Transcript Alcoholic liver disease

HCFN 430
Carine Souza
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The liver performs many essential functions for life. These functions include
metabolism, synthesis and storage of nutrients. The liver is essential in the
metabolism of alcohol. Alcohol is produced through the fermentation of
yeast, sugars and starches, and it can be divided in three main categories.
Liver damage is a common consequence of chronic alcoholism. Alcoholism is
a physical dependence characterized by the excessive intake of alcohol.
Malnutrition is often observed among these population because alcohol
interferes with nutrients digestion, absorption, storage, utilization and
excretion. Acute or chronic alcohol abuse can lead to alcoholic liver
disease. The etiology of the disease is related to genetic factors, toxicity of
alcohol and personal susceptibility. The effects of alcoholic liver disease
varies among individuals depending on the time and quantity of alcohol
abuse. Alcoholic liver disease can progress in three stages: fatty liver,
hepatitis and cirrhosis. Fatty liver is the most common alcoholic liver
disease and it is marked by excessive accumulation of fat in the liver.
Alcoholic hepatitis is characterized by inflammation of the liver cells that
occur with the consumption of a large quantity of alcohol over a period of
time. Alcoholic cirrhosis is the final stage of the disease; and it is
characterized by the replacement of healthy tissue for scar tissue. Some of
the symptoms of the alcoholic liver disease include accumulation of fluids
in the abdomen, liver cancer, enlarged spleen, kidney failure, jaundice and
high blood pressure in the liver. Physical recover may be possible with
proper nutrition, alcohol abstinence and if adequate exercise is followed.
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The liver is the largest gland in the
body
The cells in the liver are called
hepatocytes
Hepatocytes have different
concentration of glycolytic enzymes
and enzymes involved in lipid
metabolism
Two lobes (right and left) that are
enclosed and divided in a common
connective tissue
The portal vein an the hepatic artery
carries blood that enter the liver
The average flow of blood through the
liver is 1,400ml/min
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Available at:
http://www.clarian.org/ADAM/doc/graphics/images/e
n/8848.jpg. Accessed on February 13, 2010.
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Metabolism of nutrients (carbohydrates, lipid, protein,
vitamins, minerals and alcohol)
Stores glucose as glycogen (glycogenesis) and break down
glycogen to glucose (glycogenolysis)
Synthesize fatty acids
Source of factors necessary for blood coagulation
Source of albumin
Control the concentration of many nutrients
Prepare waste materials to be disposed in the urine
Production of bile
Vitamin A storage
Stores Vitamin D, Vitamin E and a small amount of vitamin K
Stores iron, copper and influence the metabolism of sodium,
potassium, calcium, phosphorus and chloride.
The liver is essential in the metabolism of ALCOHOL
Detoxication (hormones, toxins, drugs)
Alcohol can be divided into three categories: beer,
wine and distilled liquor
 Produced by the fermentation of yeast, starches
and sugars
 Rapidly absorbed from the stomach and small
intestine into the bloodstream
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Drink
Amount
(oz)
Absolute
Alcohol
(g)
Total
Calories
Beer
12
12
144
Wine
5
12
105
Liquor
1.5
12
96
Available at:
http://www.infoniac.com/uimg/alcoh
ol-drinks.jpg. Accessed on February
13, 2010.
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Chronic alcohol intake influence regulatory
factors of appetite and inflammation, which may
decrease the amount eaten
 Alcohol damages the mucosa of the upper
gastrointestinal tract
 Alcohol interferes with the nutrition process by
affecting digestion, absorption, storage,
utilization and excretion of nutrients
 It is recommended to drink alcohol in
moderation, meaning no more than one drink a
day for women and two drinks a day for men.
 1g of alcohol provides 7.1kcal
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A physical dependence
characterized by excessive
consumption of alcohol
accompanied by alcohol
dependence and impaired
control
Affects 9 to 11 million people in
the United States
Cause acute effects (shortly
after intake) or can cause
effects with chronic abuse
Have social, economic and
physiologic consequences
including liver disease
Research suggests that certain
genes can increase the risks for
alcoholism
Available at:
http://3.bp.blogspot.com/_LYoXnaQeh2k/SkrioLVCi
FI/AAAAAAAAAaM/Iyay1rK5GYs/s320/alcoholism.jp.
Accessed on February 13, 2010.
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 Alcoholics
often eat poorly, consequently
their supply of essential nutrients are limited
which affect body energy supply and
maintenance
 Malnutrition is often observed in this
population because of:
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Gastrointestinal problems
Reduced nutrient absorption
Metabolic changes
Increased excretion of nutrients
Available at: http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=79921. Accessed on February 13, 2010.
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 Preventable
disease caused after years of
excessive consumption of alcohol
 Most common liver disease in the US
 About 20 million people in the US have some
degree of alcoholic liver disease
 In 2006, it was reported 13,050 cases of
alcoholic liver disease deaths
 Alcoholic Liver Disease progress in three
stages:
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Fatty Liver (also called steatosis)
Alcoholic Hepatitis
Alcoholic Cirrhosis
 Genetic
factors (predisposition for alcohol
abuse)
 Personal susceptibility to alcohol-induced
liver disease (availability to alcohol, social
acceptability of alcohol use)
 Toxicity of alcohol to the liver
 Most
common alcoholic liver disease
 Affects 10 to 24% of the US population
 Occurs after acute alcohol ingestion
 Marked by the excessive accumulation of fat
inside the liver cells (mainly triglycerides)
 In the presence of ethanol, long-chain fatty
acids in diet have a greater tendency than
medium-chain fatty acids to promote fatty
liver
 Reversible with alcohol abstinence
 Enlargement
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of the liver
Abdominal discomfort
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Available at:
http://www.livers.org.nz/images/LIVER/Fatty_change.jpg.
Accessed on February 13, 2010.
 Acute
form of alcoholic liver
disease that occur with the
consumption of a large
quantity of alcohol over a
period of time
 Characterized by
inflammation and more
severe injury of the liver
 Destruction of hepatic cells
and scarring
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Available at:
http://atlas.kennesaw.edu/~dmurphy3/imageSRI.
JPG. Accessed on February 13, 2010.
 Fever
 Jaundice
 Increased
white blood cells count
 Enlarged and tender liver
 Spider-like veins in the skin
 Accumulation of fluids in the abdominal
cavity
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The 11th leading cause of death in the US
Final stage of alcoholic liver disease
Condition in which the liver slowly deteriorate in
consequence of chronic injury
Alcoholic Cirrhosis destroys normal liver tissue producing
scar in the liver
Scar tissue is formed because of injury or long-term
disease
Scar tissue replaces healthy tissue but it cannot work as
properly as healthy tissues
Scar tissue block the normal flow of blood through the
liver
Scarring from cirrhosis is irreversible
Can be life-treating but can also be controlled with proper
treatments
About 5% of individuals with cirrhosis will also develop
liver cancer
 Weakness
 Fatigue
 Nausea
 Vomiting
 Ascites
 Loss
of appetite
 Weight loss
 Abdominal pain
 Itching
Available at: http://protectyourliver.com/images/liver_damage.gif. Accessed on February 13, 2010.
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Available at: http://www.cwu.edu/~bergmane/images/Normal%20Liver,%20Fatty%20Liver,%20and%20Cirrhosis.GIF. Accessed on February 13,
2010.
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Enlarged liver
Liver cancer
Accumulation of fluids in the abdomen
Kidney failure
Increased white blood cell count
High blood pressure in the liver
Spider-like veins in the skin
Fever
Jaundice (yellowing of the skin and eyes)
Enlarged spleen
Confusion
Dry mouth
Excessive thirst
Development of insulin resistance
Induced Wernicke-Korsakoff
Induced Beri-beri disease
 Lifestyle
and medical
history related to
alcohol
 Blood test: INR,
bilirubin, creatinine
 X rays, magnetic
resonance imaging
and ultrasound
images
 Liver biopsy (most
accurate)
Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis.
Accessed on February 13, 2010.
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NI-1.4 Inadequate energy intake  Empty calories from alcohol
reduce appetite and food intake
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NI-5.2 Malnutrition  Malnutrition and nutrient deficiencies are
common among alcoholics because of the decreased dietary intake,
malabsorption, alterations in metabolism of nutrients, decreased
storage and increased losses of nutrients
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NI-5.9.1 Inadequate vitamin intake Folic acid, thiamin and
vitamin B6 deficit is common ALD patients because of their inability
to absorb these vitamins from foods, which can lead to decreased
serum folate and induced-beri beri
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NI-5.7.1 Inadequate protein intake Protein energy
malnourishment aggravates ALD
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NC-1.4 Altered GI function Impaired oxidation of triglycerides
Nutrition support is essential for improvement
 Malnourished alcoholics should be recommended a
high-calorie, well-balanced and nutritious diet, rich
in complex carbohydrates, dietary fiber and protein
 Calories: 35-40 kcal/kg body weight based on
adequate weight rather than current weight
 Protein, CHO and fat recommendations:
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Alcoholic Hepatitis
 1.5-2 g protein/kg body weight
 High carbohydrate 30-35 g/kg body weight
 Moderate fat
Alcoholic Cirrhosis
 1-2 g protein/kg body weight
 High carbohydrate 30-35 g/kg body weight
 Moderate fat
Personalized meal plan
 Eat 4 to 6 small meals a day instead of 3 large
ones
 Adequate fluid intake
 Vitamin and mineral supplementation (especially
thiamin, folate and vitamin B6)
 When possible liquid supplements should be
administered orally or via enteral tube feedings
 Strict abstinence from alcohol is necessary for
the liver to recover
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NOT Recommended
Foods/Beverages
Recommended Foods/Beverages
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Fresh vegetables and
fruits
Whole-wheat grains
Lean meat
Health snacks: nuts,
cheese, yogurt, wholegrain crackers, sunflower
seeds
Drink 8 glasses of fluids
each day
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Avoid foods that are high in
sodium, such as canned soups,
canned vegetables, processed
meats and cheeses,
condiments, and snack foods
Avoid foods that can cause
food borne illnesses such as
unpasteurized or raw milk, raw
or undercooked meat, raw or
undercooked eggs , unwashed
fresh fruits and vegetables,
unpasteurized fruit and
vegetable juices and cider and
all raw vegetable sprouts
Foods prepared with alcohol
Foods and beverages
containing caffeine
Foods high in sugar
Meal
Menu
Breakfast
½ cup oatmeal with 1tsp of brown sugar
1 cup of soymilk
2 slices whole wheat toast with1tsp margarine and
1tsp of strawberry jam
1 egg
Morning Snack
6 oz yogurt with 2 tbs granola
Lunch
1 cup low-sodium chicken noodle soup
2 slices of whole wheat bread
3oz of lean turkey
1 tsp of mayonnaise
4 baby carrots
1 banana
1 cup of soymilk
Afternoon Snack
1 cup of liquid high-calorie supplement (such as
Boost or Ensure)
5 whole wheat, no-salt-added crackers
Dinner
4 oz pork tenderloin
1 small baked sweet potato with 2 teaspoons
margarine
½ cup stir-fried broccoli, pea pods, onion, and
mushrooms
½ cup mixed fresh fruit
Evening Snack
2 cookies
Available at: http://www.womenfitness.net/wfimgank7/balance_diet.jpg. Accessed on February 13, 2010.
 Medications
 Liver
transplant (most alcoholics do not
qualify for transplant)
 Social support
 Psychotherapy
 Exercise
Available at:
http://www.providence.org/resources/everett/GroupTh
erapy.jpg Accessed on February 13, 2010.
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 Liver
function tests
 Prothrombin Test
 Bilirubin Test
 Hepatitis markers
 Blood counts
 Protein levels
 Vitamin and mineral levels
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Hemogram
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Hemoglobin
Hematocrit
Platelet count
Blood Chemistry
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Liver Enzymes
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Gamma glutamyl
transferase, gamma
glutamyl transpeptidase
(GGT)
Serum glutamyicoxaloacetic transaminase
(SGOT), serum glutamic
pyruvic transaminase
(SGPT)
Toxicology
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Blood alcohol content
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Glucose
Blood urea nitrogen (BUN)
Creatinine
Albumin
Total protein
Serum folate
Triglycerides
Urinalysis
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Bilirubin
Ketones
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is not enough evidence to support the
effectiveness of medications in the
treatment of ALD
 Patients with cirrhosis are more sensitive to
medications
 Some examples of medications used are:
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Pentoxifylline
Corticosteroid (alcoholic hepatitis)
Diuretic  edema
Oral antibiotics  prevent infections
Beta-blocker or nitrate  portal hypertension
Medication
Pentoxifylline
Corticosteroid
Diuretic
Beta-blocker or
nitrate
Nutritional Interaction/Monitoring
Recommendation
•No caffeine
•Take with food
•Fluid needs may increase
•Weight and appetite may decrease
•Should be consumed with food or milk to decrease
GI distress
•Sodium intake should decrease
•Adequate potassium, protein, Ca, Phos, Zn, Fol,
Vits A,B6,C,D should be consumed
•Take on an empty stomach or with milk
•Some diuretics cause loss of potassium, calcium
and magnesium
•Monitor glucose levels, weight, blood pressure
•Take with food
•Alcohol should be avoided
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Alcohol and your liver
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