Liver, Gallbladder and Pancreas Disorders

The liver is of primary importance, one cannot survive without a liver. The liver and pancreas are essential to digestion, and the entire nutritional metabolism. When these organs are diseased the necessary medical nutrition therapy is complex.

The gallbladder is important, but should it be removed, the body can be supported to adapt functioning without it.

The liver plays a mayor role in carbohydrate, protein and fat metabolism, storage and activation of vitamins and minerals, formation and excretion of bile, detoxifying drugs and alcohol, conversion of ammonia to urea, and more. Nonalcoholic fatty liver disease (NAFLD) is associated most commonly with **acquired metabolic disorders: obesity, type 2 diabetes mellitus, dyslipidemia, insulin resistance and metabolic syndrome. The initial stage is steatosis, characterized by fat accumulation within the liver. Malnutrition related to Alcoholic liver disease, due to excessive ethanol ingestion, is associated with severe nutritional abnormalities, and may progress to ascites ( abdominal fluid retention ), gastro intestinal bleeding and encephalopathy ( mental impairment ). Objective nutrition assessment is important in determining specific requirements for patients with Cirrhosis and End Stage Liver Disease.

Hemochromatosis is a condition associated with iron overload, and needs to be managed by regular blood donation and dietary control of iron intake.

Disease of the gallbladder may involve cholestasis (flow of bile into the digestive tract is obstructed ) and formation of gallstones (cholelithiasis), related to high dietary fat intake over a prolonged period. Cholelithiasis and fatty liver disease share risk factors, such as central obesity, insulin resistance and central obesity.

Pancreatitis may be acute or chronic. Alcohol use, smoking, excess body weight, diet, genetic factors and medication may be causal factors. Dietary modification has an important role after diagnosis, and admittance to hospital. Acute pancreatitis is usually associated with severe upper abdominal pain, nausea and vomiting, worsened by the ingestion of food, related to the secretion of pancreatic enzymes and bile. Severe acute pancreatitis results in metabolic demands similar to those in sepsis. The optimal timing and route of nutrition, Parenteral (Intravenous ) or Enteral, should be carefully considered.

Chronic pancreatitis evolves insidiously over many years. Epigastric pain may be precipitated by meals, and patients are at risk of developing protein- calorie malnutrition.