DISEASE OF THE LIVER

Majors functions of the liver

• Protein function
• CHO
• Lipids
• Other function
Functions of the liver
Proteins
• Deamination
• Provision of lipids transport i.e synthesis of
lipoproteins
• Synthesis of plasma protein
• Urea formation for removal of ammonia
Functions of the liver cont’d
• Carbohydrates
• Glycogenesis- synthesis and storage of glycogen
• Conversion of galactose into glucose
• Gluconeogenesis- conversion of amino acid skeletons
(residue ) to glucose
Functions of the liver cont’d
• Lipids
• Synthesis of lipoproteins i.e lipids converted to the form that can be
transported
• Oxidation of fatty acids to acetoacetic on which is then converted to
Acetylco A (for the citric acid to produce ATP)
• Synthesis of cholesterol and phospholipids
• Formation of the bile
• Lipid formation (lipogenesis)- from CHO and protein intermediates
(stored in the adipose tissue)
Functions of the liver cont’d
• Other functions
• Circulatory functions
• Blood storage- 10% of the total volume which acts as reservoir for the
body depending on the situation
• Lymph flow- the pores of the hepatic sinusoids are permeable to
fluids and proteins and are allowed to flow. When pressure in the
liver is high, the fluids (nutrient rich) leak into the abdominal cavity
causing ascites as in liver cirrhosis.
What are the common liver tests?
Common liver test
• Serum bilirubin concentration-↑ bilirubin in the blood
is indicative of the liver inability to conjugate it and
excrete it through the bile (conjugated to albumin)
• Prothrombin time- Time it takes for blood to clot.
However , this is not specific to liver disease
• ALT- alanine aminotransferases (transaminases)
• AST (aspartate aminotransferase or SGO (serum glutei
oxaloacetic transminase
Predisposing factors to liver disease
• Viral infections- currently 5 human liver viruses have
been found and these cause hepatitis or inflammation
of the hepatic cells
• Fatty infiltration e.g kwashiorkor
• Free radicals- from the environment and life style
(hepatotoxins). This may be in the form of:
-Pesticide, fungicides, herbicides, Food additives,
nicotine, drugs, industrial waste, by products
Liver cirrhosis
• Cirrhosis is a generic name/term to describe all forms
of liver disease characterized by significant loss of
functional cells.
• It is the advanced stage of liver disease regardless of
the initial problem/cause
Types of liver cirrhosis
• Laennee’s cirrhosis – in this type alcohol is usually a
factor but not always the only one in the initial stage
of disease development. It is also the most common
type of cirrhosis
• Postnecrotec cirrhosis- usually due to viral hepatitis.
There is massive necrosis (chronic hepatitis).
• Biliary cirrhosis- loss of cells that line the biliary
ductules. Cells are damaged due to obstruction of the
Types of liver cirrhosis cont’d
biliary passage
• Cardiac or congestive cirrhosis- usually a complication
of laennees
• Other types- usually due to congenital abnormalities
in the metabolism of either iron or copper
Types of liver cirrhosis cont’d
• Note:
• in cirrhosis regenerative activity (i.e cell replacement)
still takes place but the progressive loss of functional
liver cells exceeds that of liver replacement after the
disease has been there for sometime
Early symptoms
• Nausea and Vomiting
• GIT disturbances
• Low levels of serum albumin
• Urea elevation
• Elevation of bilirubin (resulting in jaundice)
• Elevation of the transaminases
• Anaemia
Late stage symptoms
• Portal hypertension which leads to ascites or
accumulation of fluid in the peritoneum or the
peritoneal cavity
• Reduced osmotic pressure due to the liver’s inability
to synthesise albumin and the body’s retention of
sodium cause ascites.
• Oesophagus varices: varicose veins in the lower
oesophagus and sometimes stomach
Late stage symptoms cont’d
• Hepatic encephalopathy- this is the degenerative loss
of brain cells/tissue.
Signs and symptoms of encephalopathy
• Lethargy, restlessness, drowsiness, impaired
intellectual function, confusion factor hepaticus
(characteristics-offensive breath, tremors of hands
and tongue when stretched/extended)
Hepatitis
5 viruses are involved in the etiology of hepatitis
a) Hepatitis A (HAV)- formerly called infection hepatitis. Mode of
transmission- enteral i.e through contamination of food and drink

b) Hepatitis B (HBV)- formerly called serum hepatitis. Mode of

transmission- through sexual intercourse.

c) Hepatitis C (HCV)- people at risk are people with autoimmune chronic

hepatitis, people on dialysis, hemophiliac and people with compromised
immune system with opportunistic infections.
Hepatitis cont’d
d) Hepatitis D virus- related to HBV. It is found in patients with chronic
hepatitis B virus infection

e) Hepatitis E- (HEV)- recently discovered- 1983. mode of transmission-

enteral route through contaminated food and water
Symptoms and signs
1. Nausea and vomiting, diarrhea

2. Jaundice

3. Fatigue
In acute hepatitis nausea is very severe thereby causing serious
aversion of food
Dietetic management of liver disease
• Dietetic principle- diet depends on the level of liver function.
• The diet is adjusted according to the laboratory results. It may change
several times even in 24hours.
Objectives of the dietetic management
1. To rest the diseased liver- the rest may be permanent in end-stage
liver cirrhosis and temporal in acute hepatitis
2. To prevent ammonaemia
3. To treat the liver & prevent complications such as portal
hypertension which may lead to heart failure, renal failure, ascites
etc
Objectives of the dietetic management cont’d

4) Prevent hepatic coma

5) To improve the quality of life of the patient
6) To change the patient’s life style so that there is no reoccurrence
(esp for hepatitis or slow down progression of the disease in case of
cirrhosis.
Lifestyle issues such as type of the food consumed, alcohol intake,
smoking etc
Principles of dietetic management
1. Each nutrient should be considered separately
2. Diet is not static
3. Diet description- several areas to be considered
DIET FOR CIRRHOSIS
Description of the diet- a diet in which protein is adjusted continuously
in accordance with laboratory findings.
Also a diet in which sodium may be restricted particularly when fluid
retention and hypertension are present.
DIET FOR CIRRHOSIS cont’d
• In order to achieve the objectives, nutrients have to be considered
seperately,
• Energy requirements- frequent feedings of glucose should be given in
order to prevent gluconeogenesis and deamination
• Protein requirements- high biological value should be given to rest
the liver. The protein is kept to a minimum or tolerance
• Lipids- restricted to low amounts of short chain lipids. Lipids may be
completely eliminated if there is jaundice (bile going into the blood
stream instead of the gall bladder).
DIET FOR CIRRHOSIS cont’d
• Lipids are also restricted to prevent further destruction of hepatic
cells due to fat infiltration.
• Minerals and vitamins- should be given in high amounts particularly
the B vitamins (to support high carbohydrate intake).
Supplementation is necessary. Some vitamins may have to be given
intravenously.
• Electrolytes- sodium is often restricted esp in ascites and/or
hypertension (both portal and systemic). Potassium is given to reduce
fluid retention when ascites is present.