Module III Diseases of Liver, Gall Bladder and Pancreas

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Module III.

Diseases of Liver, Gall Bladder and Pancreas


 Function of Liver, Gall Bladder and Pancreas
 Etiology, dietary management in liver, gall bladder and pancreas
 Jaundice, Viral Hepatitis,
 Cirrhosis,
 Hepatic coma and Fatty Liver,
 Cholecystitis and cholelithiasis,
 Acute and chronic pancreatitis.

The Liver and Its Functions


The liver is the largest solid organ in the body. It removes toxins from the body’s blood supply,
maintains healthy blood sugar levels, regulates blood clotting, and performs hundreds of other
vital functions. It is located beneath the rib cage in the right upper abdomen.

 The liver filters all of the blood in the body and breaks down poisonous substances, such as
alcohol and drugs.
 The liver also produces bile, a fluid that helps digest fats and carry away waste.
 The liver consists of four lobes, which are each made up of eight sections and thousands of
lobules (or small lobes).
Anatomy of the Liver
 The liver is reddish-brown and shaped approximately like a cone or a wedge, with the
small end above the spleen and stomach and the large end above the small intestine. The
entire organ is located below the lungs in the right upper abdomen. It weighs between 3
and 3.5 poun55ds.

Functions of the Liver


The liver is an essential organ of the body that performs over 500 vital functions. These include
removing waste products and foreign substances from the bloodstream, regulating blood sugar
levels, and creating essential nutrients. Here are some of its most important functions:

 Albumin Production: Albumin is a protein that keeps fluids in the bloodstream from
leaking into surrounding tissue. It also carries hormones, vitamins, and enzymes through the
body.
 Bile Production: Bile is a fluid that is critical to the digestion and absorption of fats in the
small intestine.
 Filters Blood: All the blood leaving the stomach and intestines passes through the liver,
which removes toxins, byproducts, and other harmful substances.
 Regulates Amino Acids: The production of proteins depend on amino acids. The liver
makes sure amino acid levels in the bloodstream remain healthy.
 Regulates Blood Clotting: Blood clotting coagulants are created using vitamin K, which
can only be absorbed with the help of bile, a fluid the liver produces.
 Resists Infections: As part of the filtering process, the liver also removes bacteria from the
bloodstream.
 Stores Vitamins and Minerals: The liver stores significant amounts of vitamins A, D, E, K,
and B12, as well as iron and copper.
 Processes Glucose: The liver removes excess glucose (sugar) from the bloodstream and
stores it as glycogen. As needed, it can convert glycogen back into glucose.

The Gall Bladder and Its Functions


Gallbladder

The gallbladder is a pear-shaped, hollow structure located under the liver and on the right side
of the abdomen. Its primary function is to store and concentrate bile, a yellow-brown digestive
enzyme produced by the liver. The gallbladder is part of the biliary tract.

The gallbladder serves as a reservoir for bile while it’s not being used for digestion. The
gallbladder’s absorbent lining concentrates the stored bile. When food enters the small intestine,
a hormone called cholecystokinin is released, signaling the gallbladder to contract and secrete
bile into the small intestine through the common bile duct.

The bile helps the digestive process by breaking up fats. It also drains waste products from the
liver into the duodenum, a part of the small intestine.

An excess of cholesterol, bilirubin, or bile salts can cause gallstones to form. Gallstones are
generally small, hard deposits inside the gallbladder that are formed when stored bile
crystallizes. A person with gallstones will rarely feel any symptoms until the gallstones reach a
certain size, or if the gallstone obstructs the bile ducts. Surgical removal of the gallbladder
(cholecystectomy) is the most common way to treat gallstones.

The Pancreas and Its Functions


The pancreas is an organ located in the abdomen. It plays an essential role in converting the
food we eat into fuel for the body's cells. The pancreas has two main functions: an exocrine
function that helps in digestion and an endocrine function that regulates blood sugar.

Functions of the Pancreas

A healthy pancreas produces the correct chemicals in the proper quantities, at the right times, to
digest the foods we eat.
Exocrine Function:
The pancreas contains exocrine glands that produce enzymes important to digestion. These
enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of
carbohydrates; and lipase to break down fats. When food enters the stomach, these pancreatic
juices are released into a system of ducts that culminate in the main pancreatic duct. The
pancreatic duct joins the common bile duct to form the ampulla of Vater which is located at
the first portion of the small intestine, called the duodenum. The common bile duct originates in
the liver and the gallbladder and produces another important digestive juice called bile. The
pancreatic juices and bile that are released into the duodenum, help the body to digest fats,
carbohydrates, and proteins.

Endocrine Function:
The endocrine component of the pancreas consists of islet cells (islets of Langerhans) that create
and release important hormones directly into the bloodstream. Two of the main pancreatic
hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to raise blood
sugar. Maintaining proper blood sugar levels is crucial to the functioning of key organs including
the brain, liver, and kidneys.

Etiology, dietary management of:


1. Jaundice,
2. Viral Hepatitis,
3. Cirrhosis,
4. Hepatic coma
5. Fatty Liver,
6. Cholecystitis
7. Cholelithiasis,
8. Acute pancreatitis
9. Chronic pancreatitis.

1. Etiology, dietary management of Jaundice

What is Jaundice?
Jaundice is a medical condition that causes a yellowish or greenish discoloration to the skin and
the white space of the eye. This happens due to the excessive presence of bilirubin in our
bloodstream. Bilirubin is a part of our normal blood composition and deals with haemoglobin.
Usually when the life cycle of a cell lasting 120 days ends the cells are broken down and
bilirubin from the bloodstream gets passed on to the bile ducts present in the liver where it’s
processed and passed on to the small intestine to excrete through urine or motion.

Jaundice is also called icterus in some parts of the world. The condition is mostly the effect of
some sort of malfunction pertaining to the liver or the bile ducts causing a problem in the
removal of bilirubin from the bloodstream. When bilirubin builds up in our bloodstream the
yellow pigmentation of the same starts showing in our skin and eyes.

When neonatal jaundice occurs in babies it can cause long-lasting effects such as brain damage
due to excess bilirubin in the blood. In adults, if jaundice is left untreated it can lead to severe
conditions such as Kernicterus which is non-reversible damage that happens to the brain cells
due to the accumulation of bilirubin in unwanted spaces such as the grey matter in the brain and
the central nervous system.

It can be conclusively told that Jaundice is an aftereffect of the liver not being able to function in
its full capacity. There might be varying reasons for it, all of them can be considered as potential
causes for Jaundice. There are various diagnostic methods that doctors implement to find the
source cause behind jaundice and treat it to remove the problem of jaundice by reducing the
amount of bilirubin before it reaches fatal levels.

Types Of Jaundice:
Since there are multiple reasons behind why jaundice can occur, it has been classified into 3
broad categories based on the causal factors. The classification is done by studying which part of
the liver is malfunctioning and how it affects the disposal of bilirubin from the bloodstream.
Below are the three major types of jaundice that can affect you.

1. Hepatocellular Jaundice:
Hepatocellular Jaundice is a type of jaundice that occurs due to damage to the liver. This damage
can be caused due to a variety of reasons. If the parenchymal cells of the liver are affected due to
damages that arise as a result of infections or other conditions it can have a significant impact
causing the reduction in the metabolism of the liver.

Hepatocellular jaundice can also be caused due to other diseases such as hepatitis wherein the
liver is highly infected by the hepatitis virus, rendering it absolutely non-functional. Other
medical conditions such as liver cancer or liver lacerations due to liver cirrhosis caused due to
alcohol abuse can also cause hepatocellular jaundice.

2. Hemolytic Jaundice:
Hemolytic jaundice happens when the red blood corpuscles in the bloodstream start to break
down at a faster than normal pace causing an issue for the liver to keep functioning with such a
large amount of bilirubin coming into the system. This condition marked by the excessive
decomposition of the red blood cells is known as hemolysis and is a serious medical condition
that can prove to be fatal very soon. Hemolytic jaundice can be defined as an imbalance between
the RBC breakdown and bilirubin clearance procedure ratio of the blood and liver.

Hemolytic jaundice is highly common in patients suffering from malaria, where the malaria
parasites attack the red blood cells at a fast pace leading to a high concentration of bilirubin
present in the blood. The production of red blood corpuscles is paramount to keep the RBC count
normal in the blood, sometimes red blood cell production fails to match with the amount of RBC
decomposition which can also lead to jaundice.

3. Obstructive Jaundice:
Obstructive jaundice is a kind of jaundice that occurs due to blocks that are formed between the
bile ducts connecting the liver, gallbladder and intestine. This obstruction or block prevents the
liver from removing the excess bilirubin from the liver causing severe malfunctioning of the liver
which in turn causes jaundice.

The bile duct is a series of tubes that are responsible for carrying bile from the liver to the
gallbladder. Obstructive jaundice can arise due to multiple elements that can cause a block in the
bile ducts. The best example of the same would be gallstones which can be present in the
passages of the biliary system. Swollen lymph glands can also cause obstructive jaundice.

Jaundice Symptoms:
1. Yellowness of the Skin and Eye Whites:
2. Vomiting:
3. High Fever:
4. Dark Tinge in Urine:
5. Lack of Hunger:
6. Discolouration of Stool:
7. Stomach Pain:
8. Abnormal Weight Loss:

Causes of Jaundice:
1. Malaria:
2. Sickle Cell Anaemia:
3. Spherocytosis:
4. Thalassemia:
5. Liver Cirrhosis:
6. Hepatitis:
7. Biliary Cirrhosis:
8. Liver Cancer:
9. Gallstones:
10. Pancreatic Cancer:
11. Bile Duct Cancer:
12. Biliary Atresia:

Diet for Jaundice:

(Refer any book)

The modification of diet is based on

• Generous intake of good quality protein to regenerate tissues and prevent fatty infiltration.

• High carbohydrate intake to spare protein and synthesis of glycogen

• A moderate fat restriction

• Providing vitamin supplements and


• Ensuring sodium restriction, if there is edema.

2. Etiology, dietary management of Viral Hepatitis.

Hepatitis is a term used to describe inflammation (swelling) of the liver. It can be caused due to
viral infection or when liver is exposed to harmful substances such as alcohol. Hepatitis may
occur with limited or no symptoms, but often leads to jaundice, anorexia (poor appetite) and
malaise. Hepatitis is of 2 types: acute and chronic.

Acute hepatitis occurs when it lasts for less than six months and chronic if it persists for longer
duration.

A group of viruses known as the hepatitis viruses most commonly cause the disease, but
hepatitis can also be caused by toxic substances (notably alcohol, certain medications, some
industrial organic solvents and plants), other infections and autoimmune diseases.

Types of hepatitis: The most common types of hepatitis are described below:
Hepatitis A: Hepatitis A is caused by the hepatitis A virus. It is the most common type of viral
hepatitis. It is generally seen in the areas where sanitation and sewage disposal are poor. This
disease is commonly spread through fecal-oral route (ingestion of contaminated food and water).
It is usually a short-term (acute) infection and its symptoms pass away within three months.
There is no specific treatment for hepatitis A other than using medication, such as the painkiller
ibuprofen, to relieve symptoms. A vaccination can protect against hepatitis A. Vaccination is
recommended if a person is travelling to countries where the virus is common, such as the Indian
subcontinent, Africa, Central and South America, the Far East and Eastern Europe.

Hepatitis B: Hepatitis B is caused by the hepatitis B virus. This can be found in blood and body
fluids, such as semen and vaginal fluids, so it generally spread during unprotected sex or by
sharing needles to inject drugs. Hepatitis B is commonly seen in drug users. It is common in
India and other parts of the world, such as China, Central and Southeast Asia and sub-Saharan
Africa. Most people infected with hepatitis B are able to fight off the virus and fully recover
from the infection within a couple of months. The infection can be unpleasant to live with, but
usually causes no lasting harm. However, a small minority of people may develop long-term
infection. This is known as chronic hepatitis B. A vaccination is available for hepatitis B, which
is recommended for people in high-risk groups, such as injecting drug users.

Hepatitis C: Hepatitis C is caused by the hepatitis C virus. This can be found in the blood and to
a much lesser extentin the saliva, semen or vaginal fluid of an infected person. It is particularly
concentrated in the blood, so it is usually transmitted through blood-to-blood contact. Hepatitis C
often causes no noticeable symptoms, or causes symptoms that are mistaken for the flu, therefore
so many people are unaware if they are infected. Many people fight off the infection and will be
free of the virus. In the remaining the virus might stay in their body for many years. This is
known as chronic hepatitis C. Chronic hepatitis C can be treated by taking antiviral medications,
although there can be some unpleasant side effects. There is currently no vaccination for
hepatitis C.
Alcoholic hepatitis: Drinking excessive amount of alcohol over the course of many years can
damage the liver, leading to hepatitis. This type of hepatitis is known as alcoholic hepatitis. It is
estimated that heavy drinkers has some degree of alcoholic hepatitis. The condition does not
usually cause any symptoms and is often detected with a blood test. If a person with alcoholic
hepatitis continues to drink alcohol, there is a real risk that he may develop cirrhosis and
possibly liver failure.

Symptoms

Initial symptoms of hepatitis caused by infection are similar to the flu and include:

 Muscle and joint pain


 A high temperature (fever) of 38C (100.4F) or above
 Feeling unwell
 Headache
 Occasionally yellowing of the eyes and skin (jaundice), Symptoms of chronic hepatitis
can include:
o Feeling tired all the time
o Depression
o Jaundice
o A general sense of feeling unwell

Causes

Hepatitis infection is caused by Hepatitis viruses: Type A, B, C, D, E

 Hepatitis is also caused by bacterias like anaplasma, nocardia and many more
 Other factors like alcohol
 Auto immune conditions: systemic lupus erythematosus
 Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many
others
 Ischemic hepatitis (circulatory insufficiency)
 Metabolic diseases: Wilson’s disease
 Pregnancy
Dietary principle of hepatic liver disease:

(refer any book)

• In hepatitis the main therapy consist of nutritionally adequate diet and bed rest.

• The aim is to ensure recovery of damaged tissues and to prevent further damage.

• In hepatitis a high calorie, high protein diet is given.

• Calories: 3000-4000 k.cal/day.

• Protein: 1.5 to 2g/day/kg body weight. Ample intake of protein is essential for regeneration of
liver cells.

• Fat: A range of 10 to 15 percent of calories as fat is generally recommended.

• Fluids and electrolytes: Sodium is commonly restricted to 2g/day. Fluid intake is usually
restricted to 1 liter/day, depending upon the severity of the edema, ascites, and low sodium

General dietary advice

• Give a full liquid diet in six small feeds, as soon as patient is able to eat

• Follow it by a soft fiber- restricted diet and then a normal diet

• Maintain healthy calorie intake

• Eat whole-grain cereals, breads, and grains

• Eat lots of fruits and vegetables

• Go easy on fatty, salty ad sugary foods

• Drink enough fluids

• Reach and maintain a healthy weight


3. Etiology, dietary management of Cirrhosis:

Cirrhosis of the liver describes a condition where scar tissue gradually replaces healthy liver

cells. It is a progressive disease, developing slowly over many years. If it is allowed to continue,

the buildup of scar tissue can eventually stop liver function. For cirrhosis to develop, long-term,
continuous damage to the liver needs to occur. When healthy liver tissue is destroyed and

replaced by scar tissue, the condition becomes serious, because it can start blocking the flow of

blood through the liver.

Signs and symptoms:

 blood capillaries become visible on the skin on the upper abdomen.

 fatigue

 insomnia

 itchy skin

 loss of appetite

 loss of bodyweight

 nausea

 pain or tenderness in the area where the liver is located

 red or blotchy palms

 weakness

Causes:

Common causes of cirrhosis are:

 long-term alcohol abuse

 hepatitis B and C infection

 fatty liver disease

 toxic metals

 genetic diseases
Regularly drinking too much alcohol

Toxins, including alcohol, are broken down by the liver. However, if the amount of alcohol is too
high, the liver will be overworked, and liver cells can eventually become damaged.

Heavy, regular, long-term drinkers are much more likely to develop cirrhosis, compared with
other, healthy people. Typically, heavy drinking needs to be sustained for at least 10 years for
cirrhosis to develop.

There are generally three stages of alcohol-induced liver disease:

1. Fatty liver: This involves a build-up of fat in the liver.

2. Alcoholic hepatitis: This occurs when the cells of the liver swell.

3. Approximately 10 to 15 percent of heavy drinkers will subsequently develop cirrhosis.

Hepatitis

Hepatitis C, a blood-borne infection, can damage the liver and eventually lead to cirrhosis.
Hepatitis C is a common cause of cirrhosis in Western Europe, North America, and many other
parts of the world. Cirrhosis can also be caused by hepatitis B and D.

Non-alcoholic steatohepatitis (NASH)

NASH, in its early stages, begins with the accumulation of too much fat in the liver. The fat
causes inflammation and scarring, resulting in possible cirrhosis later on.

NASH is more likely to occur in people who are obese, diabetes patients, those with high fat
levels in the blood, and people with high blood pressure.

Autoimmune hepatitis
The person’s own immune system attacks healthy organs in the body as though they were
foreign substances. Sometimes the liver is attacked. Eventually, the patient can develop cirrhosis.

Some genetic conditions

There are some inherited conditions that can lead to cirrhosis, including:

 Hemochromatosis: Iron accumulates in the liver and other parts of the body.

 Wilson’s disease: Copper accumulates in the liver and other parts of the body.

Blockage of the bile ducts

Some conditions and diseases, such as cancer of the bile ducts, or cancer of the pancreas, can
block the bile ducts, increasing the risk of cirrhosis.

Dietary Management:

(Refer any book)


In addition to overall malnutrition, patients with cirrhosis often have micronutrient deficiencies.
Fat-soluble vitamin deficiencies (vitamins A, D, E and K) are common, especially in patients
with cholestatic liver disease, due to malabsorption, decreased intake, and reduced production of
carrier proteins. Vitamin D deficiency has been independently associated with mortality in
patients with cirrhosis and hepatocellular carcinoma. All patients should take 2,000 IU of
vitamin D daily, with deficient patients requiring 50,000 IU weekly for 8-12 weeks, with a target
25-hydroxyvitamin D level ≥ 30 ng/mL. Patients may also be deficient in water-soluble vitamins,
including thiamine (B1), and, less commonly, pyridoxine (B6), folate (B9), and cobalamin (B12)
due to reduced hepatic storage. Zinc and magnesium deficiencies are also common. Zinc is
needed for conversion of ammonia to urea and glutamic acid, and blood concentrations of this
mineral are inversely associated with ammonia levels. Supplementation with 150-175 mg/day
can lower ammonia levels when used as monotherapy or when combined with vitamin A, C, and
E supplementation. A daily multivitamin with minerals can address most of these deficiencies.
Malnourished cirrhosis patients should consume 35-40 kcal/kg/day (using body weight corrected
for ascites) to promote anabolism. Macronutrient recommendations are for 1.2-1.5 g/kg/day of
protein, 50-70% of calories from carbohydrates, and 10-20% of calories from fat. With regard to
protein, there is an increase in aromatic amino acids (AAA) and decrease in BCAAs in cirrhosis,
which can promote hepatic encephalopathy and other neurologic complications. Supplementation
with 4 g of oral branched-chain amino acids daily can increase albumin and protein synthesis and
decrease risk for hepatic decompensation. The optimal timing, route of administration and
preparation are still not entirely clear. Vegetable protein may be preferable to animal protein for
multiple reasons. Plant protein has fewer sulfur-containing amino acids and more arginine and
ornithine than animal-based proteins. Sulfur-containing amino acids have been implicated in
hepatic encephalopathy, due to the formation of indole compounds and mercaptans during
digestion. Arginine and ornithine facilitate ammonia disposal by way of the urea cycle. Sodium
restriction is also an important part of dietary guidelines in patients with cirrhosis and ascites. A
2 g sodium-restricted diet, when combined with diuretic therapy, is effective for controlling fluid
overload in 90% of these patients. High-sodium processed foods, specifically deli meats, canned
soups, frozen meals, and packaged snacks, should be avoided. Fruits, vegetables, legumes, raw
nuts, and whole grains are naturally low in sodium and should be encouraged.

4. Etiology, dietary management of Hepatic coma (hepatic encephalopathy)

What is hepatic encephalopathy?

Hepatic encephalopathy is a decline in brain function that occurs as a result of severe liver
disease. In this condition, our liver can’t adequately remove toxins from our blood. This causes a
buildup of toxins in our bloodstream, which can lead to brain damage. Hepatic encephalopathy
can be acute (short-term) or chronic (long-term). In some cases, a person with hepatic
encephalopathy may become unresponsive and slip into a coma.

What are the different types of hepatic encephalopathy?

Acute hepatic encephalopathy develops because of severe liver disease. This mainly occurs in
people with these conditions:

 Acute fulminant viral hepatitis. This is a severe type of viral hepatitis that comes on
suddenly.

 Toxic hepatitis. Toxic hepatitis may be caused by exposure to alcohol, chemicals, drugs,
or supplements.

 Reye’s syndrome. This rare and serious condition is primarily seen in children. It causes
sudden swelling and inflammation of the liver and the brain.
Acute hepatic encephalopathy may also be a sign of terminal liver failure.

Chronic hepatic encephalopathy may be permanent or recurrent.

Those with the recurrent version will have multiple episodes of hepatic encephalopathy
throughout their lives. They’ll also require continuous treatment to help prevent the development
of symptoms. Recurrent cases are usually seen in people with severe cirrhosis, or scarring of the
liver.

Permanent cases are rare and seen in people who don’t respond to treatment and who have
permanent neurological conditions, such as:

 seizure disorder

 spinal cord injury

What are the symptoms of hepatic encephalopathy?

Symptoms of hepatic encephalopathy differ depending on the underlying cause of the liver
damage.

Symptoms and signs of moderate hepatic encephalopathy may include:

 difficulty thinking

 personality changes

 poor concentration

 problems with handwriting or loss of other small hand movements

 confusion

 forgetfulness

 poor judgment
 a musty or sweet breath odor

What causes hepatic encephalopathy?

Hepatic encephalopathy may be triggered by:

 infections such as pneumonia

 kidney problems

 dehydration

 hypoxia, or low oxygen levels

 recent surgery or trauma

 medications that suppress our immune system

 eating too much protein

 medications that suppress our central nervous system, such as barbiturates


or benzodiazepine tranquilizers

 electrolyte imbalance, especially a decrease in potassium after vomiting or


taking diuretics

Dietary Management:

Hepatic Encephalopathy is the loss of brain function which occurs when the liver is unable to
break down toxins such as ammonia and manganese properly due to a build-up of toxins in the
bloodstream. This causes the toxins to enter the brain.

Hepatic Encephalopathy diet is known to be immensely helpful when suffering from hepatic
encephalopathy as a low-protein diet structure can reduce ammonia levels in the blood. The
diet mainly focuses on what to avoid rather than what to include as the idea is to lower the
toxin levels in the bloodstream.

Protein consideration – When proteins break down, they release toxins such as ammonia. A
diseased liver is unable to do a complete breakdown which leads to confusion and
disorientation. Therefore a low-protein diet is strongly recommended. Lean protein sources
such as chicken (without skin) and fish are suggested.

Reducing salt levels – A diseased liver can lead to fluid accumulation in which case salt intake
needs to be reduced. This can be done by consuming fresh whole foods instead of packaged
and processed foods as they contain a lot of salt.

Limit carbohydrates – Excess of carbohydrates is known to deposit fatty layers on the liver
which interfere with its functioning. It is advised to avoid white-flour foods and sugary drinks
and increase the consumption of whole grains, fruits and vegetables.

5. Etiology, dietary management of Fatty Liver

Fatty liver is also known as hepatic steatosis. It happens when fat builds up in the liver. Having
small amounts of fat in our liver is normal, but too much can become a health problem.

Our liver is the second largest organ in our body. It helps process nutrients from food and drinks
and filters harmful substances from our blood.

Too much fat in our liver can cause liver inflammation, which can damage our liver and create
scarring. In severe cases, this scarring can lead to liver failure.

When fatty liver develops in someone who drinks a lot of alcohol, it’s known as alcoholic fatty
liver disease (AFLD).

In someone who doesn’t drink a lot of alcohol, it’s known as non-alcoholic fatty liver
disease (NAFLD). According to researchers in the World Journal of Gastroenterology, NAFLD
affects up to 25 to 30 percent of people in the United States and Europe.
Symptoms of fatty liver

Cirrhosis may cause symptoms such as:

 loss of appetite

 weight loss

 weakness

 fatigue

 nosebleeds

 itchy skin

 yellow skin and eyes

 web-like clusters of blood vessels under our skin

 abdominal pain

 abdominal swelling
 swelling of our legs

 breast enlargement in men

 confusion

Causes of fatty liver

Fatty liver develops when our body produces too much fat or doesn’t metabolize fat efficiently
enough. The excess fat is stored in liver cells, where it accumulates and causes fatty liver
disease. This build-up of fat can be caused by a variety of things. For example, drinking too
much alcohol can cause alcoholic fatty liver disease. This is the first stage of alcohol-related liver
disease.

In people who don’t drink a lot of alcohol, the cause of fatty liver disease is less clear.

One or more of the following factors may play a role:

 obesity

 high blood sugar

 insulin resistance

 high levels of fat, especially triglycerides, in our blood

Less common causes include:

 pregnancy

 rapid weight loss

 some types of infections, such as hepatitis C

 side effects from some types of medications, such


as methotrexate (Trexall), tamoxifen (Nolvadex), amiodorone (Pacerone), and valproic
acid (Depakote)
 exposure to certain toxins

Certain genes may also raise our risk of developing fatty liver.

Nutritional Consideration:

 Limit or avoid alcohol.

 Maintain a healthy weight.

 Eat a nutrient-rich diet that’s low in saturated fats, trans fats, and refined carbohydrates.

 Take steps to control our blood sugar, triglyceride levels, and cholesterol levels.

 Follow our doctor’s recommended treatment plan for diabetes, if you have it.

6. Etiology, dietary management of Cholecystitis

Cholecystitis (ko-luh-sis-TIE-tis) is inflammation of the gallbladder. Our gallbladder is a small,


pear-shaped organ on the right side of our abdomen, beneath our liver. The gallbladder holds a
digestive fluid that's released into our small intestine (bile). In most cases, gallstones blocking
the tube leading out of our gallbladder cause cholecystitis. This results in a bile buildup that can
cause inflammation. Other causes of cholecystitis include bile duct problems, tumors, serious
illness and certain infections. If left untreated, cholecystitis can lead to serious, sometimes life-
threatening complications, such as a gallbladder rupture. Treatment for cholecystitis often
involves gallbladder removal.

Signs and symptoms of cholecystitis may include:

 Severe pain in our upper right or center abdomen

 Pain that spreads to our right shoulder or back

 Tenderness over our abdomen when it's touched

 Nausea

 Vomiting

 Fever

Cholecystitis signs and symptoms often occur after a meal, particularly a large or fatty one.

Causes:

Cholecystitis occurs when our gallbladder becomes inflamed. Gallbladder inflammation can be
caused by:

 Gallstones. Most often, cholecystitis is the result of hard particles that develop in our
gallbladder (gallstones). Gallstones can block the tube (cystic duct) through which bile
flows when it leaves the gallbladder. Bile builds up, causing inflammation.

 Tumor. A tumor may prevent bile from draining out of our gallbladder properly, causing
bile buildup that can lead to cholecystitis.

 Bile duct blockage. Kinking or scarring of the bile ducts can cause blockages that lead to
cholecystitis.

 Infection. AIDS and certain viral infections can trigger gallbladder inflammation.

 Blood vessel problems. A very severe illness can damage blood vessels and decrease
blood flow to the gallbladder, leading to cholecystitis.
7. Etiology, dietary management of Cholelithiasis (Gallstones)

Gallstones are hardened deposits of digestive fluid that can form in our gallbladder. Our
gallbladder is a small, pear-shaped organ on the right side of our abdomen, just beneath our liver.
The gallbladder holds a digestive fluid called bile that's released into our small intestine.
Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people
develop just one gallstone, while others develop many gallstones at the same time. People who
experience symptoms from their gallstones usually require gallbladder removal surgery.
Gallstones that don't cause any signs and symptoms typically don't need treatment.

Symptoms:

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a
blockage, the resulting signs and symptoms may include:
 Sudden and rapidly intensifying pain in the upper right portion of our abdomen

 Sudden and rapidly intensifying pain in the center of our abdomen, just below our
breastbone

 Back pain between our shoulder blades

 Pain in our right shoulder

 Nausea or vomiting

Gallstone pain may last several minutes to a few hours.

Causes:

It's not clear what causes gallstones to form. Doctors think gallstones may result when:

 Our bile contains too much cholesterol. Normally, our bile contains enough chemicals to
dissolve the cholesterol excreted by our liver. But if our liver excretes more cholesterol
than our bile can dissolve, the excess cholesterol may form into crystals and eventually into
stones.

 Our bile contains too much bilirubin. Bilirubin is a chemical that's produced when our
body breaks down red blood cells. Certain conditions cause our liver to make too much
bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The
excess bilirubin contributes to gallstone formation.

 Our gallbladder doesn't empty correctly. If our gallbladder doesn't empty completely or
often enough, bile may become very concentrated, contributing to the formation of
gallstones.
Types of gallstones

Types of gallstones that can form in the gallbladder include:

 Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone,
often appears yellow in color. These gallstones are composed mainly of undissolved
cholesterol, but may contain other components.

 Pigment gallstones. These dark brown or black stones form when our bile contains too
much bilirubin.
Dietary Recommendations:

(refer any book)

 Gallstones are strongly related to high-fat, low-fiber diets.


 A surplus of animal protein and animal fat, a lack of dietary fiber, and the consumption of
fat from saturated rather than unsaturated sources appear to be the main nutritional risk
factors for gallstone development.
 The following factors are associated with reduced risk of gallstones:

Plant-based diets. Both animal fat and animal protein may contribute to the formation of
gallstones. Up to 90% of gallstones are cholesterol stones (≥ 20% cholesterol composition),
suggesting the possibility that dietary changes (e.g., reducing dietary saturated fat and cholesterol
and increasing soluble fiber) may reduce the risk of gallstones.

Vegetarian diets are often high in fiber and provide fat mainly in its unsaturated forms. Fruit and
vegetable intake may account for part of this protection. Consuming abundant amounts of fruits
and vegetables is associated with reduced risk for cholecystectomy. Vitamin C, which is found in
plants and is absent from meat, affects the rate-limiting step in the catabolism of cholesterol to
bile acids and is inversely related to the risk of gallstones in women.

Replacement of sugars and refined starches with high-fiber foods. The cholesterol saturation
index of bile, a known risk factor for gallstone formation, is higher with diets that provide
carbohydrates in a refined, as opposed to unrefined, form.

Avoidance of excess weight and a healthful approach to weight control. Women with a BMI
≥ 30 kg/m2 have at least double the risk for gallstone disease compared with women with a BMI
< 25 kg/m2. The same degree of risk exists for men with a BMI ≥ 25 kg/m2, compared with a
BMI < 22.5 kg/m2. Risk rises with increased weight.

As noted above, very-low-calorie diets (< 800 kcal/day) increase the risk of gallstones, though
the explanation for this remains unclear. Including a small amount of fat (10 g/day) provides
maximal gallbladder emptying and prevents gallstone formation in calorie-restricted
dieters. Such observations support weight control efforts based on low-fat, plant-based diets,
which typically cause healthful and sustained weight control, rather than those based on very-
low-calorie formula diets.

Moderate alcohol intake. Compared with infrequent consumption or abstinence, moderate


alcohol intake was found to be inversely associated with the risk for gallstones. However, given
the health risks (e.g., breast or colorectal cancer) associated with alcohol consumption, caution
regarding alcohol use is warranted.
8. Etiology, dietary management of Acute pancreatitis
9. Etiology, dietary management of Chronic pancreatitis

Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked
behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion
and hormones that help regulate the way our body processes sugar (glucose). Pancreatitis can
occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can
occur as chronic pancreatitis, which is pancreatitis that occurs over many years. Mild cases of
pancreatitis may go away without treatment, but severe cases can cause life-threatening
complications.

Symptoms:

Acute pancreatitis signs and symptoms include:

 Upper abdominal pain

 Abdominal pain that radiates to our back

 Abdominal pain that feels worse after eating

 Fever

 Rapid pulse
 Nausea

 Vomiting

 Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

 Upper abdominal pain

 Losing weight without trying

 Oily, smelly stools (steatorrhea)

Causes:

Pancreatitis occurs when digestive enzymes become activated while still in the pancreas,
irritating the cells of our pancreas and causing inflammation.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic
pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning
pancreas can cause digestion problems and diabetes.

Conditions that can lead to pancreatitis include:

 Abdominal surgery

 Alcoholism

 Certain medications

 Cystic fibrosis

 Gallstones

 High calcium levels in the blood (hypercalcemia), which may be caused by an overactive
parathyroid gland (hyperparathyroidism)

 High triglyceride levels in the blood (hypertriglyceridemia)

 Infection
 Injury to the abdomen

 Obesity

 Pancreatic cancer

Dietary recommendations:

(Refer any book)

Though acute pancreatitis usually heals within one to two weeks, solid foods are usually not
advised during this period, to minimize the load on the pancreas. Physicians usually recommend
eating small amounts of food once the diagnosis of pancreatitis is made; however, observations
show that most people start eating little as soon as the symptoms get relieved.

Solid foods are safe once pancreatitis is relieved; however, it is advisable to consume foods that
are easy to digest and have a low fat content.

Physicians usually recommend a diet which is high in protein and contains only moderate
amounts of animal fat and sugars. The following list shows foods which are safe during
pancreatitis:

 Protein-rich foods like lentils or beans


 Skimmed or non-fat milk or milk products
 Fresh fruits and vegetables
 Foods like berries, green leafy vegetables, nuts or berries which are high in antioxidants
 Whole grains

However, it is advisable to consume lower amounts of foods like olive oil, fatty fruits like
avocado, nuts and fatty fish because of their high fat content. The Mediterranean-type diet is
recommended during pancreatitis as it is easy to digest, especially if while convalescing from
acute or mild pancreatitis.

How do these foods help in recovering from pancreatitis?

The consumption of vegetables and fruits increases the fiber intake and reduces the overall
cholesterol intake. Reduced cholesterol consumption minimizes the chances of gallstones and
high triglyceride levels, which are among the risk factors for developing acute pancreatitis. An
antioxidant-rich diet also aids in eliminating free radicals from the body, which further reduces
the inflammation of the pancreas.

It has also been observed that foods rich in medium-chain triglycerides (MCTs) like coconut oil
also assist in improving the overall nutrient absorption following the onset of pancreatitis.

Which foods should be avoided during pancreatitis?

Foods high in fat content, especially fried foods and those containing a lot of fat and/or those rich
in sugar should be completely avoided. Refrain from foods like red meat, sugary drinks, rich
desserts and full-fat milk or milk products.

Dietary modifications:

A few basic dietary and lifestyle changes can facilitate recovery from acute pancreatitis. Below
are various simple steps which may be incorporated into the process of recovery to speed it up:

 Consuming frequent meals with small portions; dividing the total food intake into six to
eight small meals a day reduces the load on the pancreas
 Adding one to two tablespoons of MCTs daily to meals helps in recovering from
moderately severe or severe chronic pancreatitis.
 A multivitamin supplement containing A, D, E, K, B12, zinc and folic acid is useful
 Consuming less than 30 grams per day of fats; cutting out saturated fats
 Refrain from smoking and alcohol
 Drink copious amounts of water daily

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