Nutrition

in
LIVER Diseases
LIVER Diseases
1-Fatty Liver
2-Hepatitis
3- Cirrhosis

4-Gallstones
(Cholelithiasis)
1-Fatty Liver
 Fatty Liver
Accumulation of
fat in liver tissue
over the capacity
of the liver to
export it as VLDL
into blood
stream
 Fatty Liver
Causes
Accompanied
Alcoholic
Toxic by
Liver
Drugs
Disease
or Inflammation
Metals
Chronic
Liver
Diseases
Enlargement
Obesity
Malnutrition

DM Fatigue
Reversible Fatty Liver
Treatment
Fatty liver is managed by eliminating the
Causative Factor

Discontinuing Removal Weight Controlling blood

alcohol abuse of the reduction glucose level
toxic drug
or metal Rapid
weight loss
can increase Managing
the disease hyperlipidemias
progression
2-Hepatitis
Hepatitis

Causes

Acute Drug/Toxin induced

Alcoholic Hepatitis
Hepatitis

Viral Hepatitis (A, B, C,

D & E)
 Hepatitis
Highly
Symptoms
variable

Depends on CAUSE and SEVERITY of the disease

Chronic Acute
Fatigue
Nausea
Anorexia
Asymptomatic
Vomiting
Pain in the Jaundice
liver area
 Hepatitis HBV
&
Treatment HCV

Supportive Discontinuation Antiviral Agents

Care of
Alcohol/Drugs
Bed Rest Ribavarine

Adequate Interferon
Diet
 Hepatitis
Treatment
According to the Adequate
patient symptoms Diet
Persistent
Anorexia
Vomiting
Malnourished/weight loss
Small Fluid and
frequent High caloric and lean electrolyte
meals protein replacement
3-Cirrhosis
 Cirrhosis
End stage condition that
results from long term
liver disease,
characterized by
extensive SCARRING
that replaces healthy
liver tissues causing
impaired liver function
then LIVER FAILURE
Cirrhosis
 Cirrhosis
Causes
Alcoholic Liver Disease Chronic Viral Hepatitis B and C

Bile duct Obstruction (Biliary cirrhosis)

Drug-induced Liver Injury Inherited Disorders

Autoimmune Hepatitis
 Cirrhosis
Consequences

Portal
Ascites Esophageal &
Hypertension
gastric varices
Caused by:
• Portal hypertension
• Sodium and water Ruptured
retention resulted from varices can
altered kidney function cause massive
• Reduced albumin bleeding
synthesis
 Cirrhosis
Consequences
Hepatic
Elevated Malnutrition
Encephalopathy
blood and wasting
Ammonia
Caused by ammonia Due to:
toxicity. • Anorexia
Intestinal ammonia is Appears as changes • Ascites which causes
shunted through the in personality, motor rapid satiety
collaterals and bypass dysfunctions and • Vomiting, diarrhea
the liver into the may progress to and fat
systemic circulation seizures and hepatic malabsorption lead
coma to nutrient loss
 Cirrhosis
Dietary Guidelines

Energy Protein CHO

1.2 -1.5 g
Without With protein per No
malnutrition malnutrition Kg body Carbohydrates
nor ascites &/or ascites weight/day restriction

20% above 50% - 75% To

BEE above BEE prevent
wasting
 Cirrhosis
Dietary Guidelines

Fat Sodium Vitamin

and
Without With
minerals
Restrict to
malnutrition malnutrition 2 - 3 g/day Adequate
Use medium To intake either
No from diet
Chains TGs to control
restrictions or
increase ascites
calories supplements
4-Gallstones
(Cholelithiasis)
 Gallstones

Cholesterol
stones

80%

Pigment
stones
Calcium salt of
bilirubin
10 - 25%
Gallstones

Symptoms

Pain

Biliary Colic
 Gallstones

Complications

Acute and chronic

cholecystitis
If the stone lodges in the
cystic duct, it causes
irritation due to bile
entrapment and bile salts
retention, that will finally
lead to inflammation in
the gall bladder walls
 Gallstones

Complications

Cholestatic
Jaundice
If the stone lodges in the
cystic
If the duct,lodges
stones it causes
into
irritation
the common due toduct
bile bile
entrapment and bile salts
retention, that will finally
lead to inflammation in
the gall bladder walls
 Gallstones

Complications

Acute
If pancreatitis
the stone lodges in the If the stones
cystic duct, it causes lodges into the
irritation due to bile
If the stone common bile
entrapment
blocks theand bile salts duct
retention,
pancreaticthat
ductwill finally
lead to inflammation in
the gall bladder walls
 Gallstones
Treatment

Surgery

Cholecystectomy by
Laparoscopy
 Gallstones
Treatment

Non-surgical procedures

Cholecystectomy by Oral intake of

Shock wave
Laparoscopy ursodeoxycholic acid
Lithotripsy
(ursodiol)
Break
gallstones into Decrease cholesterol
pieces formation in liver and dissolve
cholesterol crystals in bile
 Gallstones
Dietary Guidelines
Fat
Protein Fiber Carbohydrates
- Use of
monounsaturated People who
Avoid protein
fats such as olive follow a fiber-rich
products high in
oil and avoid diet are at a lower -Avoid refined
fat e.g. red meat
risk of developing
saturated fats. & dairy products
gallstones
carbohydrates
Use lean and high sugar
- Omega-3 fatty - Use of whole-grain
acids may proteins e.g. foods.
bread, cereals,
minimize the risk poultry, fish, fruits & vegetables
of developing as they are a good
gallstones. soy products
source of fiber.
& legumes