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Health Differences Across the Lifespan 2 Study Guide Diet: In the past, it was thought that consumption of protein, even at normal levels, increased the risk of hepatic encephalopathy. This has been shown to be incorrect. Many people with chronic liver disease are malnourished and require adequate protein to maintain a stable body weight. A diet with adequate protein and energy is therefore recommended. Dietary supplementation with branched- chain amino acids has shown improvement of encephalopathy and other complications of cirrhosis. Some studies have shown benefit of administration of probiotics ("healthy bacteria"). Lactulose: Lactulose and lactitol are disaccharides that are not absorbed from the digestive tract. They are thought to improve the generation of ammonia by bacteria, render the ammonia in absorbable by converting it to ammonium (NH4), and increase transit of bowel content through the gut. Doses of 15-30 ml are administered three times a day; the result is aimed to be 3–5 soft stools a day, or (in some settings) a stool pH of less than 6.0. Lactulose may also be given by enema, especially if encephalopathy is severe. More commonly, phosphate enemas are used. This may relieve constipation, one of the causes of encephalopathy, and increase bowel transit. It may be mixed with fruit juice, water, or milk. The patient should drink 8 ounces or more of liquid with each dose. Store it at room temperature away from heat or light. Do not freeze. The liquid may darken in color which does not affect the medication. Supplements: Choline and methionine protect the liver from damage. Vitamin B-12, taken in lozenge form, replaces much needed B vitamins to the liver. Vitamin C with bioflavonoid protects the liver and other organs from toxins. Milk thistle encourages liver cell renewal and repair. Dandelion stimulates liver function and bile flow. Stinging nettle eliminates toxins and cleans the liver. Gallstones may develop if cirrhosis prevents bile from reaching the gallbladder. Presence of gallstones in the gallbladder may lead to acute cholecystitis, an inflammatory condition characterized by the retention of bile in the gallbladder and often a secondary infection by intestinal microorganisms, predominantly Escherichia coli and Bacteroides species. Presence of gallstones in other parts of the biliary tract can cause obstruction of the bile ducts, which can lead to serious conditions such as ascending cholangitis or pancreatitis. Either of these two conditions can be life-threatening, and are therefore considered to be medical emergencies. Hepatitis Hepatitis is an inflammation of the liver. It ranges in severity and can be caused by several different viruses or disease states. Hepatitis viruses cause local necrosis of the parenchymal cells of the liver; an inflammatory response leads to swelling and blockage of liver’s drainage system. Chronic Hepatitis C , also called post transfusion hepatitis, is the most common cause of hepatitis. Blood transfusions, sexual contact, sharing of needles, and unintentional needle sticks account for a significant number of cases. The hepatitis C virus ranks with alcohol as the major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low-grade damage to the liver that over several decades can lead to cirrhosis. The incubation period is 5-12 weeks. Anti HCV antibodies are present. No vaccination is available and the patient becomes a carrier. The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years. In some cases, those with

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