrition into jejunum

• -Provide oral pancreatic enzymes with meals and snacks
• -Add MCT oil to dishes, jams, jellies bc they don't need lipases
• -max fat tolerated
• -antacids
• -avoid large meals with fatty foods, alcohol

Pancreatic Enzyme Replacement Therapy

• Disease of exocrine glands-thick mucus that obstructs glands and ducts
• -chronic pulmonary disease
• -high perspiration-decreased electrolytes

• -Cal/Pro
• -may need 110-200% of normal energy needs
• -Pro: 15-20%
• -CHO: 45-55%
• -Liberal fat (35-40%)
• -vits a-e

• Hypertension >140/90
• -Obesity is leading cause
• want 120/80
• -Management: thiazide diuretics, restrict salt, weight loss, alcohol, PA
• DASH diet

• -may help in reducing hypertension
• -rich in ALA, high in monounsaturated fats
• -resveratrol in skin of grapes may lower blood pressure

• -Accumulation of lipids in large arteries
• -

• 3 or more risk factors are linked to insulin resistance, increases risk for coronary events
• -hypertension >130/85
• -elevated TG >150
• -fasting serum glucose >110
• -low HDL <40 men, <50 women
• -waist measurements >102 men, >88cm women

• LDL: <100=optimal
• Total Cholesterol: <200 desirable
• HDL: <40 (m) & <50 (f) are low
• *High homocysteine levels are independent risk factors for CHD

• -up to 35% of cals from fat, <7% from saturated fat
• -25-30 grams fiber (half soluble)
• -stanols and sterols inhibit cholesterol absorption (2-3g/day)
• -Prevent weight gain
• -Increase PA to at least 30 mins/day

• -weakened heart fails to maintain adequate output, reduces bloow flow so held in tissue (edema); dyspenea
• -decreased blood flow to kidneys causes increase secr in hormones that hold in sodium and fluid

• 1. digitalis increases strengeth of heart contraction
• 2. diuretics
• 3. diet: low sodium (2-3g), DASH diet, FR
• 4. 1.2 g pro/kg
• 5. Check thiamine status