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The role of diet in liver disease (Functions of the liver (Detoxify the…
The role of diet in liver disease
Functions of the liver
Detoxify the blood/deamination/ urea cycle
Metabolism of drugs
Temperature regulation
Makes vit k for clotting factors
Synthesis of plasma proteins such as albumin and clotting factors
Storage of glycogen, vitamins (ADEK) and minerals
Enzyme activation via bile
Metabolism of fats, proteins and carbohydrates
Excretion of bilirubin, cholesterol, hormones and drugs
Bile production and excretion (RBC broken down - produces bile)
Malnutrition
Methods to prevent/ avoid malnutrition include:
Tube feeding
Balanced and concentrated diet
Good quality protein
Hand feeding/ warming/ encouraging
Good nursing care
Appetite stimulant
Effects of malnutrition on the liver include:
Negative energy and negative protein = harmful effect on heptatocytes
Clotting problems
Malabsorption
Increased requirements
Cholestasis enteropathy
Nutritional support in patients with liver disease
Energy provided primarily from moderate fat and complex carbohydrates. Care must be taken with fat levels in cats with hepatic lipidosis
Restriction of dietary protein to minimum requirements. This should be derived from a high quality single source protein to minimise ammonium production. Care must be taken in cats to ensure that all the required amino acids are supplied
Maintenance of fibre content to prevent constipation, and to encourage enteric bacterial growth and so inhibit ammonia absorption into the blood stream
Supplementation of vitamins and mineral as required, although copper intake should be kept to the minimum required
Antioxidants - liver disease results in an increase production in free radicals. Supplementing with antioxidants (vitamin E, C, taurine, SAMe) will help minimise any oxidative injury of the tissue
Vitamin deficiency common in chronic liver disease, especially B vitamins and fat soluble vitamins
Mineral deficiencies - potassium, especially in cats. Supplementation of the diet may be necessary in some cases
Certain dog breeds are prone to copper accumulation in the liver and so a low or restricted copper diet is recommended for these dogs
NOTE: SaMe - S-Adenosylmethionine - a product produced by the liver from the break down of the amino acid methionine. SAMe is further converted to an anti oxidant by the liver cells and is important in the production and movement of bile in the gall bladder and bile duct. As an antioxidant it also prevents or minimises any inflammatory reaction of the bile duct
Examples of liver disease
Cats
Cholangiohepatitis/ cholangitis
Feline heptatic lipidosis
Portosystemic shunts (congenital)
Hepatic amyloidosis
Hepatobiliary neoplasia
Dogs:
Infectious hepatitis (canine infectious hepatitis/ leptospirosis)
Chronic hepatitis
Cirrhosis
Drug induced
Portosystemic shunts (congenital)
Cholestasis
Choleangitis
Natural products used in the treatment of liver disease: Milk thistle is used in many of the commercially produced products sold at veterinary practices indicated for the treatment of liver disease in dogs and cats. Owners can also purchase milk thistle in homeopathic shops