Please enable JavaScript.
Coggle requires JavaScript to display documents.
Liver + Gallbladder Diseases - Coggle Diagram
Liver + Gallbladder Diseases
Assessment
Anthropometry
: weight history, BMI, MUAC, triceps skinfold, handgrip strength, short physical performance battery. Weight considerations with ascites – IDB according to height; without ascites Actual BW.
Biochemistry:
ALT/AST – raised with hepatocellular damage (MAFLD). ALP – found in small bile tracts of the liver. Cholestasis, infiltrative disease or biliary obstruction. GGT – Cholestasis, biliary obstruction, alcohol abuse. Bilirubin – produced in blood catabolism, impaired conjugation or biliary obstruction. Conjugated bilirubin – occurs in liver. Low levels if function impaired. Prothrombin time (PT or INR). Albumin – only produced by liver cells, reflecting synthetic function, affected by other factors
Clinical
: complications of CLD, type and severity (child pugh score, MELD), medications, NIS, fatigue. Symptoms - pain, steatorrhea, jaundice
Diet
Protein – no evidence for restriction. BCAAs – beneficial effects for hepatic encephalopathy and improving muscle mass. No effect on mortality, associated with N/D, expensive. Fat – only restrict with sever streatoria or malabsorption. Sodium – no added salt diet (2300mg).
Obesity – 50% presenting for transplant (BMI>40 have increased risk during transplant), weight loss is problem surrounding muscle or fat loss.
MAFLD – progressed to NASH, aim for 7-10% weight loss, exercise, Mediterranean diet (insulin sensitivity, hepatic steatosis/fibrosis. Caution around cultural background
Note - herbal supplements affect transplantation through hepatotoxicity
Liver conditions
MAFLD, possible progression to NASH
Hepatitis
ALF
Cholestatic liver disease (autoimmune, progress to CLD)
Hepatocellular carcinoma
CLD
Malnutrition P/E. Poor dietary intake (early satiety, taste changes, low salt diet, fluid restrictions), malabsorption, low protein synthesis, hypermetabolism, fatigue, medication (lactulose)
Gall Bladder conditions
Cholecystitis
Cholelithiasis (gallstones)
Cholestasis (bile is stagnant)
Nutritional Mx
Pg 30. Protein 1.5 - 2.0
Energy 125-145
Note with steatorrhea
: low fat diet IF required, increased pain with fat consumption, steatorrhea. Generally, go down surgical path with little intervention. Possible malnutrition.