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stringlengths 12
494
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listlengths 384
384
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depleted\tstatus,\tand\tmuscle\twasting.\tHowever,\tprotein\tkinetic\tstudies\tdemonstrate\tincreased\tnitrogen\tlosses\tonly\tin\npatients\twith\tfulminant\thepatic\tfailure\tor\tdecompensated\tdisease,\tbut\tnot\tin\tstable\tcirrhosis.\nPatients\twith\tcirrhosis\talso\thave\tincreased\tprotein\tutilization.\tStudies\tsuggest\tthat\t0.8\tg\tof\tprotein/kg/day\tis\tthe
|
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] |
mean\tprotein\trequirement\tto\tachieve\tnitrogen\tbalance\tin\tstable\tcirrhosis.\n\tTherefore\tin\tuncomplicated\thepatitis\tor\ncirrhosis\twith\tor\twithout\tencephalopathy,\tprotein\trequirements\trange\tfrom\t1\tto\t1.5\tg/kg\tof\tideal\tweight\tper\tday\n(\nAmodio\tet\tal,\t2013\n).
|
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] |
(\nAmodio\tet\tal,\t2013\n).\nTo\tpromote\tnitrogen\taccumulation\tor\tpositive\tbalance,\tat\tleast\t1.2\tto\t1.3\tg/kg\tdaily\tis\tneeded.\tIn\tsituations\tof\nstress\tsuch\tas\talcoholic\thepatitis\tor\tdecompensated\tdisease\t(sepsis,\tinfection,\tgastrointestinal\tbleeding,\tor\n\tsevere
|
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] |
severe\nascites),\tat\tleast\t1.5\tg\tof\tprotein\tper\tkg\tper\tday\tshould\tbe\tprovided.\tSmall\tfrequent\tmeals\tnot\tonly\tprovide\tadditional\ncalories\tbut\talso\tprevent\tgluconeogenesis\tand\twasting\tof\tmuscle\t(\nAmodio\tet\tal,\t2014\n).\nVitamins\tand\tminerals
|
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] |
Amodio\tet\tal,\t2014\n).\nVitamins\tand\tminerals\nVitamin\tand\tmineral\tsupplementation\tshould\tbe\tconsidered\tfor\tall\tpatients\twith\tESLD\tbecause\tof\tthe\tessential\trole\tof\nthe\tliver\tin\tnutrient\ttransport,\tstorage,\n\tand\tmetabolism,\tin\taddition\tto\tthe\tpresence\tof\tnutrient\tdepletions\tdue\tto\ndrugs\t(\nTable\t28.4
|
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0.03489667549729347,
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0.0005905663128942251,
0.04639497771859169,
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0.012503411620855331,
0.0935545414686203,
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0.05096390098333359,
0.07925090938806534,
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0.11592942476272583,
-0.030451517552137375,
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0.0676010251045227,
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0.011479487642645836,
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-0.04246451333165169,
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0.06290941685438156,
0.054677814245224,
0.07117774337530136,
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0.013184516690671444,
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0.04759642481803894,
0.005519564729183912,
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0.12596631050109863,
-0.05433432012796402,
-0.060839325189590454,
-0.021669337525963783,
0.1096416711807251,
0.044033233076334,
-0.06471017003059387,
-0.013689949177205563,
0.08140785992145538,
0.0014790231361985207,
-0.0574873723089695,
-0.008321119472384453,
0.0752960667014122,
0.012489466927945614,
-0.030397916212677956,
-0.07867308706045151,
0.026605235412716866,
0.06074995920062065,
0.007245682645589113,
-0.004170025233179331,
-0.031960222870111465,
0.005445243325084448,
0.05940777808427811,
0.09292174875736237,
-0.026445673778653145
] |
drugs\t(\nTable\t28.4\n).\tVitamin\tdeficiencies\tcan\tcontribute\tto\tcomplications.\tFor\texample,\tfolate\tand\tvitamin\tB\n12\ndeficiencies\tcan\tlead\tto\tmacrocytic\tanemia.\tDeficiency\tof\tpyridoxine,\tthiamin,\tor\tvitamin\tB\n12\n\tcan\tresult\tin\nneuropathy.\tConfusion,\tataxia,\tand\tocular\tdisturbances\tcan\tresult\tfrom\ta\tthiamin\tdeficiency.
|
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0.08008021116256714,
0.0494525246322155,
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0.06413943320512772,
0.04680730774998665,
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0.07056132704019547,
0.00035237823612987995,
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0.07891616225242615,
0.08662264794111252,
0.04351945221424103,
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0.02188200317323208,
0.08471941947937012,
0.05403735116124153,
-0.007345015183091164
] |
TABLE\t28.4\nVitamin\tand\tMineral\tDeficits\tin\tSevere\tHepatic\tFailure\nVitamin\tor\nMineral\nPredisposing\tFactors\nSigns\tof\tDeficiency\t(See\n\t\nAppendix\t21\n)\nVitamin\tA\nSteatorrhea,\tneomycin,\ncholestyramine,\nalcoholism\nNight\tblindness,\tincreased\tinfection\trisk\nVitamin\tB\n1\n(thiamine)\nAlcoholism,\thigh-\ncarbohydrate\tdiet
|
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0.031277626752853394,
0.010539055801928043,
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1.6318810656783724e-34,
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] |
Vitamin\tB\n1\n(thiamine)\nAlcoholism,\thigh-\ncarbohydrate\tdiet\nNeuropathy,\tascites,\tedema,\tcentral\tnervous\tsystem\t(CNS)\tdysfunction\nVitamin\tB\n3\n\t(niacin)\nAlcoholism\nDermatitis,\tdementia,\tdiarrhea,\tinflammation\tof\tmucous\tmembranes\nVitamin\tB\n6\n(pyridoxine)\nAlcoholism\nMucous\tmembrane\tlesions,\tseborrheic\tdermatitis,\tglossitis,\tangular
|
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0.020099733024835587
] |
Mucous\tmembrane\tlesions,\tseborrheic\tdermatitis,\tglossitis,\tangular\nstomatitis,\tblepharitis,\tperipheral\tneuropathy,\tmicrocytic\tanemia,\ndepression\nVitamin\tB\n12\n(cyanocobalamin)\nAlcoholism,\ncholestyramine\nMegaloblastic\tanemia,\tglossitis,\tCNS\tdysfunction\nFolate\nAlcoholism\nMegaloblastic\tanemia,\tglossitis,\n\tirritability\nVitamin\tD\nSteatorrhea,
|
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] |
Megaloblastic\tanemia,\tglossitis,\n\tirritability\nVitamin\tD\nSteatorrhea,\nglucocorticoids,\ncholestyramine\nOsteomalacia,\trickets\t(in\tchildren),\tpossible\tlink\tto\tcancer\tor\tautoimmune\ndisorders\nVitamin\tE\nSteatorrhea,\ncholestyramine\nPeripheral\tneuropathy,\tataxia,\tskeletal\tmyopathy,\tretinopathy,\timmune\nsystem\timpairment\nVitamin\tK\nSteatorrhea,\tantibiotics,
|
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] |
system\timpairment\nVitamin\tK\nSteatorrhea,\tantibiotics,\ncholestyramine\nExcessive\tbleeding,\tbruising\nIron\nChronic\tbleeding\nStomatitis,\n\tmicrocytic\tanemia,\tmalaise\nMagnesium\nAlcoholism,\tdiuretics\nNeuromuscular\tirritability,\thypokalemia,\thypocalcemia\nPhosphorus\nAnabolism,\talcoholism\nAnorexia,\tweakness,\tcardiac\tfailure,\tglucose\tintolerance\nZinc
|
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] |
Anorexia,\tweakness,\tcardiac\tfailure,\tglucose\tintolerance\nZinc\nDiarrhea,\tdiuretics,\nalcoholism\nImmunodeficiency,\timpaired\ttaste\tacuity,\tdelayed\twound\thealing,\timpaired\nprotein\tsynthesis\nDeficiencies\tof\tfat-soluble\tvitamins\thave\tbeen\tfound\tin\n\tall\ttypes\tof\tliver\tfailure,\tespecially\tin\tcholestatic\tdiseases\tin
|
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] |
all\ttypes\tof\tliver\tfailure,\tespecially\tin\tcholestatic\tdiseases\tin\nwhich\tmalabsorption\tand\tsteatorrhea\toccur.\tImpaired\tdark\tadaptation\tcan\toccur\tfrom\tvitamin\tA\tdeficiency.\tHepatic\nosteodystrophy\tor\tosteopenia\tcan\tdevelop\tfrom\tvitamin\tD\tdeficiency.\tTherefore\tsupplementation\tis\tnecessary,\tand
|
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] |
may\trequire\tusing\twater-miscible\tforms\tof\tfat\tsoluble\tvitamins.\tIntravenous\tor\tintramuscular\tvitamin\tK\toften\n\tis\tgiven\nfor\t3\tdays\tto\trule\tout\tvitamin\tK\tdeficiency\tas\tthe\tcause\tof\ta\tprolonged\tprothrombin\ttime.\tWater-soluble\tvitamin\ndeficiencies\tassociated\twith\tliver\tdisease\tinclude\tthiamin\t(which\tcan\tlead\tto\t\nWernicke\tencephalopathy\n),\tpyridoxine
|
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] |
Wernicke\tencephalopathy\n),\tpyridoxine\n(B\n6\n),\tcyanocobalamin\t(B\n12\n),\tfolate,\tand\tniacin\t(B\n3\n).\tLarge\tdoses\t(100\tmg)\tof\tthiamin\tare\tgiven\tdaily\tfor\ta\tlimited\ttime\nif\tdeficiency\tis\tsuspected\t(see\t\nAppendices\t12\n\tand\t\n13\n).\nMineral\tnutriture\talso\tis\taltered\tin\tliver\tdisease.\tIron\tstores\tmay\tbe\tdepleted\tin\tpatients\texperiencing
|
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] |
gastrointestinal\tbleeding;\thowever,\tiron\tsupplementation\tshould\tbe\tavoided\tby\tpersons\twith\themochromatosis\tor\nhemosiderosis\t(see\t\nChapter\t31\n).\tManganese\tdeposition\thas\tbeen\tnoted\tto\taccumulate\tin\tbrains\tof\tpatients\twith\ncirrhosis,\tleading\tto\timpaired\tmotor\tfunction\tand\tparkinsonism\n\tand\tincreased\toccurrence\tof\thepatic\tencephalopathy\n(
|
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0.06954539567232132,
0.14264485239982605,
0.07720240950584412,
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] |
and\tincreased\toccurrence\tof\thepatic\tencephalopathy\n(\nButterworth,\t2013\n;\t\nKobtan\tet\tal,\t2016\n;\t\nSureka\tet\tal,\t2015\n).\tElevated\tserum\tcopper\tlevels\tare\tfound\tin\tcholestatic\nliver\tdiseases\t(i.e.,\tPBC\tand\tPSC).\nIn\tWilson’s\tdisease,\texcess\tcopper\tin\tvarious\torgans\tcauses\tsevere\tdamage.\tTreatment\ttypically\tincludes
|
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] |
administration\tof\toral\tchelating\tagents\tsuch\tas\td-penicillamine,\ttrientine,\tor\ttetrathiomolybdate.\n\tZinc\tacetate\tcan\nblock\tabsorption\tof\tcopper\tfrom\tfood\tbut\ttypically\tis\tused\twith\tone\tof\tthe\tchelating\tdrugs.\tDietary\tcopper\trestriction
|
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] |
can\tbe\tuseful\tduring\tinitial\ttherapy.\tCopper\talso\tcan\tbe\tpresent\tin\twater\twhere\tcopper\tpipes\tare\tused.\tRunning\ttap\nwater\tfor\tseveral\tseconds\tbefore\tusing\tthe\twater\tcan\treduce\tcopper\tconcentrations.\nZinc\tand\tmagnesium\tlevels\tare\tlow\tin\tliver\tdisease\trelated\tto\n\talcoholism\tand\tdiuretic\ttherapy.\tCalcium,\tas\twell\tas
|
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] |
alcoholism\tand\tdiuretic\ttherapy.\tCalcium,\tas\twell\tas\nmagnesium\tand\tzinc,\tmay\tbe\tmalabsorbed\twith\tsteatorrhea.\tTherefore\tthe\tpatient\tshould\ttake\tsupplements\tof\tthese\nminerals\tat\tleast\tat\tthe\tlevel\tof\tthe\tDRI.\nHerbal\tand\tdietary\tsupplements\tand\tliver\tdisease
|
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] |
Herbal\tand\tdietary\tsupplements\tand\tliver\tdisease\nHepatotoxicity\tis\tone\tof\tthe\tgreatest\tconcerns\tassociated\twith\therbal\tand\tdietary\tsupplementation.\tWhile\tmost\nculinary\therbs\tare\tsafe,\n\tthere\tare\tcase\treports\tof\tsome\therbal\tsupplements\tresulting\tin\tliver\tfailure\t(\nBox\t28.3\n).\tOne
|
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] |
Box\t28.3\n).\tOne\nreview\tlists\tmore\tthan\t150\therbal\tproducts\tthat\thave\tbeen\treported\tas\ta\tcause\tof\thepatotoxicity\t(\nTeschke\tet\tal,\n2013\n).\tThis\textensive\tlist\temphasizes\tthe\tgravity\tof\tthe\tpotential\tfor\tharm\tto\tthe\tliver\tfrom\tsome\therbal\tproducts,\tso\npractitioners\tshould\tbe\tvigilant\tin\tasking\tpatients\tabout\tsupplement\tusage.\nBOX\t28.3
|
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] |
BOX\t28.3\nSelected\tHerbal\tSupplements\tAssociated\tWith\tHepatotoxicity\nBaikal\tskullcap\t(\nScutellaria\n)\nChaparral\t(\nLarrea\ttridentate\n)\nPyrrolizidine\talkaloids\t(found\tin\therbs\tof\tthe\t\nCompositae,\tLeguminosae,\tBoraginaceae\n\tfamily)\nComfrey\t(\nSymphytum\tofficinale\n)\nHeliotropium\nCrotalaria\nGermander\t(\nTeucrium\tchamaedrys\n)\nGreater\tcelandine\t(
|
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] |
Crotalaria\nGermander\t(\nTeucrium\tchamaedrys\n)\nGreater\tcelandine\t(\nChelidonium\tmajus\n)\nSaw\tpalmetto\t(\nSerenoa\trepens\n)\nNoni\n\tjuice\t(\nMorinda\tcitrifolia\n)\nMargosa\toil\t(\nAntelaea\tazadirachta\n)\nAloe\tvera\t(aloe\tlatex)\nBlack\tcohosh\t(\nActea\tracemosa\n\tor\t\nActea\tcimicifuga\n)
|
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] |
LipoKinetix\t(\nusnic\tacid\n)\nAtractylis\tgummifera\nImpila\t(\nCallilepis\tlaureola\n)\nMistletoe\t(\nViscum\talbum\n)\nValerian\t(\nValerian\tofficinalis\n)\nSenna\t(\nCassia\tangustifolia\n)\nPennyroyal\t(squaw\tmint\toil)\nKava\t(\nPiper\tmethysticum\n)\nLiatris\tcallilepis\nGreen\ttea\textract\n\t(\nCamellia\tsinensis\n),\talthough\tgreen\ttea\tin\treasonable\tamounts\tappears\tsafe
|
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] |
),\talthough\tgreen\ttea\tin\treasonable\tamounts\tappears\tsafe\nCascara\tsagrada\nOxyElite\tPro\nJin\tBu\tHuan\t(\nLycopodium\tserratum\n)\nMa\tHuang\t(\nEphedra\tsinica\n)\nDai-saiko-to\t(\nSho-saiko-to\n)\nHydroxycut\nLipoKinetix\t(Syntrax\tInnovations,\tInc,\tCape\tGirardeau,\tMO),\tOxyElite\tPro\t(USP\tLabs,\tLLC,\tDallas,\tTX),\tHydroxycut\t(Iovate
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] |
Health\tSciences\tUSA,\tInc,\tBlasdell,\tNY).\t\nReprinted\twith\tpermission\n\tfrom:\tCorey\tRL,\tRakela\tJ:\tComplementary\tand\talternative\tmedicine:\trisks\tand\tspecial\nconsiderations\tin\tpre-\tand\tpost-transplant\tpatients,\t\nNutr\tClin\tPract\n\t29:322,\t2014.\nOther\tdietary\tproducts\talso\thave\tbeen\timplicated\tin\thepatotoxicity.\tAmong\tthe\tmost\tcommon\tproducts\tare\tgarcinia
|
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] |
cambogia,\tHerbalife\tproducts,\tHydroxycut,\tand\tOxyElite\tPro\t(\nCrescioli\tet\tal,\t2018\n;\t\nCenters\tfor\tDisease\tControl\tand\nPrevention\t[CDC],\t2013\n;\t\nFong\tet\tal,\t2010\n;\t\nJóhannsson\tet\tal,\t2010\n;\t\nSchoepfer\tet\tal,\t2007\n;\t\nSharma\tet\tal,\t2010\n).\tOne\tof
|
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] |
;\t\nSchoepfer\tet\tal,\t2007\n;\t\nSharma\tet\tal,\t2010\n).\tOne\tof\nthe\tmost\tsignificant\tevents\toccurred\tin\t2013\twhen\t56\tindividuals\t(43\tin\tHawaii)\ttaking\tOxyElite\tPro\tdeveloped\tacute\nor\tfulminant\tliver\tfailure.\tSeveral\tpatients\trequired\tliver\ttransplantation\tand\tat\tleast\tone\tpatient\tdied\t(\nCDC,\t2013\n;\nFood\tand\tDrug\tAdministration\t[FDA],\t2014\n).
|
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CDC,\t2013\n;\nFood\tand\tDrug\tAdministration\t[FDA],\t2014\n).\nDespite\treports\tof\thepatotoxicity\n\twith\tnumerous\therbal\tsupplements,\tsome\tsupplements\thave\tbeen\tinvestigated\tfor\nbenefits\ton\tliver\tdisease.\t\nS\n-adenosyl-\nL\n-methionine\t(SAMe)\tis\tsometimes\tsuggested\tfor\tuse\twith\tliver\tdisease.\tIt\tis
|
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] |
purported\tto\tact\tas\ta\tmethyl\tdonor\tfor\tmethylation\treactions\tand\tparticipates\tin\tglutathione\tsynthesis\t(an\nantioxidant).\tA\trecent\tsystematic\treview\tand\tmeta-analysis\tsuggested\tSAMe\tmay\timprove\tliver\tfunction\n\tbut\tdoes\tnot\nimprove\toutcomes\tfor\tchronic\tliver\tdisease\t(\nGuo\tet\tal,\t2015\n).\tBetaine\thas\tbeen\tproposed\tfor\ttreatment\tof\tNASH,
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] |
Guo\tet\tal,\t2015\n).\tBetaine\thas\tbeen\tproposed\tfor\ttreatment\tof\tNASH,\nalcoholic\tliver\tdisease,\tand\tother\tconditions.\tBetaine\tfunctions\tin\tthe\tliver\tas\ta\tmethyl\tdonor.\tAlthough\tthere\tis\ntheoretical\tpromise,\tthere\tis\ta\tlack\tof\tstrong\tevidence\tfor\tbenefit\t(\nDay\tand\tKempson,\t2016\n;\t\nAbdelmalek\tet\tal,\t2009\n;\nMukherjee,\t2011\n).\nMilk\tthistle\tappears\tto
|
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] |
Abdelmalek\tet\tal,\t2009\n;\nMukherjee,\t2011\n).\nMilk\tthistle\tappears\tto\n\tbe\tthe\tmost\tpopular\tand\textensively\tstudied\therbal\tsupplement\tfor\tliver\tdisease.\tThe\tactive\ncomponent\tin\tmilk\tthistle\tis\tsilymarin\twith\tsilybin\t(constituting\t50%\tto\t70%\tof\tsilymarin)\tbelieved\tto\thave\tthe\tmost
|
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] |
biologic\tactivity.\tMilk\tthistle\tis\tproposed\tto\thave\tantiinflammatory,\tantioxidant,\tand\tantifibrotic\tproperties,\twhich\nwould\tbe\tbeneficial\tin\tliver\tdisease\t(\nAbenavoli\tet\tal,\t2010\n).\tMilk\tthistle\n\thas\tbeen\tevaluated\tfor\tviral\thepatitis,
|
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).\tMilk\tthistle\n\thas\tbeen\tevaluated\tfor\tviral\thepatitis,\nalcoholic\tliver\tdisease,\tand\ttoxin-induced\tliver\tdisease.\tA\trecent\tmeta-analysis\tevaluated\tthe\tbenefits\tof\tsilymarin\ton\nNAFLD.\tThe\tstudy\tshowed\tthat\tsilymarin\tmay\treduce\ttransaminases,\tbut\tthere\twas\tno\tevaluation\tof\thistologic\nchanges\tin\tthe\tliver\t(\nZhong\tet\tal,\t2017
|
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] |
changes\tin\tthe\tliver\t(\nZhong\tet\tal,\t2017\n).\tDespite\tits\tpopularity\tand\twidespread\tuse,\ta\tclear\tconsensus\tis\tlacking\tas\tto\na\tbeneficial\n\teffect\tof\tmilk\tthistle\ton\tall\tforms\tof\tliver\tdisease,\tso\tindividual\tassessment\tis\tneeded.\tHowever,\tdata\tare\nnot\tsufficient\tto\tsuggest\tthat\tit\tis\tunsafe\tor\ttoxic\tfor\tpatients\twith\tliver\tdisease.
|
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Liver\tresection\tand\ttransplantation\nAs\twith\tany\tmajor\tsurgery,\tprotein\tand\tenergy\tneeds\tincrease\tafter\tliver\tresection.\tNeeds\talso\tare\tincreased\tfor\tliver\ncell\tregeneration.\tEN\tcan\tbe\tbeneficial\tby\n\tproviding\tportal\thepatotropic\tfactors\tnecessary\tfor\tliver\tcell\tproliferation.
|
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] |
Optimal\tnutrition\tis\tmost\timportant\tfor\tpatients\twith\tpoor\tnutrition\tstatus\tbefore\thepatectomy\t(e.g.,\tpatients\twith\ncholangiocarcinoma).\nLiver\ttransplantation\thas\tbecome\tan\testablished\ttreatment\tfor\tESLD.\tMalnutrition\tis\tcommon\tin\tliver\ttransplant\ncandidates.\tDietary\tintake\toften\tcan\tbe\tenhanced\tif\tpatients\teat\tsmall,
|
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frequent,\tnutrient-dense\tmeals,\tand\toral\nnutritional\tsupplements\talso\tmay\tbe\twell\ttolerated.\tEN\tis\tindicated\twhen\toral\tintake\tis\tinadequate\tor\ncontraindicated.\tVarices\tare\tnot\tan\tabsolute\tcontraindication\tfor\tplacement\tof\ta\tfeeding\ttube.\tBecause\tPN\tcan\taffect
|
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liver\tfunction\tadversely,\tEN\tis\tpreferred.\tPN\tis\treserved\tfor\tpatients\twithout\tadequate\tgut\tfunction\t(see\t\nChapter\t12\n).\nIn\tthe\tacute\tposttransplant\n\tphase,\tnutrient\tneeds\tare\tincreased\tto\tpromote\thealing,\tdeter\tinfection,\tprovide\tenergy
|
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] |
for\trecovery,\tand\treplenish\tdepleted\tbody\tstores.\tNitrogen\trequirements\tare\televated\tin\tthe\tacute\tposttransplant\nphase\tand\tcan\tbe\tmet\twith\tearly\tpostoperative\tEN.\tEarly\tpostoperative\tEN\thas\tbeen\tassociated\twith\treduced\ninfections\tin\tliver\ttransplant\trecipients\t(\nHasse\tet\tal,\t1995\n;\t\nIkegami\tet\tal,\t2012\n;\t\nMasuda\tet\tal,\t2014\n).\tAdministration
|
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] |
;\t\nIkegami\tet\tal,\t2012\n;\t\nMasuda\tet\tal,\t2014\n).\tAdministration\nof\tprobiotics\tand\tfiber\twith\ttube\tfeeding\tmay\treduce\tpostoperative\tinfection\trate\tbetter\tthan\ttube\tfeeding\tor\tfiber\nalone\t(\nRayes\tet\tal,\t2005\n).\nMultiple\tmedications\tused\tafter\ttransplant\thave\tnutritional\tside\teffects\tsuch\tas\tanorexia,\tgastrointestinal\tupset,
|
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] |
hypercatabolism,\tdiarrhea,\thyperglycemia,\thyperlipidemia,\tsodium\tretention,\thypertension,\thyperkalemia,\tand\nhypercalciuria.\n\tTherefore\tdietary\tmodification\tis\tbased\ton\tthe\tspecific\tside\teffects\tof\tdrug\ttherapy\t(\nTable\t28.5\n).\nDuring\tthe\tposttransplant\tphase,\tnutrient\trequirements\tare\tadjusted\tto\tprevent\tor\ttreat\tproblems\tof\tobesity,
|
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] |
hyperlipidemia,\thypertension,\tdiabetes\tmellitus,\tand\tosteopenia.\t\nTable\t28.6\n\tsummarizes\tnutrient\tneeds\tafter\tliver\ntransplantation.
|
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] |
TABLE\t28.5\nDrugs\tCommonly\tUsed\tAfter\tLiver\tTransplantation\nImmunosuppressant\tDrug\nPossible\tNutritional\tSide\tEffects\nProposed\tNutrition\tTherapy\nAzathioprine\nMacrocytic\tanemia\nMouth\tsores\nNausea,\tvomiting,\tdiarrhea,\tanorexia,\tsore\nthroat,\tstomach\tpain,\tdecreased\ttaste\nacuity\nGive\tfolate\tsupplements.\nAdjust\tfood\tand\tmeals\tas\tneeded;\nmonitor\tintake.
|
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] |
Adjust\tfood\tand\tmeals\tas\tneeded;\nmonitor\tintake.\nAntithymocyte\tglobulin\t(ATG),\nlymphocyte\timmune\tglobulin\nNausea,\tvomiting\nAdjust\tfood\tand\tmeals\n\tas\tneeded;\nmonitor\tintake.\nCyclosporine\nSodium\tretention\nDecrease\tsodium\tintake.\nHyperkalemia\nDecrease\tpotassium\tintake.\nHyperlipidemia\nLimit\tfat\tand\tsimple\tcarbohydrate\nintake.\nHyperglycemia
|
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] |
Limit\tfat\tand\tsimple\tcarbohydrate\nintake.\nHyperglycemia\nDecrease\tsimple\tcarbohydrate\tintake.\nDecreased\tserum\tmagnesium\tlevel\nIncrease\tmagnesium\tintake;\tgive\nsupplements.\nHypertension\nLimit\tsodium\tintake.\nNausea,\tvomiting\nAdjust\tfood\tand\tmeals\n\tas\tneeded;\nmonitor\tintake.\nGlucocorticoids\nSodium\tretention\nDecrease\tsodium\tintake.\nHyperglycemia
|
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] |
Sodium\tretention\nDecrease\tsodium\tintake.\nHyperglycemia\nDecrease\tsimple\tcarbohydrate\tintake.\nHyperlipidemia\nLimit\tfat\tand\tsimple\tcarbohydrate\nintake.\nFalse\thunger\nAvoid\tovereating.\nProtein\twasting\twith\thigh\tdoses\nIncrease\tprotein\tintake.\nDecreased\tabsorption\tof\tcalcium\tand\tphosphorus\nIncrease\tcalcium\tand\tphosphorus\nintake;\tgive\tsupplements\n\tas
|
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0.010634791105985641,
0.06931252032518387,
0.0793086513876915,
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0.01238866988569498
] |
Increase\tcalcium\tand\tphosphorus\nintake;\tgive\tsupplements\n\tas\nneeded.\nMycophenolate\tmofetil,\nmycophenolic\tacid\nNausea,\tvomiting,\tdiarrhea\nAdjust\tfood\tand\tmeals\tas\tneeded;\nmonitor\tintake.\nSirolimus\nPossible\tGI\tsymptoms\nAdjust\tfood\tand\tmeals\tas\tneeded;\nmonitor\tintake.\nHyperlipidemia\nLimit\tfat\tand\tsimple\tcarbohydrate\nintake.\nInhibits\twound\thealing
|
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0.0008587970514781773
] |
Limit\tfat\tand\tsimple\tcarbohydrate\nintake.\nInhibits\twound\thealing\nEnsure\tadequate\tmacro-\tand\nmicronutrients.\nDepressed\tappetite.\nConsider\tappetite\tstimulants.\nTacrolimus\nHyperglycemia\nDecrease\tsimple\tcarbohydrate\tintake.\nHyperkalemia\nDecrease\tpotassium\tintake.\nNausea,\tvomiting\nAdjust\tfood\tand\tmeals\tas\tneeded;\nmonitor\tintake.\nGI\n,\tGastrointestinal.
|
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0.04674432426691055,
0.1303565502166748,
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0.07977671176195145,
-0.032319020479917526,
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-0.03732949122786522,
0.021285630762577057,
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0.001693584374152124,
0.07575158029794693,
-0.005267114378511906,
-0.0022989867720752954,
-0.016887547448277473,
0.14494362473487854,
-0.050213705748319626,
-0.013213519006967545,
0.03507206588983536,
0.032287124544382095,
0.020782649517059326,
0.07058821618556976,
-0.015799637883901596,
-0.08712296187877655,
-0.06412030756473541,
0.010957766324281693,
-0.014294628985226154,
-0.005903763230890036,
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-0.046447526663541794,
0.012888327240943909,
0.011844526045024395,
0.04948505759239197,
0.031041672453284264,
0.06030259281396866,
-0.05956573411822319,
-0.001946931006386876,
-0.0318441279232502,
0.02276192419230938,
0.04245138540863991,
-0.0163408312946558,
-0.022457152605056763,
-0.00298722623847425,
0.08152700960636139,
-0.0518452450633049,
-0.053521957248449326,
0.017318231984972954,
0.04913247376680374,
0.02936168946325779,
-0.0837339535355568,
-0.012603738345205784,
0.0656411424279213,
0.04380612075328827,
-0.10552572458982468,
-0.03299827501177788,
0.07591662555932999,
-0.008528032340109348,
-0.009393425658345222,
-0.0420810766518116,
0.05507161095738411,
0.10020603984594345,
-0.005519172176718712,
0.014025026001036167,
0.02194206975400448,
0.02750254236161709,
0.09979195147752762,
0.049454957246780396,
0.016513358801603317
] |
TABLE\t28.6\nGeneral\tNutrient\tRequirements\tfor\tLiver\tTransplant\tPatients\nPretransplantation\nImmediate\tPosttransplantation\n(First\t2\tPosttransplant\nMonths)\nLong-Term\tPosttransplantation\n*\nProtein\nDependent\ton\tnutrition\tstatus\tand\nmedical\tcondition\tbut\tusually\t1-\n1.5\tg/kg\nDependent\ton\tnutrition\tstatus,\nmedical\tcondition,\tand\tdialysis
|
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0.03640836477279663,
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0.07572842389345169,
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0.004914312157779932,
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0.020057519897818565,
2.622199860292247e-33,
0.05498509481549263,
0.03587500378489494,
0.07934247702360153,
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0.035703469067811966,
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0.08175978809595108,
0.00480773625895381,
0.004027490504086018,
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0.10840460658073425,
0.03663238510489464,
0.03671454265713692,
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0.036890849471092224,
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0.06966222822666168,
0.04947584494948387,
0.08890505135059357,
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0.008871175348758698,
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0.01791464537382126,
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0.023587346076965332,
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0.012022345326840878,
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0.07799695432186127,
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0.09755196422338486,
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0.02228737063705921,
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0.05967569351196289,
0.006702392362058163,
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0.04100297763943672,
0.06771693378686905,
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0.030225789174437523,
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0.019886422902345657,
0.009241046383976936,
0.03453585132956505,
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0.07083459198474884,
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0.024527186527848244,
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0.08934079110622406,
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0.018693599849939346,
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0.0652269572019577,
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0.0356590710580349,
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0.02373044192790985,
0.06974326074123383,
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0.007999648340046406,
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0.06227000057697296,
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0.04690149053931236,
0.006452138070017099,
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0.0453871488571167,
-0.020687758922576904,
-0.05433063581585884,
0.04162038117647171,
0.06884240359067917,
0.0016387341311201453,
-0.011488175950944424,
0.000501867791172117,
0.11552734673023224,
0.011680676601827145,
-0.060173578560352325,
0.01591431349515915,
-0.009678192436695099,
-0.04473840445280075,
0.06120544299483299,
-0.016861863434314728,
-0.09218649566173553,
-0.04899887368083,
0.00997922383248806,
-0.061342474073171616,
-0.028640707954764366,
0.002204615855589509,
0.031067868694663048,
-0.0036718999035656452,
0.034974124282598495,
0.007393358740955591,
0.0234655924141407,
0.09974825382232666,
-0.03695469722151756,
0.0022377660498023033,
0.012555764056742191,
-0.02076190523803234,
-0.0022105404641479254,
0.025102850049734116,
-0.008722220547497272,
0.0033695166930556297,
0.0446963794529438,
-0.06909111887216568,
-0.04652394726872444,
0.015270303934812546,
0.0901239886879921,
0.056525565683841705,
0.0017869455041363835,
-0.10465197265148163,
0.11530489474534988,
0.038511332124471664,
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0.030080461874604225,
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-0.03864592686295509,
-0.024142101407051086,
-0.06402159482240677,
0.08416201919317245,
0.11767363548278809,
0.014723233878612518,
-0.005793525371700525,
0.012808920815587044,
0.07999972999095917,
0.05970000848174095,
0.05073181167244911,
-0.03414161875844002
] |
Dependent\ton\tnutrition\tstatus,\nmedical\tcondition,\tand\tdialysis\nrequirement\tbut\tusually\t1.2-2\ng/kg\nMaintenance\t–\tabout\t1\tg/kg\n*\nCalories\nDependent\ton\tnutrition\tstatus\tand\nlosses;\tusually\t20%-50%\n\tabove\nbasal\nDependent\ton\tnutrition\tstatus\tand\nmetabolic\tstress\tbut\tusually\n20%-30%\tabove\tbasal\nDependent\ton\tactivity\tand\tweight
|
[
0.005302478093653917,
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0.02599167264997959,
0.03367890045046806,
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0.06672628223896027,
0.03908758610486984,
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0.027813680469989777,
0.10147786885499954,
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20%-30%\tabove\tbasal\nDependent\ton\tactivity\tand\tweight\ngoals;\tusually\t20%\tabove\tbasal\nfor\tsedentary\tactivity\tif\tat\tgoal\nweight\nFat\nAs\tneeded\nApproximately\t30%\tof\tcalories\nModerate\tfat\t(30%\tof\tcalories)\nCarbohydrate\nReduced\tcarbohydrate\tif\tdiabetes\nor\tobesity\tpresent\nReduced\tcarbohydrate\tif\tdiabetes\npresent\nReduced\tsimple\n\tcarbohydrate,
|
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] |
present\nReduced\tsimple\n\tcarbohydrate,\nespecially\tif\tdiabetes\tor\tobesity\npresent\nSodium\n2\tg/day\n2\tg/day\t(as\tindicated)\n2\tg/day\t(as\tindicated)\nFluid\nRestrict\tto\t1000-1500\tmL/day\t(if\nhyponatremic)\nAs\tneeded\nAs\tneeded\nCalcium\n800-1200\tmg/day\n800-1200\tmg/day\n1200-1500\tmg/day\nVitamins\nMultivitamin/mineral\nsupplementation\tto\tDRI\tlevels;
|
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] |
Vitamins\nMultivitamin/mineral\nsupplementation\tto\tDRI\tlevels;\nadditional\twater-\tand\tfat-soluble\nvitamins\tas\tindicated\nMultivitamin/mineral\nsupplementation\n\tto\tDRI\tlevels;\nadditional\twater-\tand\tfat-soluble\nvitamins\tas\tindicated\nMultivitamin/mineral\nsupplementation\tto\tDRI\tlevels\nDRI\n,\tDietary\treference\tintake.\n*\nUse\testimated\tdry\tor\tideal\tweight.
|
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] |
DRI\n,\tDietary\treference\tintake.\n*\nUse\testimated\tdry\tor\tideal\tweight.\nPhysiology\tand\tfunctions\tof\tthe\tgallbladder\nThe\tgallbladder\tlies\ton\tthe\tundersurface\tof\tthe\tright\tlobe\tof\tthe\tliver\t(\nFig.\t28.6\n).\tThe\tmain\tfunction\tof\tthe\tgallbladder\nis\tto\tconcentrate,\tstore,\tand
|
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] |
).\tThe\tmain\tfunction\tof\tthe\tgallbladder\nis\tto\tconcentrate,\tstore,\tand\n\texcrete\tbile,\twhich\tis\tproduced\tby\tthe\tliver.\tDuring\tthe\tconcentration\tprocess,\twater\tand\nelectrolytes\tare\tresorbed\tby\tthe\tgallbladder\tmucosa.\tBile\tis\tcomposed\tof\tbile\tsalts\tand\texcretory\tendogenous\tand
|
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] |
exogenous\tcompounds.\tOther\tcomponents\tinclude\tfatty\tacids,\tcholesterol,\tphospholipids,\tbilirubin,\tprotein,\tand\nother\tcompounds.\tBile\tsalts\tare\tmade\tby\tliver\tcells\tfrom\tcholesterol\tand\tare\tessential\n\tfor\tthe\tdigestion\tand\nabsorption\tof\tfats,\tfat-soluble\tvitamins,\tand\tsome\tminerals\t(see\t\nChapter\t1\n).\tBilirubin,\tthe\tmain\tbile\tpigment,\tis
|
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] |
Chapter\t1\n).\tBilirubin,\tthe\tmain\tbile\tpigment,\tis\nderived\tfrom\tthe\trelease\tof\themoglobin\tfrom\tred\tblood\tcell\tdestruction.\tIt\tis\ttransported\tto\tthe\tliver,\twhere\tit\tis\nconjugated\tand\texcreted\tvia\tbile.\nFIG.\t28.6\nSchematic\tdrawing\tshowing\trelationship\tof\torgans\tof\tthe\tupper\tabdomen.\t\nA,\n\tLiver\t(retracted\tupward);\t\nB,\n\tgallbladder;\t\nC,
|
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] |
A,\n\tLiver\t(retracted\tupward);\t\nB,\n\tgallbladder;\t\nC,\nesophageal\topening\tof\tstomach;\t\nD,\n\tstomach\t(\nshown\tin\tdotted\toutline\n);\t\nE,\n\tcommon\tbile\tduct;\t\nF,\n\tduodenum;\t\nG,\n\tpancreas\tand\npancreatic\tduct;\t\nH,\n\tspleen;\t\nI,\n\tkidneys.\n\t\nSource:\n\t(Courtesy\tCleveland\tClinic,\tCleveland,\tOhio,\t2002.)\nThe\tprimary\ttransporter\tresponsible\tfor\tbile
|
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The\tprimary\ttransporter\tresponsible\tfor\tbile\n\tsalt\tsecretion\tis\tthe\tbile\tsalt\texport\tpump\t(BSEP).\tOverall,\tbile\tsalts\nplay\ta\tkey\trole\tin\ta\twide\trange\tof\tphysiologic\tand\tpathophysiologic\tprocesses\t(\nKubitz\tet\tal,\t2012\n).\tExcreted\tinto\tthe
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Kubitz\tet\tal,\t2012\n).\tExcreted\tinto\tthe\nsmall\tintestine\tvia\tbile,\tbile\tsalts\tare\tlater\tresorbed\tinto\tthe\tportal\tsystem\t(enterohepatic\tcirculation).\tThis\tis\tthe\nprimary\texcretory\tpathway\tfor\tthe\tminerals\tcopper\tand\tmanganese.\nBile\tcontains\timmunoglobulins\n\tthat\tsupport\tthe\tintegrity\tof\tthe\tintestinal\tmucosa.\tFibroblast\tgrowth\tfactor
|
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] |
receptor\t(FGFR4)\tcontrols\tbile\tacid\tmetabolism\tand\tprotects\tthe\tliver\tfrom\tfibrosis;\tFGFR1\tand\tFGFR2\tassist\tin\nregeneration\tof\tthe\tliver\t(\nBöhm\tet\tal,\t2010\n).\tMolecular\tcrosstalk\tbetween\tbile\tacid–activated\tnuclear\treceptors\tand\nproinflammatory\tnuclear\tmediators\tprovides\tnew\tunderstanding\tof\tinflammation-induced\tcholestasis\n\t(\nKosters\tand
|
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] |
(\nKosters\tand\nKarpen,\t2010\n;\t\nLam\tet\tal,\t2010\n).\nBile\tis\tremoved\tby\tthe\tliver\tvia\tbile\tcanaliculi\tthat\tdrain\tinto\tintrahepatic\tbile\tducts.\tThe\tducts\tlead\tto\tthe\tleft\tand\nright\thepatic\tducts,\twhich\tleave\tthe\tliver\tand\tjoin\tto\tbecome\tthe\tcommon\thepatic\tduct.\tThe\tbile\tis\tdirected\tto\tthe
|
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] |
gallbladder\tvia\tthe\tcystic\tduct\tfor\tconcentration\tand\tstorage.\tThe\tcystic\tduct\tjoins\tthe\tcommon\thepatic\tduct\tto\tform\nthe\tcommon\tbile\tduct.\tThe\tbile\tduct\tthen\tjoins\tthe\tpancreatic\tduct,\twhich\tcarries\tdigestive\tenzymes.\nDuring\tthe\tcourse\tof\tdigestion,\tfood\treaches\tthe\tduodenum,\tcausing\tthe\trelease\tof\tintestinal\thormones\tsuch\tas
|
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] |
cholecystokinin\t(CCK)\tand\tsecretin.\tThis\tstimulates\tthe\tgallbladder\tand\tpancreas\tand\tcauses\tthe\tsphincter\tof\tOddi\tto\nrelax,\tallowing\tpancreatic\tjuice\tand\tbile\tto\tflow\tinto\tthe\tduodenum\n\tat\tthe\tampulla\tof\tVater\tto\tassist\tin\tfat\tdigestion.\nFor\tthis\treason\tdiseases\tof\tthe\tgallbladder,\tliver,\tand\tpancreas\toften\tare\tinterrelated.
|
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Diseases\tof\tthe\tgallbladder\nDisorders\tof\tthe\tbiliary\ttract\taffect\tmillions\tof\tpeople\teach\tyear,\tcausing\tsignificant\tsuffering\tand\teven\tdeath\tby\nprecipitating\tpancreatitis\tand\tsepsis.\tA\tdiverse\tspectrum\tof\tdisease\taffects\tthe\tbiliary\tsystem,\toften\tpresenting\n\twith
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] |
with\nsimilar\tclinical\tsigns\tand\tsymptoms.\tTreatment\tmay\tinvolve\tdiet,\tmedication,\tand/or\tsurgery.\nCholestasis\nPathophysiology\tand\tmedical\tmanagement\nCholestasis\n\tis\ta\tcondition\tin\twhich\tlittle\tor\tno\tbile\tis\tsecreted\tor\tthe\tflow\tof\tbile\tinto\tthe\tdigestive\ttract\tis
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obstructed.\tThis\tcan\toccur\tin\tpatients\twithout\toral\tor\tenteral\tfeeding\tfor\ta\tprolonged\tperiod,\tsuch\tas\tthose\trequiring\nPN,\tand\tcan\n\tpredispose\tto\t\nacalculous\tcholecystitis\n,\tan\tinflammatory\tdisease\tof\tthe\tgall\tbladder\twithout\tevidence\nof\tgallstones\tor\tcystic\tduct\tobstruction.\tBSEP\tis\tthe\tmajor\ttransporter\tfor\tthe\tsecretion\tof\tbile\tacids\tfrom\tthe
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] |
hepatocytes\tinto\tbile.\tBSEP\tdeficiency\tresults\tin\tseveral\tdifferent\tgenetic\tforms\tof\tcholestasis\tand\tacquired\tforms\tof\ncholestasis\tsuch\tas\tdrug-induced\tcholestasis\tand\tintrahepatic\tcholestasis\n\tof\tpregnancy\t(\nLam\tet\tal,\t2010\n).\tPrevention
|
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] |
of\tpregnancy\t(\nLam\tet\tal,\t2010\n).\tPrevention\nof\tcholestasis\trequires\tstimulation\tof\tbiliary\tmotility\tand\tsecretions\tby\tat\tleast\tminimum\tenteral\tfeedings.\tIf\tthis\tis\nnot\tpossible,\tdrug\ttherapy\tis\tused.\nCholelithiasis\nPathophysiology\nThe\tformation\tof\tgallstones\t(\ncalculi\n)\tis\tknown\tas\t\ncholelithiasis
|
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] |
The\tformation\tof\tgallstones\t(\ncalculi\n)\tis\tknown\tas\t\ncholelithiasis\n.\tVirtually\tall\tgallstones\tform\twithin\tthe\tgallbladder.\nGallstone\tdisease\taffects\tmillions\tof\tAmericans\n\teach\tyear\tand\tcan\tcause\tsignificant\thealth\trisks.\tIn\tmost\tcases
|
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] |
each\tyear\tand\tcan\tcause\tsignificant\thealth\trisks.\tIn\tmost\tcases\ngallstones\tare\tasymptomatic.\tGallstones\tthat\tpass\tfrom\tthe\tgallbladder\tinto\tthe\tcommon\tbile\tduct\tmay\tremain\tthere\nindefinitely\twithout\tcausing\tsymptoms,\tor\tthey\tmay\tpass\tinto\tthe\tduodenum\twith\tor\twithout\tsymptoms.\nCholedocholithiasis
|
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] |
Choledocholithiasis\n\tdevelops\twhen\tstones\tslip\tinto\tthe\tbile\tducts,\tproducing\tobstruction,\tpain,\tand\tcramps.\tIf\npassage\n\tof\tbile\tinto\tthe\tduodenum\tis\tinterrupted,\t\ncholecystitis\n,\tinflammation\tof\tthe\tgallbladder,\tcan\tdevelop.\tIn\tthe
|
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] |
cholecystitis\n,\tinflammation\tof\tthe\tgallbladder,\tcan\tdevelop.\tIn\tthe\nabsence\tof\tbile\tin\tthe\tintestine,\tlipid\tabsorption\tis\timpaired,\tand\twithout\tbile\tpigments,\tstools\tbecome\tlight\tin\tcolor\n(acholic).\tIf\tuncorrected,\tbile\tbackup\tcan\tresult\tin\tjaundice\tand\tliver\tdamage\t(\nsecondary\tbiliary\tcirrhosis\n).
|
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] |
secondary\tbiliary\tcirrhosis\n).\nObstruction\tof\tthe\tdistal\tcommon\tbile\tduct\tcan\tlead\tto\tpancreatitis\n\tif\tthe\tpancreatic\tduct\tis\tblocked.\nMost\tgallstones\tare\tunpigmented\tcholesterol\tstones\tcomposed\tprimarily\tof\tcholesterol,\tbilirubin,\tand\tcalcium\tsalts.
|
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] |
Bacteria\talso\tplay\ta\trole\tin\tgallstone\tformation.\tLow-grade\tchronic\tinfections\tproduce\tchanges\tin\tthe\tgallbladder\nmucosa,\twhich\taffect\tits\tabsorptive\tcapabilities.\tExcess\twater\tor\tbile\tacid\tmay\tbe\tabsorbed\tas\ta\tresult.\tCholesterol\nmay\tthen\tprecipitate\n\tout\tand\tcause\tgallstones\t(\nNjeze,\t2013\n).
|
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0.142527773976326,
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0.05004272982478142,
0.11584179103374481,
0.00053508544806391,
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0.006120078265666962,
0.05031382665038109,
0.03837081789970398,
0.12941794097423553,
-0.013581647537648678
] |
may\tthen\tprecipitate\n\tout\tand\tcause\tgallstones\t(\nNjeze,\t2013\n).\nThere\tare\tnumerous\trisk\tfactors\tthat\tmay\tpredispose\tan\tindividual\tto\tgallstone\tformation\t(\nStinton\tet\tal,\t2010\n).\nSome\tof\tthese\tare\tmodifiable,\tothers\tare\tnot\t(\nTable\t28.7\n)\tHigh\tdietary\tfat\tintake\tover\ta\tprolonged\tperiod\tmay
|
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0.08204441517591476,
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0.04591424763202667,
0.04122629761695862,
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0.08631809055805206,
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0.021233154460787773,
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0.07829014211893082,
0.02367253415286541,
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0.06463182717561722,
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0.09390995651483536,
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0.020428894087672234,
0.09331458061933517,
0.025871440768241882,
0.015003788284957409,
0.02905215509235859,
0.040151264518499374,
0.03278065472841263,
0.08628133684396744,
-0.021682625636458397
] |
Table\t28.7\n)\tHigh\tdietary\tfat\tintake\tover\ta\tprolonged\tperiod\tmay\npredispose\ta\tperson\tto\tgallstone\tformation\tbecause\tof\tthe\tconstant\tstimulus\tto\tproduce\tmore\tcholesterol\tfor\tbile\nsynthesis\trequired\tin\n\tfat\tdigestion.\tRapid\tweight\tloss\t(as\twith\tjejunoileal\tand\tgastric\tbypass\tsurgery\tand\tfasting\tor
|
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0.0004884809022769332
] |
severe\tcalorie\trestriction)\tis\tassociated\twith\ta\thigh\tincidence\tof\tbiliary\tsludge\tand\tgallstone\tformation.\tIndeed,\ncholelithiasis\tand\tfatty\tliver\tdisease\tshare\trisk\tfactors,\tincluding\tcentral\tobesity,\tinsulin\tresistance,\tand\tdiabetes\nmellitus\t(\nKoller\tet\tal,\t2012\n;\t\nWeikert\tet\tal,\t2010\n).\nTABLE\t28.7\nRisk\tFactors\tfor\tGallstone\tFormation\nModifiable
|
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0.08107136189937592,
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0.024660568684339523,
0.0021634611766785383,
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0.10389745980501175,
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0.032077856361866,
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0.02366577833890915,
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0.029019849374890327,
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0.01701328717172146,
0.0901016965508461,
0.013625266030430794,
0.08284678310155869,
0.02018256112933159
] |
).\nTABLE\t28.7\nRisk\tFactors\tfor\tGallstone\tFormation\nModifiable\nNonmodifiable\nHigh-fat\tdiet\nFamilial/genetics\nFemale\tsex\thormone\tuse\nEthnicity\nObesity/metabolic\tsyndrome/diabetes\nFemale\tgender\nRapid\tweight\tloss\nIncreasing\tage\nPhysical\tinactivity\nUnderlying\tdisease:\tcirrhosis,\tCrohn’s\tdisease\nDrugs\nParenteral\tnutrition
|
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0.12735866010189056,
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] |
Drugs\nParenteral\tnutrition\nAdapted\tfrom\tStinton\tLM,\tMyers\tRP,\tShaffer\tEA:\tEpidemiology\tof\tGallstones,\n\t\nGastroenterol\tClin\tNorth\tAm\n\t39:157–169,\t2010;\tShaffer\tEA:\tGallstone\tdisease:\tepidemiology\nof\tgallbladder\tstone\tdisease,\t\nBest\tPract\tRes\tClin\tGastroenterol\n\t20(6):981–996,\t2006.
|
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] |
Best\tPract\tRes\tClin\tGastroenterol\n\t20(6):981–996,\t2006.\nRisk\tfactors\tfor\tcholesterol\tstone\tformation\tinclude\tfemale\tgender,\tpregnancy,\tolder\tage,\tfamily\thistory,\tobesity\tand\ntruncal\tbody\tfat\tdistribution,\tdiabetes\tmellitus,\tinflammatory\tbowel\tdisease,\tand\tdrugs\t(lipid-lowering\n\tmedications,
|
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] |
medications,\noral\tcontraceptives,\tand\testrogens).\tCertain\tethnic\tgroups\tare\tat\tgreater\trisk\tof\tstone\tformation,\tincluding\tNative\nAmericans,\tScandinavians,\tand\tMexican\tAmericans.\tIn\taddition,\tapproximately\t30%\tof\tindividuals\twith\tcirrhosis\thave\ngallstones\t(\nAcalovschi,\t2014\n).
|
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] |
gallstones\t(\nAcalovschi,\t2014\n).\nPigmented\tstones\ttypically\tconsist\tof\tbilirubin\tpolymers\tor\tcalcium\tsalts.\tThey\tare\tassociated\twith\tchronic\nhemolysis.\tRisk\n\tfactors\tassociated\twith\tthese\tstones\tinclude\tolder\tage,\tsickle\tcell\tanemia,\tthalassemia,\tbiliary\ttract\ninfection,\tcirrhosis,\talcoholism,\tand\tlong-term\tPN.\nMedical\tand\tsurgical\tmanagement
|
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] |
Medical\tand\tsurgical\tmanagement\nCholecystectomy\n\tis\tsurgical\tremoval\tof\tthe\tgallbladder,\tespecially\tif\tthe\tstones\tare\tnumerous,\tlarge,\tor\tcalcified.\nThe\tcholecystectomy\tmay\tbe\tperformed\tas\ta\ttraditional\topen\tlaparotomy\tor\tas\ta\tless\tinvasive\n\tlaparoscopic\nprocedure.
|
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] |
laparoscopic\nprocedure.\nChemical\tdissolution\twith\tthe\tadministration\tof\tbile\tsalts,\tchenodeoxycholic\tacid,\tand\tursodeoxycholic\tacid\n(litholytic\ttherapy),\tor\tdissolution\tby\textracorporeal\tshockwave\tlithotripsy,\tmay\talso\tbe\tused\tless\toften\tthan\tsurgical
|
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] |
techniques.\tPatients\twith\tgallstones\tthat\thave\tmigrated\tinto\tthe\tbile\tducts\tmay\tbe\tcandidates\tfor\ta\tdiagnostic\nprocedure\tusing\tX-ray\tcalled\tendoscopic\n\tretrograde\tcholangiopancreatography.
|
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] |
Medical\tnutrition\ttherapy\nThe\trole\tof\tdiet\tin\tthe\tpathogenesis\tof\tgallstones\tand\ttherefore\ttreatment\trecommendations\tremains\tunclear.\tObesity\nis\ta\trisk\tfactor,\tbut\tthe\texact\tcomposition\tof\tthe\tdiet\tthat\tresults\tin\tgallstones\tis\tless\tclear.\tDiets\thigh\tin\tcholesterol
|
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] |
and\tfat\tseem\tto\tincrease\tthe\trisk\tof\tcholelithiasis.\tIn\tcontrast,\tunsaturated\tfats,\tcoffee,\n\tfiber,\tascorbic\tacid\t(vitamin\nC),\tcalcium,\tand\tmoderate\tconsumption\tof\talcohol\treduce\tthe\trisk\t(\nShaffer,\t2006\n).\nThere\talso\tmay\tbe\tsome\tbenefit\tin\treplacing\tsimple\tsugars\tand\trefined\tstarches\twith\thigh-fiber\tcarbohydrates.
|
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] |
Individuals\tconsuming\trefined\tcarbohydrates\thave\ta\t60%\tgreater\trisk\tfor\tdeveloping\tgallstones,\tcompared\twith\tthose\nwho\tconsumed\tthe\tmost\tfiber,\tin\tparticular\tinsoluble\tfiber\t(\nMendez-Sanchez\tet\tal,\t2007\n).\tThus\tplant-based\tdiets\tmay
|
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] |
Mendez-Sanchez\tet\tal,\t2007\n).\tThus\tplant-based\tdiets\tmay\nreduce\tthe\trisk\tof\tcholelithiasis.\tVegetarian\tdiets\tare\thigh\tin\tfiber\tand\tlow\tin\tfat,\tconsisting\tprimarily\tof\tunsaturated\nfat.\tVitamin\tC,\twhich\tis\tgenerally\thigh\tin\tvegetarian\tdiets,\taffects\tthe\trate-limiting\tstep\tin\tthe\tcatabolism\tof
|
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cholesterol\tto\tbile\tacids\tand\tinversely\tis\trelated\tto\tthe\trisk\tof\tgallstones,\tespecially\tin\twomen.\nWeight\tcycling\t(repeatedly\tlosing\n\tand\tregaining\tweight),\tfasting,\tand\tvery-low-calorie\tdiets\tincrease\tthe\tlikelihood\nof\tcholelithiasis.\tAlong\twith\tweight\treduction,\tsome\tevidence\tindicates\tthat\tphysical\tactivity\treduces\tthe\trisk\tof
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cholecystitis.\tIn\tcholecystitis,\tMNT\tincludes\ta\thigh-fiber,\tlow-fat,\tplant-based\tdiet\tto\tprevent\tgallbladder\ncontractions.\tData\tare\tconflicting\tas\tto\twhether\tintravenous\tlipids\tstimulate\tgallbladder\tcontraction.\nAfter\tsurgical\tremoval\tof\tthe\tgallbladder,\toral\tfeedings\tcan\tbe\tadvanced\tto\ta\tregular\tdiet\tas\ttolerated,\talthough\ta
|
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lower\tfat\tdiet\twith\tadequate\tsoluble\tfiber\tmay\tbe\timportant\tat\tfirst.\tIn\tthe\tabsence\tof\tthe\tgallbladder,\tbile\tis\tsecreted\ndirectly\tby\tthe\tliver\tinto\tthe\tintestine.\tThe\tbiliary\ttract\tdilates,\tforming\ta\t“simulated\tpouch”\tover\ttime\tto\tallow\tbile\tto\nbe\theld\tin\ta\tmanner\tsimilar\tto\tthe
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be\theld\tin\ta\tmanner\tsimilar\tto\tthe\n\toriginal\tgallbladder.\tSome\tpatients\tmay\tdevelop\tfrequent\tloose,\twatery\tstools\tif\nthey\teat\tfatty\tmeals\tduring\tthis\tadaptation\ttime\tframe.\tIn\tmost\tcases,\tthe\tdiarrhea\tis\ttemporary\tand\tself-limiting.\nCholecystitis\nPathophysiology\nInflammation\tof\tthe\tgallbladder\tis\tknown\tas\t\ncholecystitis
|
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] |
Inflammation\tof\tthe\tgallbladder\tis\tknown\tas\t\ncholecystitis\n,\tand\tit\tmay\tbe\tchronic\tor\tacute.\tIt\tusually\tis\tcaused\tby\ngallstones\tobstructing\tthe\tbile\tducts\t(calculous\n\tcholecystitis),\tleading\tto\tthe\tbackup\tof\tbile.\tBilirubin,\tthe\tmain\tbile
|
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] |
pigment,\tgives\tbile\tits\tgreenish\tcolor.\tWhen\tbiliary\ttract\tobstruction\tprevents\tbile\tfrom\treaching\tthe\tintestine,\tit\nbacks\tup\tand\treturns\tto\tthe\tcirculation.\tBilirubin\thas\tan\taffinity\tfor\telastic\ttissues\t(such\tas\tthe\teye\tand\tthe\tskin);\ntherefore\twhen\tit\toverflows\tinto\tthe\tgeneral\tcirculation,\tit\tcauses\tthe\tyellow\tskin\tpigmentation
|
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] |
and\teye\tdiscoloration\ntypical\tof\t\njaundice\n.\nAcute\tcholecystitis\twithout\tstones\t(acalculous\tcholecystitis)\tmay\toccur\tin\tcritically\till\tpatients\tor\twhen\tthe\ngallbladder\tand\tits\tbile\tare\tstagnant.\tImpaired\tgallbladder\temptying\tin\tchronic\tacalculous\tcholecystitis\tappears\tto\tbe
|
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] |
due\tto\tdiminished\tspontaneous\tcontractile\tactivity\tand\tdecreased\tcontractile\tresponsiveness\tto\tCCK.\tThe\twalls\tof\tthe\ngallbladder\n\tbecome\tinflamed\tand\tdistended,\tand\tinfection\tcan\toccur.\tDuring\tsuch\tepisodes,\tthe\tpatient\texperiences\nupper-quadrant\tabdominal\tpain\taccompanied\tby\tnausea,\tvomiting,\tand\tflatulence.
|
[
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