DISEASES OF THE LIVER: HEPATITIS
The liver is probably the most complex organ in the body with numerous functions that are listed only briefly here. It synthesizes plasma proteins, hemoglobin, prothrombin, heparin, glycogen, lipoproteins, phospholipids, cholesterol, and numerous other substances. It stores glycogen, iron, copper, and vitamins A and D. It participates in the metabolism of nutrients by the removal of the amino group from amino acids, the synthesis of urea, the release of glycogen to maintain normal blood sugar levels, the formation of bile for the normal digestion of fats, the oxidation of fatty acids, and the conversion of carotene to vitamin A. It detoxifies poisons that would otherwise be harmful to the body. With such a variety of functions it is evident that any disease can seriously interfere with nutritional status and health.
Hepatitis
Hepatitis is an inflammation of the liver. Among the causes are viral infection transmitted by contaminated food or water; infection following transfusion of blood products that contain the virus; alcoholism; drug addiction; and poisonings by such agents as carbon tetrachloride.
Among the symptoms that interfere with food intake are anorexia, nausea, vomiting, fever, abdominal discomfort, and diarrhea. Weight loss is often great. Bed rest and diet therapy are the principal treatment.
Dietary management
A nutritionally adequate diet is an important aspect of therapy, since poor nutritional status can result in permanent damage to the liver. Because of nausea and vomiting in the early stages it may be necessary to resort to parenteral fluids or to tube feedings.
The appetite usually remains poor, so that the nurse and dietitian must be sure that the diet is attractive and appealing to the taste, and must use a good deal of persuasion to get the patient to eat. Each meal should include only the amounts of food that the patient can be expected to eat. Six small meals are better than three overly large meals. The diet is based upon the following considerations.
1. As soon as the patient is able to eat a full-fluid diet six or more feedings may be given initially followed by a soft diet and then a regular diet.
2. If weight loss is great and if there are other signs of malnutrition, the caloric intake should be increased to 3000 kcal or more, and the protein to 100 gm or more.
3. Most patients tolerate a normal fat intake, although fried foods are sometimes omitted. When there is obstruction of the biliary tract a low-fat intake is necessary.
4. A liberal carbohydrate intake enhances the caloric intake and also assures a continuous synthesis of glycogen.
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GENERAL HEALTH
