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Liver and Gallbladder - Coggle Diagram
Liver and Gallbladder
Biochem
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Alkaline Phosphatase (ALP). Found in small bile tracts of liver. Cholestasis, infiltrative disease or biliary obstruction
Gamma Glutamyl Transpeptidase (GGT). Found in liver cells and ducts. Cholestasis, biliary obstruction, alcohol abuse.
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Albumin. Only produced by liver cells. Levels can reflect synthetic function. can also be affected by other factors
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Anthro
WT
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REE should be measured using indirect calorimetry. REE usually increased in ALF, ASH and normal in NAFLD. In chronic liver disease total energy should be 1.3 x REE
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Hand Grip Strength, assessment of mortality
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Diet/ Intervention
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Protein restriction no longer advised. no clinical evidence (1.2- 1.5 g/kg BW). Should not be restricted in encephalopathy.
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Nutrition Support
EN, use nutrient dense, low volume feeds
infants, children and adults use EN, As PN in infants and children can cause cholestasis (PNAC)
PN, second line treatment when airways are unprotected and in hepatic encephalopathy
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ALF: deranged CHO, protein and lipids is anticipated. ALF without malnutrition= ONS when unlikely to resume normal oral diet in next 5-7 days. ALF with malnutrition EN or PN promptly adm.
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MAFLD
Body weight, obesity has an increase mortality and need for transplantation and an increase mortality post transplant.
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Clinical
Complications of chronic liver disease, type and severity
NIS, N &V, bowels, fatigue, loss appetite
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Diagnosis
Malnutrition
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periods of starvtion should be kept short, 3-5 meals per day with 1 late evening snack
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