DEFINITION INTRODUCTION SIGN AND SYMPTOMS RISK FACTORS ETIOLOGY PATHOPHYSIOLOGY MANAGEMENT PREVENTION MEDICAL NUTRITION THERAPY DIET PLAN

1. LIVER DISEASE

2. Definition
Introduction
Signs and symptoms
Risk factors
Etiology
Pathophysiology
Management
Prevention
Medical Nutrition
Therapy
CONTENT

3.  Liver disease is any disturbance of liver function that causes
illness.

 Liver disease is a broad term that covers all the potential
problems that cause the liver to fail to perform its designated
functions.
DEFINITION Also referred as
hepatic disease

4.  Liver is most metabolic active organ plays a central role in
processing, storing, and redistributing the nutrients
provided by the meals we eat and synthesizes most of the
proteins that circulate in plasma, and produces the bile that
emulsifies fat during digestion.
INTRODUCTION

5.  Detoxify drugs and alcohol and processes excess nitrogen so
that it can be safely excreted as urea.
 Liver’s numerous roles are upset by liver damage or disease,
that has profound effects on health and nutrition status.
Liver disease
progresses
slowly.

7. CLASSICAL SIGNS AND SYMPTOMS

8.  Heavy alcohol use.
 Injecting drugs using shared needles.
 Tattoos or body piercings.
 Exposure to other people's blood and body. fluids.
 Exposure to certain chemicals or toxins.
 Diabetes.
 Obesity
RISK FACTORS OF LIVER DISEASE

9.  Chronic alcohol abuse.
 Fat accumulating in the liver. (nonalcoholic
fatty liver disease)
 Immune system abnormality.
 Infections.
 Genetics.
 Cancer and other growth.
ETIOLOGY

11. - Abnormal liver function tests.
- Jaundice.
- Ascites and edema.
- Hepatic encephalopathy.
- Portal hypertension and varices.
- Vitamin/mineral deficits.
- Glucose intolerance or fasting. (hypoglycemia)
CLINICAL FINDINGS

12. NUTRITION ASSESSMENT
- Serial monitoring of body weight and anthropometry.
- Dietary intake.
- Subjective global assessment.
- Laboratory tests for nutritional deficiencies such as
vitamins, magnesium, iron, and others.
,

13. MANAGEMENT
MEDICAL MANAGEMENT:
• Diuretic therapy.
• Medication for encephalopathy (e.g.
lactulose, rifaximin).
• Management of portal hypertensive
bleeding (e.g. pharmacologic therapy,
shunts, banding)
• Monitoring of blood glucose.
NUTRITION MANAGEMENT
• Increased energy intake via small, frequent meals.
• Sodium restriction for fluid retention.
• Fluid restriction for hypernatremia.
• Carbohydrate-controlled diets for hyperglycemia.
• Vitamin and mineral supplements
• Oral liquid supplements or enteral (tube) feeding.

14.  Maintain a healthy weight.
 Protect your skin.
 Take care with aerosol sprays.
 Avoid contact with other people's blood and body fluids.
 Use medications wisely.
 Get vaccinated.
 Avoid risky behavior.
 Drink alcohol in moderation.
PREVENTION

15.  Viral hepatitis is a systemic disease with primary inflammation of the liver
by any one of a heterogeneous group of hepatotropic viruses.
 The most common causes of viral hepatitis are the five unrelated
hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and
Hepatitis E.
WHAT IS VIRAL HEPATITIS?

17.  Hepatitis A (infectious hepatitis or epidemic jaundice) is an acute
infectious disease caused by Hepatitis A virus (HAV).
 The disease is heralded by non-specific symptoms such as fever, chills,
headache, fatigue, generalized weakness and aches and pains, followed by
anorexia, nausea, vomiting, dark urine and jaundice.
HEPATITIS A

18.  AGE: Infection with HAV is more frequent among children than in
adults. However, people from all ages may be infected if susceptible.
 SEX: Both sexes are equally susceptible.
 IMMUNITY: Immunity after attack probably lasts for life.
HOST FACTORS

19.  FAECAL-ORAL ROUTE: Major route of transmission. By
contaminated water, food or milk.
 PARENTERAL ROUTE (Rarely): By blood and blood products or by
skin penetration through contaminated needles.
 SEXUAL TRANSMISSION: May occur mainly among homosexual
men because of oral-anal contact.
MODE OF TRANSMISSION

20. PREVENTION:
 Hygienic measures and sanitation.
 Passive immunization (Human Immunoglobulin Gamma globulin given before
exposure to virus or early during the incubation period, will prevent or
attenuate a clinical illness.
 Active immunization: Several inactivated or live attenuated vaccines against
hepatitis A have been developed.
TREATMENT:
 No specific dietary food and long rest

21.  Hepatitis B (serum hepatitis) is an acute systemic infection with major
pathology in the liver, caused by hepatitis B virus.
 The acute illness causes liver inflammation, vomiting, jaundice, and,
rarely, death. Chronic hepatitis B may eventually cause cirrhosis and
liver cancer.
HEPATITIS B

22.  People from endemic regions.
 Babies of mothers with chronic HBV.
 Intravenous drug abusers.
 Hemophiliacs and other patients requiting blood and blood product
treatments.
 Health care personnel who have contact with blood.
 Patients who are immuno-compromised.
HIGH RISK GROUP

23.  Parenteral: drug abusers, health workers are at increased risk.
 Sexual: ex workers and homosexuals are particular at risk.
 Mother → infant: Mothers who are HBeAg positive are much more likely
to transmit to their offspring than those who are not. Perinatal
transmission is the main means of transmission in high prevalence
populations
MODE OF TRANSMISSION

24.  Vaccination: highly effective recombinant vaccines.
 Hepatitis B Immunoglobulin (HBIG): exposed within 48 hours of the incident/
neonates whose mothers are HBsAg and HBeAg positive.
 Other measures: screening of blood donors, blood and body fluid precautions.
PREVENTION

25.  Interferon Alfa (Intron A) Response rate is 30 to 40%.
 Lamivudine (Epivir HBV) (relapse ,drug resistance)
 Adefovir dipivoxil (Hepsera)
TREATMENT

26.  Hepatitis C is an infectious disease affecting primarily the liver, caused by
the hepatitis C virus (HCV).
 The infection is often asymptomatic, but chronic infection can lead to
scarring of the liver and ultimately to cirrhosis, which is generally apparent
after many years.
 The important part in type C hepatitis is the chronic illness.
 About 50 to 80 % of patients progress to chronic hepatitis.
HEPATITIS C

27.  Intravenous Drug Use.
 Healthcare Exposure: Blood Transfusion, transfusion of Blood products, Organ
Transplant without HCV screening carry significant risk of infection.
 Hemodialysis.
 Accidental injuries with needles/sharps.
 Sexual/household exposure to anti-HCV-positive contact.
 Vertical Transmission: Vertical transmission of hepatitis C from an infected
mother to her child.
MODE OF TRANSMISSION

28. PREVENTION:
 Only General Prophylaxis, such as blood, tissue, organ screening, is possible.
 No specific active or passive immunizing agent is available.
TREATMENT:
 Interferon.
 Ribavirin.

29.  Hepatitis D, also referred to as hepatitis D virus (HDV) and classified as
Hepatitis delta virus, is a disease caused by a small circular enveloped
RNA virus.
 HDV is considered to be a sub viral satellite because it can propagate only
in the presence of the hepatitis B virus (HBV).
HEPATITIS D

30. MODE OF TRANSMISSION:
 The primary route of Transmission are believed to be similar to those of
HBV, though HDV does not appear to be sexually transmitted disease.
PREVENTION:
 HBV-HDV (Co infection): Pre or post exposure prophylaxis to prevent
HBV infection. Screening of blood donor for HBsAg.
 HBV-HDV (Super infection): Education to reduce risk behaviors among
persons with chronic HBV infection.

31.  Hepatitis E is a viral hepatitis (liver inflammation) caused by infection with a
virus called hepatitis E virus (HEV).
 It bears a high risk of developing chronic hepatitis in immuno-compromised
patients with substantial mortality rates.
 Hepatitis E occasionally develops into an acute, severe liver disease, and is
fatal in about 2% of all cases.
 In pregnant women the disease is more often severe and is associated with a
clinical syndrome called fulminant hepatic failure.
HEPATITIS E

32. MODE OF TRANSMISSION:
 It is spread mainly by the fecal-oral route due to fecal
contamination of water supplies or food; person-to-person
transmission is uncommon.
PREVENTION:
 Sanitation: Avoid drinking water of unknown purity, uncooked
shellfish, and uncooked fruit/vegetables not peeled or prepared by
traveler.

33.  GB virus C (GBV-C), formerly known as hepatitis G virus (HGV)
and also known as HPgV is a virus in the Flaviviridae family and a
member of the Pegivirus genus, is known to infect humans, but is
not known to cause human disease.
 HGV RNA has been found in patients with acute, chronic and
fulminant hepatitis, hemophiliacs, patients with multiple
transfusions and hemodialysis, intravenous drug addicts and blood
donors.
HEPATITIS G

35. MEDICAL NUTRITION THERAPY

36.  Liver disease is often associated
with muscle and body fat loss. This may
be difficult to detect because of fluid
retention. For example, you may be
losing muscle, but if you are retaining
fluid you may stay the same weight.
PREVENTING WEIGHT LOSS

37.  Historically, it was recommended that people with
liver disease need to avoid protein-rich foods to help
prevent a condition called hepatic encephalopathy.
 However, new research shows this is not the case.
Hepatic encephalopathy is treated by medications
and avoiding protein will only make you more
malnourished.
HIGH PROTEIN INTAKE

38.  Eat 6-8 smaller meals and snacks throughout the day rather than 3 large
meals.
 Use extra oil in cooking, frying and baking and onto veggies and salads.
 Add eggs, legumes, yoghurt or low salt cheese to your meat dishes or salads.
 Replace tea, coffee or water with fluids that provide energy. (such as milk,
juice, cordial or soft drink)
 Have an energy-rich snack just before bed.
IDEAS TO INCREASE THE PROTEIN AND
ENERGY IN YOUR DIET

39.  The liver plays an essential role in
supplying energy (in the form of glycogen)
to the body while you are not eating
overnight. When you have liver disease this
becomes harder to do and can result in the
body having to use protein (e.g. muscle).
Carbohydrate is the best type of energy.
Examples of carbohydrate sources include
breads and cereals, rice, pasta, fruit, milk
and yoghurt.
HIGH ENERGY INTAKE

40.  2 thick slices of bread with sweet
spread. (e.g. honey, jam)
 2 thick slices of raisin bread/toast.
 Glass of milk with milo and slice of
bread/toast.
 Thick slice of banana bread.
 2 crumpets with honey.
 Muesli bar and fruit smoothie.
 Yoghurt/custard/ice cream with fruit
and honey.
 Creamed rice/rice pudding with
fruit/honey.
 High energy supplement drink (e.g.
Sustagen, Ensure)
SOME PRE-BED SNACK IDEAS

41.  As liver disease progresses, excess fluid can build up around your stomach
(ascites) and in the feet and legs (edema). If this occurs it becomes very
important to limit the amount of salt (sodium) you consume.
 Aim to have less than 2000mg of sodium each day. In some cases, a limit of
1400mg daily may be needed. Any food with more than 400mg sodium per
100g serve should be limited.
FLUID AND SALT

42. HIGH ENERGY FOODS LOWER
IN SALT
HIGH PROTEIN FOODS LOWER IN
SALT
rolled oats, wheat or oat bran milk, milk powder and soy milk
pasta, rice, noodles cheese: Swiss, ricotta, bocconcini, cottage
potato, sweet potato, corn, avocado yoghurt, custard
unsalted butter/margarine, olive oil, sunflower
oil, canola oil
meat, chicken, lamb, fresh fish
cream, mayonnaise tinned fish in spring water/oil
jam, honey, golden syrup, ice cream unsalted nuts and seeds
fruit, dried fruit and fruit juice dried legumes (lentils, chickpeas, kidney beans, soup
mixes)
sugar and sugary products eggs

43. If you are overweight you
should focus on having a high
protein intake and
limit fatty and sweet foods.

44.  The changes that occur in chronic
liver disease can lead to vitamin
and/or mineral deficiencies.
Problems such as excessive
bleeding, osteoporosis, anemia and
night blindness can occur if vitamin
and/or mineral levels are too low.
 Eating a variety of foods can help
to avoid deficiencies.
VITAMINS AND MINERALS
INTAKE

45.  A recent study found that middle-age men
who exercised at least 240 minutes a week
were able to greatly improve damage caused
by fatty liver disease.
 Even brisk walking can be beneficial. Try
walking 10 minutes, three to five days a
week, and, gradually over the course of
several weeks or a few months, make your
way up to an hour a day.
PHYSICALACTIVITY

46. FOOD GROUP CHOOSE AVOID
BREAD AND CEREALS salt reduced bread • fresh and dried
pasta • salt reduced and low salt
crackers and biscuits e.g. plain
rice/corn cake• rolled oats, porridge
• puffed wheat, oat or wheat bran •
rice (plain) • plain flour & corn
flour
savory crackers • sweet biscuits &
shortbread • croissants, pastry,
cakes, muffins • bread, bread
rolls, savory breads • packet rice
& pasta with flavoring, instant
noodles, tinned spaghetti •
breakfast cereals with more than
400mg sodium per 100g e.g.
Cornflakes, Rice Bubbles
FRUIT fresh/tinned/frozen fruit • dried fruit
• fruit juices
canned plums
VEGETABLES all fresh and frozen vegetables •
dried legumes (lentils, chickpeas,
soup mix, soybeans, kidney beans) •
‘no added salt’ canned vegetables
and beans
pickled and canned vegetables
and legumes • tomato or vegetable
juice • baked beans or reduced
salt baked beans • olives

47. FOOD GROUP CHOOSE AVOID
MILK AND MILK PRODUCTS milk – all types • yoghurt • custard,
dairy desserts, ice cream • cheese:
cottage, ricotta, continental, Swiss
cheese: cheddar, cream, brie,
camembert, feta, parmesan
• cheese spreads and dips
MEAT AND MEAT PRODUCTS fresh, unprocessed meat (lamb,
beef, chicken, fish) • eggs • tinned
fish in spring water
cured, smoked, canned or salted meat •
meat pies, sausage rolls, fish fingers,
crumbed/battered fish, BBQ chicken,
pizza, chicken nuggets, Chinese •
shellfish e.g. prawns• flavoured tinned
fish or in brine
FATS AND OILS unsalted butter, oil and avocado •
reduced salt margarine • no added
salt peanut butter
butter • margarine • peanut butter

48. If you are a liver patient, your diet is adjusted to meet your individual need.
Here are some general tips for a healthy liver:
 What to avoid: Do not eat food high in fat, sugar and salt. Stay away from a
lot of fried food including fast food restaurant meal.
 Avoid alcohol.
 Eat a balanced diet: Select food from all food groups: Grains, fruits
vegetables, meats and beans, milk and oil.
DIETARY GUIDELINES

49.  Eat food with fiber: Fiber help your liver work at optimal level. Fruits,
vegetables, whole grain bread and cereal can take care of your body fiber
need.
 Drink lot of water: It can prevent dehydration and it help your liver to
function better.
 Limit salt and food that contain lot of salt.

51. MEAL TIME FOOD ITEMS
BREAKFAST ½ cup rolled oats or muesli with full cream milk with sugar
or honey or cream Or 2 slices salt reduced bread with 2
eggs, tomato and unsalted butter or avocado Plus Yoghurt
or fruit
MORNING SNACK Raw, unsalted nuts Milk-based drink (e.g. milkshake)
LUNCH 2 slices salt reduced bread or 1 reduced salt flatbread With
salad, avocado and fresh meat Plus Yoghurt or dairy
dessert or fruit
EVENING SNACK Reduced salt rice crackers with ricotta cheese or cottage
cheese
100-120g lean meat, chicken or fish (fresh) Plus 1 cup plain
pasta or 2/3 cups rice or mashed potato (using unsalted
butter/margarine) Plus vegetables – roasted or stir-fried
with olive, canola, safflower or sunflower oils
BEFORE BED Dairy-based dessert (e.g. rice pudding)
and a piece of fruit

52.  https://www.medicinenet.com/liver_disease/article.htm#what_is_the_function_of_the_li
ver
 understanding normal and clinical nutrition
 https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-
20374502
 https://www.health.qld.gov.au/__data/assets/pdf_file/0031/145948/gastro_cld.pdf
 American liver foundation
 https://www.hepmag.com/basics/hepatitis-b-basics/nutrition-exercise-hepatitis-b
REFERENCES