FN-301.

Clinical and Therapeutic Nutrition Topic-5

Liver: Largest gland of human body.

Liver.
• Liver is the largest gland of the
human body.
• Liver forms bile salt and secrets
bile juice.
• It controls all metabolic functions of
the human body.

• Location and structure.

→ In humans, it is in the upper right quadrant of the abdomen, below the
diaphragm.
→ The liver is a reddish-brown wedge shape organ with four lobes of unequal
size and shape. A human liver normally weighs 1.44 to 1.66 KG (3.2 - 3.7lb).
It is is. the heaviest internal organ and the largest gland in the human body. It
is in the upper right quadrant of the abdominal cavity. It raised just below the
diaphragm to the right of the stomach and overlies the gallbladder.

• Functions.
1) Production of bile, which helps carry away waste and break fats in a small
intestine during digestion.
2) Production of certain proteins for blood plasma.
3) Production of cholesterol and special proteins to help carry through the body.
4) Store and release glucose as needed.
5) Processing of hemoglobin for use of its iron content, the liver iron.

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FN-301.Clinical and Therapeutic Nutrition Topic-5

6) Conversion of harmful ammonia to urea. Urea is one of the end products of

protein metabolism that is excreted in the urine.
7) Bring the blood of drugs and other harmful substances.
8) Regulating blood clotting.

• Liver diseases.
Common liver diseases are.
→ Jaundice.
→ Hepatitis.
→ Cirrhosis.
→ Hepatic coma.
→ Fatty liver.
→ Gallbladder disorder.
But jaundice is seen in all liver diseases.
• Liver function tests.
Liver function tests (LFT) are blood tests used to help find the cause of your
symptoms and monitor liver disease or damage. The tests measure the levels of
certain enzymes and proteins in your blood.
In blood.
→ Serum glutamic oxaloacetic transaminase test. (SGOT- between 8 and 45
units per liter of serum)
→ Serum glutamic pyruvic transaminase test. (SGPT- 7 to 56 units per liter of
blood serum.)
→ Serum alkaline phosphatase test. (The normal range is 44 to 147
international units per liter (IU/L) or 0.73 to 2.45 microkatal per liter (µkat/L))
→ Serum total proteins tests. (The normal serum protein level is 6 to 8 g/dl.)
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→ Serum albumin test. (A normal albumin range is 3.4 to 5.4 g/dL.)

→ Serum globulin test. (2.0 to 3.5 grams per deciliter (g/dL)
→ Serum albumin globulin ratio. (The normal range for albumin/globulin ratio
is over 1 , usually around 1 to 2.)
→ Serum cholesterol. (the ranges for total cholesterol in adults: Normal: Less
than 200 mg/dL. Borderline high: 200 to 239 mg/dL. High: At or above 240
mg/dL.)
In urine.
→ Bile salts.
→ Bile pigments.
→ Urobilinogen. (Urobilinogen is a colorless pigment produced in the gut from
the metabolism of bilirubin. Some is excreted in feces, and the rest is
reabsorbed and excreted in the urine. Urobilinogen is normally found in trace
amounts in the urine (0.2 – 1.0 mg/dL). Urobilinogen levels < 0.2 mg/dL are
considered low. Urobilinogen levels > 1.0 mg/dL are considered high)

• Complications of liver disease.

The following are the complications of chronic liver disease.
→ Variceal bleeding. Due to high pressure (portal hypertension) and thinning of
the walls of varices, they may rupture, causing bleeding within the upper
gastrointestinal tract.
→ Ascites and spontaneous bacterial peritonitis (SBP). Spontaneous
bacterial peritonitis (SBP) is infection of ascitic fluid without an apparent
source. Manifestations may include fever, malaise, and symptoms of ascites
and worsening hepatic failure. Diagnosis is by examination of ascitic fluid.
Treatment is with cefotaxime or another antibiotic.
→ Hepatic encephalopathy is an often-temporary neurological (nervous
system) disorder due to chronic, severe liver disease. A diseased liver
struggles to filter toxins (substances created from the breakdown of food,
alcohol, medications and even muscle) from the bloodstream.
→ Hepatorenal syndrome (HRS) is a multiorgan condition affecting the kidneys
and the liver.
→ Hepatopulmonary syndrome is an uncommon condition that affects the
lungs of people with advanced liver disease. Hepatopulmonary syndrome is
caused by blood vessels in the lungs expanding (dilating) and increasing in
number, making it hard for red blood cells to properly absorb oxygen.
→ Hepatocellular carcinoma (HCC) is the most common type of primary liver
cancer. Hepatocellular carcinoma occurs most often in people with chronic
liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.

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FN-301.Clinical and Therapeutic Nutrition Topic-5

• Jaundice.
→ Most people do not realize that jaundice itself is not a disease but is a
symptoms of an underlying health condition or disease.
→ Jaundice is a term used to describe the yellowing of the skin and the whites of
the eyes.
→ Jaundice is not a disease. It is a symptom of several different diseases and
disorders of the liver and gallbladder, and of hemolytic blood disorder.
→ The pigment causing the jaundice is called bilirubin.
→ The normal total level of bilirubin in blood is 0.2 - 0.8 mg/100mL. But when it
is more than 1.8 0.2 - 0.8 mg/100mL then it is called jaundice.
Causes of Jaundice.
Jaundice most often occurs because of an underlying disorder that either causes
tissues to become over saturated with bilirubin or prevents the liver from disposing of
bilirubin.
Some underlying conditions that may cause jaundice are:
• Acute inflammation of the liver. may impair the ability of the liver to
conjugate and secrete bilirubin, resulting in a buildup of bilirubin.
• Inflammation of the bile duct. May prevent the secretion of bile and removal
of bilirubin causing jaundice.
• Obstruction of the bile duct. Prevents the liver from disposing of bilirubin,
which results in hyperbilirubinemia.
• Hemolytic anemia. Production of bilirubin increases when large quantities of
erythrocytes are broken down.
• Gilbert’s Syndrome. An inherited condition that impairs the ability of
enzymes (biomolecules that provoke chemical reactions between substances)
to process the excretion of bile.
• Gallstones
• Inflammation of the gallbladder.
Jaundice is caused by a buildup of • Autoimmune disorders.
substance called bilirubin in the blood and
• Drinking too much alcohol.
tissues of the body.
• Infections such as hepatitis A,
hepatitis B or hepatitis C.
• Increase level of bilirubin due to
blood clots or hemolytic anemia.
• Types of jaundice.
There are three main types of jaundice.
1) Hepatocellular jaundice. A type of jaundice that occurs because of liver
disease or injury.
2) Hemolytic jaundice. A type of jaundice that occurs because of hemolysis (an
accelerated breakdown of erythrocytes, red blood cells) leading to an increase
in production of bilirubin.

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3) Obstructive Jaundice. A type of jaundice that occurs because of an

obstruction in the bile duct (a system of tubes that carries bile from the liver to
the gallbladder and small intestine), which prevents bilirubin from leaving the
liver.
Jaundice is not to be confused with infant jaundice, which is usually a sign of an
underlying disorder.

• Symptoms of jaundice.

Symptoms of jaundice include.

→ Yellow tinge to the skin and the
whites of the eyes.
→ Fatigue.
→ Abdominal pain typically indicates
a blockage of the bile duct.
→ Weight loss.
→ Vomiting.
→ Fever.
→ Paler than usual stools.
→ Dark urine.

• Complications.
1) Anemia. 6) Liver failure.
2) Bleeding. 7) Kidney failure.
3) Infection (sepsis). 8) Hepatic encephalopathy (Brain
4) Chronic hepatitis. dysfunction).
5) Cancer. 9) Death.

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• Dietary Management of jaundice.

→ There are no specific foods that are recommended during jaundice, but there
are certain dietary changes and guidelines that should be enforced for a
patient suffering from or recovering from the condition.
→ Jaundice patients are advised to follow a liquid diet for the first four to five
days of treatment.
→ Increase fluid intake by consuming a lot of water. Vegetable and fruit juice
should form the bulk of diet during this period. Keep in mind that all food
should be consumed as boiled or steamed foods and they should not be fried
or cooked with oil.
→ This type of diet also helps to cleanse the body as it facilitates increased
elimination of bilirubin through urination and excretion.
→ Sugar cane juice for jaundice.
→ Lemon juice, barley water, jaundice, Berry (also known as berries vultaris)
→ Foods to eat. Lean protein coffee and tea. Whole grains. Fruits and
vegetables.
→ Foods to avoid. Alcohol. High fat foods, High sodium and sugar, packaged
food.

Jaundice diet.
→ Barley water and fruit juice are effective.
→ Do not give fatty foods and avoid foods
which alligator stomach.
→ Do not give cereals and pulses.
→ In case of fever give fruit diet and fresh
fruits juice to drink and to take good rest.
→ Grapes, black soybeans, nuts, sweet
potatoes, are effective fruits for jaundice
patients.

• Hepatitis.
→ The word hepatitis comes from the ancient Greek word hepar (root word
hepat), meaning liver, and the Latin itis, meaning inflammation.
→ Hepatitis is an inflammation of the liver.
→ The condition can be self limiting or can progress to fibrosis, scarring,
cirrhosis or liver cancer.
→ Hepatitis viruses are the most common cause of hepatitis in the world, but
other infections toxic substances, (alcohol, certain drugs) and autoimmune
diseases can also cause hepatitis.
→ There are five main types of hepatitis, and the type is commonly determined
by all laboratory tests.

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• Types of hepatitis.
Scientists have identified 5 unique hepatitis viruses identified by the letters A,B,C,D
& E. While all cause liver disease they vary in important ways.
• Hepatitis A virus. (HAV) is present in the feces of infected persons and is
most often transmitted through consumption of contaminated water or food.
Certain sex practices can also spread HAV. Infections are in many cases
mild, with most people making a full recovery and remaining immune from
further HAV infections. However, HAV infections can also be severe and life
threatening. Most people in areas of the world with poor sanitation have been
infected with this virus. Safe and effective vaccines are available to prevent
HAV.
Hepatitis A virus can be transmitted several ways, such as.
→ Eating food handled by someone with the virus who doesn't thoroughly wash
his or her hands after using the toilet.
→ Drinking contaminated water.
→ Eating raw shellfish from water polluted with sewage.
→ Being in close contact with a person who is infected, even if the person has
no signs or symptoms.
→ Having sex with someone who has the virus.
• Hepatitis B virus. (HBV) is transmitted through exposure to infective blood,
semen, and other body fluids. HBV can be transmitted from infected mothers
to infants at the time of birth or from family members to infants in early
childhood. Transmission may also occur through transfusion of HBV
contaminated blood and blood products, contaminated injections during
medical procedure, and through injection drug use. HBV also poses a risk to
healthcare workers who sustain accidental needle sticks injury while caring for
infected HBV patients. Safe and effective vaccines are available to prevent
HBV.

• Hepatitis C virus. (HCV) is mostly transmitted through exposure to infective

blood. This may happen through transfusion of HCV contaminated blood and
blood products, contaminated injections during medical procedure and
through injection drug use. Sexual transmission is also possible but is much
less common. There is no vaccine for HCV.

• Hepatitis D virus. (HDV) infections occur only in those who are infected with
HBV. The dual infection of HDV and HBV can result in a more serious disease
and worse outcome. Hepatitis B vaccines provide protection from HDV
infection.

• Hepatitis E virus. (HEV) is mostly transmitted through consumption of

contaminated water or food. HEV is a common cause of hepatitis outbreaks in
developing parts of the world and is increasingly recognized as an important
cause of disease in developed countries. Safe and effective vaccines to
prevent HEV infection have been developed but are not widely available.

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* Hepatitis E was not recognized as a distinct human disease until 1980.

Hepatitis E is caused by infection with the hepatitis E virus, a non-enveloped,
positive sense, single stranded RNA virus.
Although man is considered the natural host of HEV, antibodies to HEV or
closely related viruses have been detected in primates and several other
animal species.

• Causes of hepatitis.
Infectious. Noninfectious.
→ Viral. → Alcohol.
→ Bacterial. → Drugs.
→ Fungal. → Autoimmune.
→ Parasitic. → Metabolic diseases.

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• Symptoms of hepatitis.
• Acute hepatitis symptoms. • Chronic hepatitis symptoms.
(Less than six months.) (Six months or more.)
1) Joint pain. 1) Asymptomatic.
2) Rash. 2) Liver cells are destroyed.
3) Vomiting. 3) Liver cirrhosis.
4) Diarrhea. 4) Liver cancer.
5) Muscle aches.
6) Dark urine.
7) Tired.
8) Yellowish color of the skin and
eyes.
9) Decreased appetite and weight
loss.
Many people with hepatitis experience either mild symptoms or none. Remember
that an infected person's feces are always infectious to other people. When
symptoms appear, they usually do so about 15 to 180 days after the person has
become infected.

The acute phase of hepatitis symptoms.

The initial phase of hepatitis is called the acute phase. The symptoms are like mild
flu and may include. Diarrhea, fatigue, loss of appetite, mild fever, muscle or joint
ache, nausea, slight abdominal pain, vomiting, weight loss.
Common symptoms of hepatitis.
Fatigue, flu like symptoms, Dark urine fails, stool abdominal pain, loss of appetite,
unexplained or weight loss, yellow skin and eyes, which may be signs of jaundice.
Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle
to notice.
• Complications.
→ Fibrosis.
→ Cirrhosis of the liver.
→ Portal hypertension.
→ Viral Co infection.
→ Liver failure.
→ Glomerulonephritis.
→ Cancer of the liver.

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• Diagnosis of hepatitis.

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• Diet recommendation.
→ 1600 to 2000 kcal per day can be given by age.
→ With severe jaundice 40 grams, while a mild jaundice 60 to 80 gram of protein
is permitted.
→ Patients should be provided with 40 to 45% of total calories from
carbohydrates.
→ A smaller amount of fat can be given, and a greater amount of carbohydrates
should be provided.
→ 15 to 20% fat should be provided, and this is fats should come from
polyunsaturated fatty acids.
→ One supplement of vitamins and one supplement of mineral should be added
to every day's food chart.
→ 500 mg vitamin C,10 mg vitamin K and supplements of vitamin B complex are
essential according to daily needs.

• Fatty liver.

→ Fatty liver or steatosis is a term that describes the buildup of fat in the liver.
→ While it's normal to have some fat in the liver, more than five to 10% of liver
weight is fat in the case of fatty liver.
→ Fatty liver is a reversible condition that can be resolved with changed
behaviours.
→ It often has no symptoms and typically doesn't cause permanent damage.

• Types of fatty liver.

There are four types of fatty liver.
1) Non-alcoholic fatty liver.
Nonalcoholic fatty liver (NAFL) develops when the liver has difficulty breaking down
fats which causes a buildup in the liver tissue. The cause is not related to alcohol.
NAFL is diagnosed when more than 10% of the liver is fat.
2) Alcoholic fatty liver.
Alcoholic fatty liver is the earliest stage of alcohol related liver disease. Heavy
drinking damages the liver, and the liver cannot breakdown fats as a result.

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Abstaining from alcohol will likely cause the fatty liver to subside. Within six weeks of
not drinking alcohol, the fat will disappear. However, if excessive alcohol use,
continuous cirrhosis may develop.
3) Non-alcoholic Steatohepatitis (NASH).
When the fat builds up enough it will cause the liver to swell. If the original cause is
not from alcohol, it's called nonalcoholic steatohepatitis (NASH). This disease can
impair liver function. Symptoms can be seen with this disease. These include.
→ Appetite loss, nausea, vomiting, abdominal pain, yelling of the skin
(Jaundice). If left untreated, NASH can progress to permanent scarring of the
liver and eventual liver failure.
4) Acute fatty liver of pregnancy.
Acute fatty liver is a rare complication of pregnancy that can be life threatening.
Symptoms begin in the third trimester. These include.
→ Persistent nausea and vomiting.
→ Pain in the upper right abdomen.
→ Jaundice.
→ General Malaise.
→ Women who are pregnant will be screened for this condition. Most women
improve after delivery and have no lasting effect.

• Symptoms of fatty liver.

A fatty liver typically has no associated symptoms. You may experience fatigue or
vague abdominal discomfort. The liver may become slightly enlarged and doctors
can detect this during a physical exam.
→ Excess fat can cause liver inflammation. If liver becomes inflamed, may have
a poor appetite.
→ Weight loss.
→ Abdominal pain.
→ Weakness.
→ Confusion.
→ Overheating of body hyperthermia.
→ Pain around the liver.
→ Excess abdominal weight.

• Causes of fatty liver.

→ The most common cause of fatty liver is alcoholism and heavy drinking. In
many cases, doctors don't know what causes fatty liver in people who are not
Alcoholics.
→ Fatty liver develops when body creates too much fat or cannot metabolize fat
fast enough.
→ Eating a high fat diet may not directly result in fatty liver.

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Besides alcoholism, other common causes of fatty liver include.

→ Obesity.
→ Hyperlipidemia, or high levels of fats in the blood.
→ Diabetes.
→ Genetic inheritance.
→ Rapid weight loss.
→ Side effects of certain medications including aspirin, steroids, tamoxifen, and
tetracycline.

• At risk group.
Fatty liver is the buildup of extra fats in the liver, it's more likely to develop if
overweight or obese.
Having type 2 diabetes also may increase the risk for fatty liver. Fat accumulation in
the liver has been linked to insulin resistance, which is the most common cause of
type 2 diabetes.
Other factors that may increase risk of fatty liver are.
→ excessive alcohol use.
→ Taking more than the recommended dose of certain over the counter
medications such as acetaminophen.
→ Pregnancy.
→ high cholesterol.
→ High triglyceride levels.
→ Malnutrition.
→ Metabolic syndrome.

• Diagnosis of fatty liver.

→ Physical exam,
→ blood tests,
→ ultrasound,
→ Liver biopsy.

• Treatment.
There isn't medication or surgery to treat fatty liver. Instead, doctors will offer
recommendations to reduce risk factors.
These recommendations are included.
→ Limiting or avoiding alcoholic beverages.
→ Managing your cholesterol.
→ Losing weight.
→ Controlling your blood sugar.

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FN-301.Clinical and Therapeutic Nutrition Topic-5

• Dietary management of fatty liver.

→ High calorie food is not given.
→ 800 to 1000 kcal/day can be given according to age, weight.
→ High biological value containing protein is needed to recover damaged
tissues. 50 to 60 gram per day protein is recommended.
→ Calories cannot be obtained from fat, so carbohydrates are the only source of
calories at that time. About 60 to 70% calories are recommended from
carbohydrate.
→ Though fat supplies are more calories, it is inhibited for this reason. 5 to 8%
fat per day can be given.

• Foods to avoid in fatty liver.

1) High fat food. A fatty liver will have problems in breaking down dietary fats
the any further. This is why consumption of foods high in unhealthy fat needs
to be avoided or done in minimum amount by the sufferer. Also, fatty foods
contribute to piling up body weight which can also aggravate fatty liver
condition. Uncle. Recently.
2) High glycemic food. Potatoes, watermelons, bananas, raisins, white breads,
airs, white rice, corn and corn products, ice creams, fruit yogurts and
chocolate bars are high in simple carbohydrates and need to be avoided.
3) Processed grain foods. These too need to be avoided and instead whole
grains be made part of the sufferer's daily diet, for this will contain all nutrients
in their natural form. They are also rich in fiber which will help in controlling
cholesterol and blood sugar levels.
4) Alcohol. Alcohol consumption, be it in moderate or excessive amounts, will
eventually cause fat buildup in the liver cells. When buildup goes beyond
acceptable limits, inflammation of the liver cells can set in, which will cause
overtime scarring of the tissues.

• Cirrhosis of liver.
→ Cirrhosis is a slowly progressing
disease in which healthy liver
tissue is replaced with scar tissue,
eventually preventing the liver from
functioning properly.
→ The scar tissue blocks the flow of
blood through the liver and slows
the processing of nutrients,
hormones, drugs and naturally
processed toxins.
→ Symptoms of cirrhosis are
expressed at the last stage of the
disease.
→ At that time 85 to 90% of liver is
damaged.

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FN-301.Clinical and Therapeutic Nutrition Topic-5

• Causes of liver cirrhosis.

A wide range of diseases and conditions can damage the liver and lead to cirrhosis.
The most common causes are.
→ Chronic alcohol abuse.
→ Chronic viral hepatitis (hepatitis B&C).
→ Fat accumulating in the liver (Nonalcoholic fatty liver disease).
Other possible causes include.
→ Iron builds up in the body, (hemochromatosis).
→ Cystic fibrosis.
→ Copper accumulated in the liver. (Wilson's disease).
→ Poorly formed bile ducts. (Biliary Atresia).
→ Inherited disorders of sugar metabolism. (Galactosemia or glycogen storage
disease).
→ Genetic digestive disorder. (Alagille syndrome).
→ Liver disease caused by your body's immune system. (Autoimmune hepatitis).
→ Destruction of the bile ducts, (primary biliary cirrhosis).
→ Hardening and scarring of the bile ducts (primary sclerosing cholangitis).
→ Infections such as Schistosomiasis.
→ Medications such as Methotrexate.

• Symptoms of liver cirrhosis.

Cirrhosis often has no signs or symptoms until liver damage is extensive. When
signs and symptoms do occur, they may include.
1. Fatigue. 9. Weight loss.
2. Bleeding easily. 10. Confusion, drowsiness and
3. Bruising easily. slurred speech. (Hepatitis,
4. Itchy skin. Encephalopathy).
5. Yellow discoloration in the skin and 11. Spider like blood vessels on your
eyes (jaundice). skin.
6. Fluid accumulation in your abdomen 12. Redness in the palms of the
(ascites). hands.
7. Loss appetite. 13. Testicular atrophy in men.
8. Swelling in your leg. 14. Breast enlargement in men.

• Complications of liver cirrhosis.

→ High blood pressure in the veins that supply the liver (portal
hypertension). Cirrhosis slows the normal flow of blood through the liver,
thus increasing pressure in the veins that brings blood from the intestine and
spleen to the liver.
→ Malnutrition. Cirrhosis may make it more difficult for your body to process
nutrients, leading to weakness and weight loss.

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FN-301.Clinical and Therapeutic Nutrition Topic-5

→ Buildup of toxins in the brain. (Hepatic encephalopathy). A liver damaged

by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver
can. These toxins can then build up in the brain and cause mental confusion
and difficulty concentrating. Hepatic encephalopathy symptoms may range
from fatigue and mild impairment in cognition to unresponsiveness or coma.
→ Increased risk of liver cancer. A large proportion of people who develop
liver cancer that forms within the liver itself have cirrhosis.
→ Acute or chronic liver failure. Some people end up experiencing multiorgan
failure. Researchers now believe this is a distinct complication in some people
who have cirrhosis, but they don't fully understand its causes.

• Dietary management of liver cirrhosis.

Though liver cells are damaged badly, so high calorie, high protein, high
carbohydrate and moderate or restricted fat, high vitamin containing food should be
given.
→ At least 2000 to 2500 kcal must be given.
→ 1.5-2 gm/day/kg body weight vitamin B complex containing protein should be
given.
→ Fat is restricted; so a lot of carbohydrates should be supplied so that glycogen
can be stored in liver.
→ High-powered vitamin tablets should be prescribed.
→ Salt taking should be lessened if water is stored in the body.
→ Fibrous food should not be prescribed.
→ Food should be given 8 to 10 times in a small amount.

• Hepatic coma or Encephalopathy.

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

• Causes of hepatic coma.

Hepatic encephalopathy may be triggered by.
→ Infections such as pneumonia.
→ Kidney problems.
→ Dehydration.
→ Low oxygen levels (Hypoxia).
→ Recent surgery or trauma.
→ Use of medication to suppress the immune system.

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→ Eating too much protein.

→ Use of medication (such as barbiturates or benzodiazepine tranquilizers) that
suppress the central nervous system.
→ Electrolyte imbalance, especially a decrease in potassium after vomiting or
taking diuretics.

• Symptoms of hepatic coma.

Symptoms of severe hepatic encephalopathy are.
→ Confusion.
→ Drowsiness or lethargy.
→ Anxiety.
→ Seizures
→ Severe personality changes.
→ Fatigue.
→ Confused speech.
→ Shaky hands.
→ Slow movements.

• Dietary management.
→ A low protein diet should be given.
→ About 1500 to 2000 kilocalories are needed to prevent breakdown of tissue
protein of energy.
→ First 2/3 days protein is completely omitted, or 20 to 30 g/day are given.
→ Fat is also restricted.
→ About 400-to-500-gram carbohydrates should be given from simple
carbohydrates like glucose.
→ High vitamin and mineral supplement should be given.

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• Gallbladder disorders
Gallbladder disorders include inflammation, infection, stones or blockage of the
gallbladder. The gallbladder is a sac located under the liver. It stores and
concentrates bile produced in the liver. Bile aids in the digestion of fat and is
released from the gallbladder into the upper small intestine in response to food
(especially fats). Types of gallbladder disease include:
→ Cholecystitis (inflammation of the gallbladder)
→ Porcelain gallbladder (occurs when calcium deposits stiffen the gallbladder
walls, making them rigid)
→ Gallstones (hardened deposits of bile that can form in your gallbladder)
→ Choledocholithiasis (common bile duct stones)
→ Abscess of the gallbladder (The development of pus, also known as an
abscess)
→ Gallstone ileus (A gallstone may travel into the intestine and block it)
→ Perforated gallbladder
→ Gallbladder polyps (abnormal tissue growths that may be benign. Polyps
can cause obstruction of the gallbladder)
→ Chronic acalculous gallbladder disease (in which the natural movements
needed to empty the gallbladder do not work well)
→ Gangrene or abscesses
→ Congenital defects of the gallbladder
→ Sclerosing cholangitis (bile ducts become scarred)
→ Tumors of the gallbladder and bile ducts
→ Gallbladder cancer

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FN-301.Clinical and Therapeutic Nutrition Topic-5

• Symptoms
Gallbladder conditions share similar symptoms. These include:
→ Pain: It usually occurs in the mid to upper-right section of your abdomen.
→ Nausea or vomiting: Chronic gallbladder disease may cause digestive
problems, such as acid reflux and gas.
→ Fever or chills: This may indicate infection and should be treated
immediately.
→ Chronic diarrhea: Defined as loose or watery stools that occur more than
three or more times per day and last for 4 weeks or more.
→ Jaundice: Marked by yellow-tinted skin, it may be a symptom of a block or
stone in the common bile duct.
→ Stool abnormality: Lighter-colored stool is a possible symptom of a common
bile duct block.
→ Discolored urine: Dark urine is a potential symptom of a common bile duct
block.
Stones lodged in the common bile duct can cause symptoms that are like those
produced by stones that lodge in the gallbladder, but they may also cause:
→ Jaundice
→ Dark urine, lighter stools or both
→ Rapid heartbeat and abrupt blood pressure drop
→ Fever, chills, nausea and vomiting, with severe pain in the upper right
abdomen

• Diagnosis
→ Blood tests
→ Ultrasound and other imaging techniques

• Treatment
Surgery may be warranted to remove the gallbladder if the patient has gallstones, or
the gallbladder is not functioning normally. Most of the time this can be performed
either laparoscopically (through small incisions) or with robotic-assisted surgery, both
as outpatient procedures.
• The gallbladder diets
Foods that may aggravate gallbladder disease include:
→ foods high in trans fats and other unhealthy fats
→ highly processed foods
→ refined carbohydrates, such as white bread and sugar
Instead, try to build your diet around:
→ fiber-rich fruits and vegetables
→ calcium-rich foods, such as low-fat dairy and dark leafy greens
→ foods containing vitamin C, such as berries
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FN-301.Clinical and Therapeutic Nutrition Topic-5

→ plant-based protein, such as tofu, beans, and lentils

→ healthy fats, such as nuts and fish
→ coffee, which reduces your risk of gallstones and other gallbladder diseases.

• Healthy foods for gallbladder.

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