Liver

- The biggest single organ in the body located just beneath the
diaphragm. It is a triangular shape and weighs 1.5 kg.

Functions:
1. Protein Metabolism
2. Carbohydrate Metabolism
3. Fat Metabolism
4. Others

Disease of the Liver:

• Jaundice- a yellowish discoloration of the skin, mucous membranes

and some body fluids due to the accumulation of the bile pigment
bilirubin in the blood.

Types of Jaundice:
 Obstructive Jaundice- results from the interference of the flow of bile
by stones, tumors or inflammation of the mucosa of the ducts.
 Hemolytic Jaundice- originates from an abnormal destruction of the
blood cells.
 Toxic Jaundice- caused by the poisons, drugs or virus infections.

• Hepatitis- inflammation of the liver accompanied by rapid destruction

of the liver cells. This is caused by Hepatitis A&B virus, non-A&B
hepatitis virus, alcohol and drugs.

Symptoms:
 Anorexia
 Nausea
 Vomiting
 Fever
 Head ache
 Weight Loss
 Fatigue
 Abdominal discomfort

Dietary Management:
- For Anorexia- good cookery, creative ideas, attractive food service
and judicious use of spices and condiments to stimulate appetite.
- For Acute Illness- liquid-to-soft diet.
- Small to moderate portions at meal time with between meal
supplements of high protein beverages are frequently more
acceptable.
Principles of Dietary Management:

High Protein- intake of 1 to 2 ms/kg of body weight of 100-150 grams daily

for adults.
High Carbohydrates- intake of 300-400 grams daily.
Moderate Fat- diet should incorporate from 80-100 grams daily.
High Calorie- intake of 3000 to 3500 kCal daily.
Vitamins- Vitamins K and B and ascorbic acid.
Food Selection- well-balanced normal diet consisting of simple foods.

• Cirrhosis- a chronic liver disease where increased fibrous connective

tissue replaces the functioning liver cells following fatty degeneration
of long standing. This is caused by chronic alcohol abuse and fatty liver
or hepatitis.

Symptoms:
 Nausea
 Vomiting
 Anorexia
 Distention
 Jaundice
 Epigastric pain
 Nutritional Edema
 Portal Hypertension

Dietary Management:
- A regimen of bed rest during acute phase and prohibition of all forms of
alcohol, protection of patient from hepatotoxic drugs and chemicals
and provision of diet rich in proteins, calories and others.
- Increase in protein, carbohydrates and enough fats for severely
malnourished individuals.

Principles of Dietary Management:

Calories-daily intake of 35-50 kCal/kg of actual body weight.

Protein- 0.5-1.0 g/kg body weight, but of high biological value.
Carbohydrates- increase dietary carbohydrates (300-400 grams).
Fat- moderate amounts.
Vitamins and Iron- Vitamins K and B.
Fluid and Sodium- liquid or soft diet. 250 mg of sodium restricted diet.
 • Hepatic Coma- a complex syndrome characterized by neurological
disturbances which may develop as a complication of severe liver
disease. Usually results from the entrance of certain nitrogen
containing substances such as ammonia into the cerebral circulation
and being metabolized by the liver.

Symptoms:
 Confusion
 Irritability
 Slurred and monotonous speech
 Typical motor system change
 Breath has sweet, musty, or pungent odor.
 Mental disturbances such as changes in judgment, personality or mood
 Sleep pattern change

Dietary Management:
- Reduce protein intake to a minimum.

Principles of Dietary Management:

Protein- protein intake must be restricted to 20-35 gms or less of high

quality protein per day.
Fat- not restricted unless the cirrhotic person develops steatorrhea
Calories and Vitamins- amounts are ordered according to need.
Fluids and Sodium- Sodium: 250-2,000 mgs per day; Fluids: 1,500-2,000
ml per day.

• Liver Cancer- a malignant neoclassic disease of the liver, occuring

most frequently as a metastasis from other malignancy.

Symptoms:
 Abdominal bloating
 Anorexia
 Weakness
 Dull upper abdominal pain
 Ascites
 Mild jaundice
 Tender enlarged liver

Pancreas
- an elongated growth pink lobulated gland that stretches transversely
across the posterior abdominal wall in the epigastric and hypochondriac
region of the body and secretes various substances such as digestive
enzymes, insulin and glucagon.
Disorders of the Exocrine Pancreas:

• Pancreatitis- the inflammation of the pancreas caused by biliary tract

disease, surgery (stomach or biliary tract) or alcoholic abuse.

Symptoms:
 Severe abdominal pain radiating to the back
 Nausea and Vomiting
 Epigastric tenderness, distention and constipation
 Flatulence, anorexia and weight loss.

Dietary Management:

Acute stage:
- NPO
- NGT insertion
- IVF or electrolytes
- Gradually upgrade the diet from clear liquid diet to low fat diet with 15-
20 % or less of total kCal derived from fat.

Chronic Stage:
- Special diet
- Low- fat bland diet, of about 30-60 gms fat per day
- Fat-soluble vitamins in supplement form for steatorrhea

• Cystic Fibrosis- a generalized hereditary disease of children that

involves the endocrine glands particularly the pancreas and thus also
affects many tissues and organs.

Symptoms:
 Pancreatic insufficiency
 Chronic lung disease
 Abnormal electrolyte levels in the sweat

Dietary Management:
- Use of protein hydrolysates, emulsified simple fats and simple sugars.
- Amount of fat intake is usually prescribed according to character of
stools.
- Large increase of protein intake.
- Food use varies in form according to child’s age.

Principles of Dietary Managemet:

High Calories
High Protein
Moderate Carbohydrates
Enzymes Replacement
Breastfeeding for infants with CF
Vitamins Supplement
Fat-Soluble Vitamins
Assessment of height and weight and nutritional status

• Cancer of the Pancreas- the terminal stage process which may

originate from gallstone disease and chronic pancreatitis. Older males
with a history of pancreatitis, smoking and alcoholism are prone to this
disease.

Symptoms:
 Malaise
 Anorexia
 Epigastric pain
 Change in bowel habit
 Classic weigh loss

Dietary Management:
- Total parenteral feeding
- Nutritional Support
- High protein and high carbohydrates diet
- Vitamins and Minerals supplements
- H2 inhibitor drug

Gallbladder
- A pear-like-shape with large end pointing upward. Its main function is
to concentrate and store bile.

Disorders of Gallbladder:

• Cholecystitis- and inflammation of the gallbladder usually resulting

from a low grade chorionic infection.

Symptoms:
 The walls of the gallbladder becomes red and swollen and sometimes
pus.
 Pain in the region accompanied by nausea, vomiting, flatulence and
soreness in the upper right side of abdomen.
 Jaundice
 • Gallstones- formation of stones maybe due to infection, stagnation of
the bile or changes in chemical composition of the bile, overeating or
poor eating habits.

Chole Cystolithiasis- a combination of infection and stones

Cholelithiasis, Choledocholithiasis- the formation of the gallstones
without infection.

2 General Types of Gallstones:

• Cholesterol Gallstones
• Pigment Gallstones

Symptoms:
 Existence of stones: no symptoms and patient may be unaware of their
presence.
 Traveling of stones: obstruction of bile pathways.

Dietary Management:
- Diet restricted in fat
- Eating of plan, simple foods and avoid rich in pastries, nuts, chocolates,
fatty, fried and gas forming foods.
- Reduction of fibrous foods.
- Determining for oneself the food which cause discomfort and eliminate
the offending ones in the pattern.
- Obese people should be encouraged to lose weight.

Principles of Dietary Management:

Fat- low-fat diet with 50-60 gms fat per day

Cholesterol- for cholesterol content reduction: egg yolks, liver and other
organ meats are omitted and skin milk and margarine are substituted for
whole milk and butter.
Protein and Carbohydrates- normal protein and carbohydrates allowance
but may be decreased or increased to maintain the patient’s weight at
desirable level.
Calories:
- Weight Loss: calories should be reduced according to the need.
- Preparing meals by baking, broiling, roasting or stewing and use only
lean meats trimmed of all visible fats.
- Moderate use of herbs and spices for food flavoring.
- Use of fortified skin milk inclusion of green leafy or yellow vegetables.