Liver, Gallbladder and Pancreas Disease

The pancreas and the liver are of primary importance and essential to nutritional metabolism.

When they are diseased, the necessary MNT is complex. The gallbladder, however, is important but can be removed and the body can adapt to its absence.

Diseases of the liver, acute or chronic, inherited or acquired, may include viral hepatitis, nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD),  and others. The treatment recommended for NAFLD, by the  American Association for the Study of Liver Diseases, is nutrition therapy, weight loss and lifestyle management. ALD progresses from hepatic steatosis, to alcoholic hepatitis, and finally cirrhosis. Forty % of deaths from cirrhosis are attributed to alcohol.

Cholestatic liver diseases refer to conditions affecting the bile ducts. Primary Biliary Cirrhosis progresses slowly, eventually resulting in cirrhosis. Primary Sclerosing Cholangitis also results in biliary cirrhosis.

End Stage Liver Disease (ESLD) may be the reason for hospital admittance of a patient, with symptoms such as ascites and edema, portal hypertension, hyponatremia and hepatic encephalopathy. Oral nutritional care is the preferred route of feeding, but Enteral (tube) feeding may be necessary in a malnourished patient with inadequate nutrient intake. Special attention is given to sodium and fluid restriction, small frequent meals, 1-1.5g of protein / kg, Branched Chain Amino Acids vs  Aromatic Amino Acids, carbohydrate control for hyperglycemia, and addressing vitamin and mineral deficiencies.

Cholecystectomy is the surgical removal of the gallbladder. A patient needs attention in hospital, to understand predisposing nutritional risk factors such  obesity, high% cholesterol and fat in the diet, lack of vit C, and weight cycling, and to adopt a lower fat diet with sufficient fibre as a safer life long nutritional  strategy.

Pancreatitis is an inflammatory condition of the pancreas, and may be acute or chronic, with the latter causing pancreatic destruction so extensive that exocrine and endocrine  function is impaired, resulting in maldigestion and diabetes. Alcohol use, smoking, unhealthy diet, and medication are risk factors. Patients are admitted to hospital with clinical symptoms of Acute Pancreatitis including abdominal pain, distention, nausea, vomiting, steatorrhea ( bulky greasy stools ), stress-induced malnutrition such as decreased serum transferrin and albumin, and in severe cases hypotension, oliguria, dyspnoea.  MNT include withholding enteral and oral nutrition, support with intravenous fluids, and if tolerated, specialized selection of oral nutritional supplements and low fat, small easily digestible meals. In Severe Acute Pancreatitis, the best treatment recommended is  Enteral (tube feeding) or Parenteral (intravenous ) Nutrition. Supplementation with nutritional modulators of inflammation such as arginine, glutamine, omega-3 fatty acids is found to be favorable. Enteral Nutrition is preferred as failure to use the GIT may exacerbate the stress response.

Chronic Pancreatitis evolves insidiously over years,   characterized by recurrent attacks of epigastric pain. Nausea, vomiting or diarrhea make it difficult to maintain adequate nutrition status. Patients admitted to hospital may have developed protein- calorie malnutrition, weight loss, deficits in lean muscle tissue, impaired immune function and vitamin deficiencies. The goal of MNT is to provide optimum nutrition support, enzyme supplementation and a lower fat diet (40-60g/day) to decrease pain by minimizing stimulation of the exocrine pancreas.