NUTRITIONAL MANAGEMENT ON HEPATIC DISORDERS

HEPAR / LIVER
One of the largest vital organ

25 % parenchymal tissues function in normal

condition still sustainable life Has multicomplex important function, play a role in maintain and providing to perform implementing life process As metabolism centre, formation and enzymatic arrangement, fashioned clotting factors Act in detoxification, phagocytics (RES) The occurrence of Kupffer cell, macrophage within the liver reveals bodys defense

Concerred on
1. Energy nutrients metabolism, such as glikogenesis, glikogenolisis, glukoneogenesis ; deliver numerous enzymes (SGOT, SGPT, -GT, and bile) and regulate the value of blood glucose and cholesterol. 2. Plasma protein synthesis (albumin, globulin, fibrinogen, prothrombine and coagulation/clotting factors) Storage place for fat soluble vitamins, vit. B12 and mineral Cu & Fe

 The liver metabolized 40% up to 80% amino acids

depends on its configuration perform degradation (catabolism) of 7 sort essential amino acids includes Aromatic Amino Acid, while Branch Chained Amino Acid (BCAA : Leucine, Isoleucine & Valine) be metabolized and yielding energy in the muscle

HEPATITIS

Acute (Inflammatory) Hepatitis

Viral Hepatitis

VH-A, VH-B, VH-non A non B, VH-C, VH-D, etc Acute Recurrence Hepatitis May caused by medications, toxins, alcoholic (drunk) Incomplete recover / healing of Viral Hepatitis also in addition with repeated infection and nutritional intake especially in extremly in adequacy of protein will lead to become necrotics and fibrotics. Necrotics resulting from hepatic cellular damage will stimulate to regenerate in effort healing liver function as well as compensation in liver parenchyme performance / feature accompany with fibrosis

 Furthermore reveals pseudolobulasi with noduls

as spesifics mark for Chirrosis Hepatis. It will happened obstruction post sinusoid / vena porta and decrease of albumin syntesis, tends to get ascites. Lack of protein in long time, it will makes lack of lipoprotein such as lipotropics factors (choline, methionine) resulting fat accumulation Fatty Liver. In case of chronic liver failure, will appear shunt between portal circulation and systemic circulation half part of glucose enterred systemic hyperglycaemia hyperinsulinaemia ; diabetic cirrhosis Catabolism of BCAA (energy sources in the muscle)

Nutritional Management on Hepatitis

Acute (Viral) Hepatitis

The aim to effort the improvement of liver cell

parenchyme. Function of the liver have to recover absolutely. The value of enzymes tends back to normal, and improve the complaints. Giving the liver to rest. Soft-foods meal in a few portion consumed and frequent, kinds of chopped food, unirritation taste. Energy needs - 2/3 requirements (65% normal) Protein - around 0,5 gram/kg BW (animal protein : plant protein = 1 : 2-3)

 Fat maximally 20% total energy, which is substance

food stuff easy to digest Refined simple carbohydrate Adequate vitamin and mineral (B1, Cu, Fe) If there is ascites - a few or without salt. Better or improve condition and better or improve appetite protein can be increased 0,75 gram/kg BW. Energy and lipid - increase gradually (suitable tolerance)

Chronic Hepatitis
Chrirrosis without complication Soft food stuff, can be strained (filtered), chopped meal uniritation taste Sufficient energy initially 40 Kkal/kgBW/day, appropriate and tolerance with the appetite can be gradually increase up 45 Kkal/kgBW/day. Protein also gradually arise depends on it illness. Beginning 0,3 0,5 gram/kg BW/day, which 60-70% from animal source (high biological value) arise 0,75 gram, mind in source of BCAA Carbohydrate 65% total energy - 20% from refined CH or complex CH Lipid / Fat 15-20% from total energy Supplement for vitamin, mineral

Chirrosis hepatis with cemplication (encephalo hepatic)

Conform with condition, might be / mostly

parenteral Amonia yielding from the urolysis process taken by gut / bowel bacterias can not be enterred the urea cycle. The existence of Portal Systemic Shunt - leads to disturbance of metabolism process ; resulting ammonia and other toxical substances yielding pathological central sign and symptom.

The aim nutritional treat is to prevent the interference of neuropsichiatrics disorders.

Energy has to be positive anabolic, 35-40 Kkal/kg

BW/ day Protein especially BCAA, recommend 0,3 gram/kg BW/day Carbohydrate 65% from total energy (simple CH : complex CH = 1 : 3) Fat 20% total energy Vitamin & mineral (includes some antioxidants)

SosIalIze
Intended for suffer post hepatitis virus, the

possibility getting relapse and recurrence or have got cirrhosis (in early stage), have to give food sources from BCAA compound in daily food pattern consumed. Legumes / beans especially red/kidney bean, soy bean, and its product (soy bean curd tahu/tofu, soy bean cake - tempe), green/mung bean and four sided bean (kecipir) are plant sources which rich contents of BCAA

 Pass through animal experiment (wistar albino rat

240 gam) could be proved by microphotoes in anatomical pathology that chirrosis hepatis can be obstructed / blocked or can be restrained and controlled by (pure-powdered) BCAA, kidney bean and soy bean cake.