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Liver Diseases Nutrition
Any guesses on the largest organ in your body??? It’s simply your liver. Liver helps to digest your food, store energy and perform metabolic activities. Details on the structure and functions of the liver and its relevant diseases are discussed below.
Physiology and Functions of the Liver
Being the largest gland, the liver weighs about 1500g. The liver has two main lobes, the left and right, and these lobes are further divided into two segments each. The hepatic artery and the portal vein are the two large blood vessels connected with the liver. Bile, a thick viscous fluid secreted from the liver and formed in the liver cells, exits the liver through bile ducts which are similar to the blood vessels that are present throughout the liver.
Functions
The liver performs over 500 vital tasks. Everyday our liver helps our body by supplying it with ample energy, fighting off infections and diseases, clotting blood, acting as a filter to remove bacteria, assisting with regulating hormone balance and body cholesterol and many, many more other functions. Adding to this, the liver produces and excretes bile. These bile salts help to digest and absorb fats and fat-soluble vitamins.
Laboratory Assessment of Liver Function
Biochemical markers help to assay the presence of any liver disease. Enzyme examinations help to measure the release of liver enzymes while other tests measure liver functions.
Diseases of the Liver
Liver diseases have many root causes and these are discussed below under their relevant subheadings.
Infection
Hepatitis is inflammation of the liver due to parasites and viruses thereby reducing liver functionality. These viruses can spread through blood, semen, contaminated food or water or physical closeness with an infected person. Hepatitis A, B, C, D and E are the most common hepatitis viruses while hepatitis B and C virus are agents for liver cancer.
Others
Fulminant hepatitis, a severe liver function disorder, is a syndrome characterized by the absence of pre-existing liver diseases and the onset of hepatic encephalopathy within 2 to 8 weeks of the onset of illness. Hepatic encephalopathy is due to accumulated toxins in the bloodstream which are usually removed by the liver. This accumulation can result in coma and ultimately death. Fulminant hepatitis can cause bleeding, cardiovascular abnormalities, renal failure, pulmonary complications and pancreatitis.
If a patient is said to have hepatitis for at least 6 months with clinical evidence of liver disease and unresolved hepatitis inflammation confirmed through biopsy, the individual can be affirmed of chronic hepatitis disease. Symptoms include fatigue, sleep disorders, lost focus and concentration and mild upper quadrant pain.
NASH or nonalcoholic steatohepatitis is a fatty liver disorder where fibrous tissues get accumulated in them. Obesity, drugs, malnutrition and inborn metabolic errors are few causes namely.
Alcohol
Alcoholic liver disease is very common in Western countries and results from over consumption of alcohol for a prolonged period. Risk factors include increased quantity of alcohol taken, gender, genetic factors, diet and hepatitis C infection. The disease manifestation happens through three stages.
Hepatic steatosis or fatty liver, the first stage, is caused by the accumulation of fatty acids in liver cells. Self-restriction on alcohol can easily stop this accumulation from multiplying whereas further consumption can lead to the final stage, cirrhosis.
Alcohol hepatitis, the second stage, is characterized by the inflammation of hepatocytes or liver cells. Patients may suffer from abdominal pain, anorexia, nausea, vomiting, weight loss or fever. Though this problem may be resolved with alcohol discontinuation, usually the condition progresses to the third stage.
Cirrhosis is distinct with inflammation, fibrosis (Cellular hardening) and damaged membranes. Symptoms may be similar to the previous stage or can be marked by gastrointestinal bleeding, hepatic encephalopathy or portal hypertension. Abstinence from alcohol during cirrhosis can only maintain the disease from worsening but not reverse the disease as in the first two stages.
Immune System Abnormalities
Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver. It is marked by slow destruction of the small bile ducts of the liver which result in bile and other toxins building up in the liver finally damaging the liver tissues. This leads to scarring, fibrosis and cirrhosis. PBC is predominant among women and is marked by extreme fatigue and sleepiness.
Sclerosing cholangitis, a chronic cholestatic liver disease, is characterized by inflammation of segments of extrahepatic bile ducts with or without the involvement of intrahepatic ducts. Primary sclerosing cholangitis (PSC) is the most common type of sclerosing cholangitis. PSC is present along with inflammatory bowel disease and is predominant among men than women.
Genetics or Inherited Disorders
An abnormal gene inherited from either or both of the parents can end up in various substances building up in your liver, resulting in liver diseases. Hemochromatosis, Wilson’s disease and α1-antitrypsin deficiency are the most common genetic disorders causing liver failure. Hemochromatosis is due to excessive iron overload. HFE gene from either of the parent is often the cause for this disease. Symptoms of this disease overlap with common symptoms like joint pain, abdominal pain, diabetes, fatigue and weakness. Treatment is to regularly remove blood from the body as in blood donation. This lowers iron levels as most of the iron is contained in red blood cells.
Wilson’s disease is characterized by excess copper accumulation in liver, brain and other vital organs. Fatigue, jaundice, fluid accumulation in legs and abdomen, muscle stiffness, impaired speech and lack of physical coordination are manifestations of the disease. Unlike hemochromatosis, Wilson’s disease is passed on only if two copies of the defective gene, one from each parent, are inherited. Doctors usually prescribe chelating agents as medication. These agents help the organs to release copper into the bloodstream which is finally excreted as urine.
α1-antitrypsin deficiency results in both liver and lung disease affecting both males and females equally. Cholestasis or cirrhosis is caused due to this deficiency. Liver transplantation is the only treatment possible for this disease.
Treatment of Cirrhosis and its Complications
Cirrhosis occurs in response to damage to the liver. Each time the damaged liver tries to repair itself, scar tissues are formed in this process. As cirrhosis advances scar tissues increase making it impossible for the liver to function properly.
Complications of cirrhosis include enlargement of the spleen, swelling in legs and abdomen, infections, malnutrition, toxin accumulation in the brain, jaundice and liver cancer.
Nutrient Requirements
Energy requirements differ depending on the patient undergoing treatment. Lipids and amino acids are preferred over carbohydrates for energy. Patients with cirrhosis require additional protein requirements that normal persons. Vitamin and mineral supplementation is a must for all cirrhosis patients because of the important role of liver nutrient transport, storage and metabolism. Iron supplementation depends on the liver disease at hand. In Wilson’s disease a vegetarian diet is useful because of reduced copper content in the diet.
Portal Hypertension
Portal hypertension results in varices in the gastrointestinal tract. These varices bleed resulting in medical emergency. Treatment for bleeding can be pharmacologic, endoscopic, decompression, devascularization and transplant. Oral pharmacotherapy is used to reduce initial bleed and avoid rebleeding. Decompression of varices is by surgical or by radiologic shunt. Devascularization is a procedure to interrupt the inflow into the gastroesophageal varices.
During acute bleeding nutrition cannot be administered enterally. Repeated endoscopic therapies may affect a patient’s swallowing ability.
Ascites
Ascites is the accumulation of fluid due to portal hypertension in the space between the lining of the abdomen and the abdominal organs. Pathogenesis of ascites involves portal hypertension, altered sodium and water handling and hypoalbuminemia. Treatment primarily involves restricting sodium intake to 2gm/day.
Hyponatremia
Hyponatremia occurs due to decreased ability to excrete water due to abnormally low sodium levels and excessive diuretic use. You need to simply cut back on the level of fluid intake and continue moderate sodium consumption to treat hyponatremia.
Hepatic Encephalopathy
Ammonia is the main factor that causes hepatic encephalopathy. Brain edema, infections, constipation, kidney problems and bleeding are other causes of this disease. Multiple treatment options are available for people with this disease. Lactulose, an artificial form of sugar not absorbed by the body, can be given to the patient as a first step. This lowers ammonia production in the intestine by creating a hostile environment for the bad bacteria. Antibiotics, probiotics, branched-chain amino acids and thiamine are other available treatment options. If all these fail, it is always better to go for a liver transplantation.
Glucose Alterations
People with liver disease have glucose intolerance due to insulin resistance in peripheral tissues. Hypoglycemia is decreased availability of glucose and occurs in Fulminant liver failure more frequently. Diabetic patients are always advised to adhere to strict medical and nutrition therapies. Hypoglycemia patients should be encouraged to consume frequent meals at regular intervals.
Subheadings ‘Fat Malabsorption’ ‘Renal Insufficiency and Hepatorenal Syndrome’ and ‘Osteopenia’ have been omitted.
Liver Resection and Transplantation
Protein and energy need increase after liver resection. Nutrition needs are also a concern with patients having hepatocellular carcinoma or cholangiocarcinoma. Liver transplantations have increased in patients having severe liver diseases. But these transplants result in malnutrition which can be compensation by dietary modifications. Medications prescribed after a transplant has nutritional side effects which should be taken care of while suggesting diet changes for the patients. These modifications also help to prevent or treat problems like obesity, hyperlipidemia, hypertension, Osteopenia and diabetes mellitus.
Any guesses on the largest organ in your body??? It’s simply your liver. Liver helps to digest your food, store energy and perform metabolic activities. Details on the structure and functions of the liver and its relevant diseases are discussed below.
Physiology and Functions of the Liver
Being the largest gland, the liver weighs about 1500g. The liver has two main lobes, the left and right, and these lobes are further divided into two segments each. The hepatic artery and the portal vein are the two large blood vessels connected with the liver. Bile, a thick viscous fluid secreted from the liver and formed in the liver cells, exits the liver through bile ducts which are similar to the blood vessels that are present throughout the liver.
Functions
The liver performs over 500 vital tasks. Everyday our liver helps our body by supplying it with ample energy, fighting off infections and diseases, clotting blood, acting as a filter to remove bacteria, assisting with regulating hormone balance and body cholesterol and many, many more other functions. Adding to this, the liver produces and excretes bile. These bile salts help to digest and absorb fats and fat-soluble vitamins.
Laboratory Assessment of Liver Function
Biochemical markers help to assay the presence of any liver disease. Enzyme examinations help to measure the release of liver enzymes while other tests measure liver functions.
Diseases of the Liver
Liver diseases have many root causes and these are discussed below under their relevant subheadings.
Infection
Hepatitis is inflammation of the liver due to parasites and viruses thereby reducing liver functionality. These viruses can spread through blood, semen, contaminated food or water or physical closeness with an infected person. Hepatitis A, B, C, D and E are the most common hepatitis viruses while hepatitis B and C virus are agents for liver cancer.
Others
Fulminant hepatitis, a severe liver function disorder, is a syndrome characterized by the absence of pre-existing liver diseases and the onset of hepatic encephalopathy within 2 to 8 weeks of the onset of illness. Hepatic encephalopathy is due to accumulated toxins in the bloodstream which are usually removed by the liver. This accumulation can result in coma and ultimately death. Fulminant hepatitis can cause bleeding, cardiovascular abnormalities, renal failure, pulmonary complications and pancreatitis.
If a patient is said to have hepatitis for at least 6 months with clinical evidence of liver disease and unresolved hepatitis inflammation confirmed through biopsy, the individual can be affirmed of chronic hepatitis disease. Symptoms include fatigue, sleep disorders, lost focus and concentration and mild upper quadrant pain.
NASH or nonalcoholic steatohepatitis is a fatty liver disorder where fibrous tissues get accumulated in them. Obesity, drugs, malnutrition and inborn metabolic errors are few causes namely.
Alcohol
Alcoholic liver disease is very common in Western countries and results from over consumption of alcohol for a prolonged period. Risk factors include increased quantity of alcohol taken, gender, genetic factors, diet and hepatitis C infection. The disease manifestation happens through three stages.
Hepatic steatosis or fatty liver, the first stage, is caused by the accumulation of fatty acids in liver cells. Self-restriction on alcohol can easily stop this accumulation from multiplying whereas further consumption can lead to the final stage, cirrhosis.
Alcohol hepatitis, the second stage, is characterized by the inflammation of hepatocytes or liver cells. Patients may suffer from abdominal pain, anorexia, nausea, vomiting, weight loss or fever. Though this problem may be resolved with alcohol discontinuation, usually the condition progresses to the third stage.
Cirrhosis is distinct with inflammation, fibrosis (Cellular hardening) and damaged membranes. Symptoms may be similar to the previous stage or can be marked by gastrointestinal bleeding, hepatic encephalopathy or portal hypertension. Abstinence from alcohol during cirrhosis can only maintain the disease from worsening but not reverse the disease as in the first two stages.
Immune System Abnormalities
Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver. It is marked by slow destruction of the small bile ducts of the liver which result in bile and other toxins building up in the liver finally damaging the liver tissues. This leads to scarring, fibrosis and cirrhosis. PBC is predominant among women and is marked by extreme fatigue and sleepiness.
Sclerosing cholangitis, a chronic cholestatic liver disease, is characterized by inflammation of segments of extrahepatic bile ducts with or without the involvement of intrahepatic ducts. Primary sclerosing cholangitis (PSC) is the most common type of sclerosing cholangitis. PSC is present along with inflammatory bowel disease and is predominant among men than women.
Genetics or Inherited Disorders
An abnormal gene inherited from either or both of the parents can end up in various substances building up in your liver, resulting in liver diseases. Hemochromatosis, Wilson’s disease and α1-antitrypsin deficiency are the most common genetic disorders causing liver failure. Hemochromatosis is due to excessive iron overload. HFE gene from either of the parent is often the cause for this disease. Symptoms of this disease overlap with common symptoms like joint pain, abdominal pain, diabetes, fatigue and weakness. Treatment is to regularly remove blood from the body as in blood donation. This lowers iron levels as most of the iron is contained in red blood cells.
Wilson’s disease is characterized by excess copper accumulation in liver, brain and other vital organs. Fatigue, jaundice, fluid accumulation in legs and abdomen, muscle stiffness, impaired speech and lack of physical coordination are manifestations of the disease. Unlike hemochromatosis, Wilson’s disease is passed on only if two copies of the defective gene, one from each parent, are inherited. Doctors usually prescribe chelating agents as medication. These agents help the organs to release copper into the bloodstream which is finally excreted as urine.
α1-antitrypsin deficiency results in both liver and lung disease affecting both males and females equally. Cholestasis or cirrhosis is caused due to this deficiency. Liver transplantation is the only treatment possible for this disease.
Treatment of Cirrhosis and its Complications
Cirrhosis occurs in response to damage to the liver. Each time the damaged liver tries to repair itself, scar tissues are formed in this process. As cirrhosis advances scar tissues increase making it impossible for the liver to function properly.
Complications of cirrhosis include enlargement of the spleen, swelling in legs and abdomen, infections, malnutrition, toxin accumulation in the brain, jaundice and liver cancer.
Nutrient Requirements
Energy requirements differ depending on the patient undergoing treatment. Lipids and amino acids are preferred over carbohydrates for energy. Patients with cirrhosis require additional protein requirements that normal persons. Vitamin and mineral supplementation is a must for all cirrhosis patients because of the important role of liver nutrient transport, storage and metabolism. Iron supplementation depends on the liver disease at hand. In Wilson’s disease a vegetarian diet is useful because of reduced copper content in the diet.
Portal Hypertension
Portal hypertension results in varices in the gastrointestinal tract. These varices bleed resulting in medical emergency. Treatment for bleeding can be pharmacologic, endoscopic, decompression, devascularization and transplant. Oral pharmacotherapy is used to reduce initial bleed and avoid rebleeding. Decompression of varices is by surgical or by radiologic shunt. Devascularization is a procedure to interrupt the inflow into the gastroesophageal varices.
During acute bleeding nutrition cannot be administered enterally. Repeated endoscopic therapies may affect a patient’s swallowing ability.
Ascites
Ascites is the accumulation of fluid due to portal hypertension in the space between the lining of the abdomen and the abdominal organs. Pathogenesis of ascites involves portal hypertension, altered sodium and water handling and hypoalbuminemia. Treatment primarily involves restricting sodium intake to 2gm/day.
Hyponatremia
Hyponatremia occurs due to decreased ability to excrete water due to abnormally low sodium levels and excessive diuretic use. You need to simply cut back on the level of fluid intake and continue moderate sodium consumption to treat hyponatremia.
Hepatic Encephalopathy
Ammonia is the main factor that causes hepatic encephalopathy. Brain edema, infections, constipation, kidney problems and bleeding are other causes of this disease. Multiple treatment options are available for people with this disease. Lactulose, an artificial form of sugar not absorbed by the body, can be given to the patient as a first step. This lowers ammonia production in the intestine by creating a hostile environment for the bad bacteria. Antibiotics, probiotics, branched-chain amino acids and thiamine are other available treatment options. If all these fail, it is always better to go for a liver transplantation.
Glucose Alterations
People with liver disease have glucose intolerance due to insulin resistance in peripheral tissues. Hypoglycemia is decreased availability of glucose and occurs in Fulminant liver failure more frequently. Diabetic patients are always advised to adhere to strict medical and nutrition therapies. Hypoglycemia patients should be encouraged to consume frequent meals at regular intervals.
Subheadings ‘Fat Malabsorption’ ‘Renal Insufficiency and Hepatorenal Syndrome’ and ‘Osteopenia’ have been omitted.
Liver Resection and Transplantation
Protein and energy need increase after liver resection. Nutrition needs are also a concern with patients having hepatocellular carcinoma or cholangiocarcinoma. Liver transplantations have increased in patients having severe liver diseases. But these transplants result in malnutrition which can be compensation by dietary modifications. Medications prescribed after a transplant has nutritional side effects which should be taken care of while suggesting diet changes for the patients. These modifications also help to prevent or treat problems like obesity, hyperlipidemia, hypertension, Osteopenia and diabetes mellitus.
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Dr. Nafeesa Imteyaz of First Eat Right clinic, is the Best Dietitian Nutritionist in Bangalore. Best Dietitian Nutritionist in Pune. Best Dietitian Nutritionist in Hyderabad. Best Dietitian Nutritionist in Chennai. Best Dietitian Nutritionist in Mumbai. Best Dietitian Nutritionist in Delhi. Best Dietitian Nutritionist in Kolkata.