It's easy to see why an organ with an estimated 1,500 biochemical functions plays such a pivotal role in metabolism. The liver also has a major influence on the nutritional status of the body, occupying a central role in the metabolism of amino acids, carbohydrates, fats and vitamins.

The liver has a huge reserve and is capable of regeneration, which helps to protect it from insults and disease. However, for this same reason, clinical signs are often not seen until late in the course of a disease and are often vague. The aetiology in many cases is not known either and so treatment is often non-specific. Even then, treatment aimed at supporting the organ and alleviating clinical signs can make the patient feel a lot better and may also increase survival time.

Nutritional and nursing support is vital in helping to address the needs of each individual.

Vague clinical signs

Clinical signs can include weight loss, nausea, vomiting and diarrhoea, jaundice and ascites. By the time they are diagnosed, patients are likely to have a low body condition score and be energy- depleted. For this reason, nutritional invention should be started early, and in anorectic patients include the placement of feeding tubes where necessary. Daily weight and body condition scores should be recorded.

The food given should be tailored to the individual as much as possible, and take into account clinical signs, body condition, any haematological, biochemical or electrolyte disturbances, with reassessment and adjustment of the food type and feeding plan accordingly.

Feed little and often

Liver patients benefit from being fed a palatable diet to encourage intake. Multiple small meals (four to six a day) help to control nausea, limit the amount of work given to the liver at any one time, and minimise signs of encephalopathy. The placing of a tube can help to avoid food aversion, particularly if the patients have GI signs associated with nausea.

Key nutritional factors

Ensuring adequate energy intake is paramount, with the aim of meeting the patients daily energy requirement (DER). Fats need not be restricted unless the patient has steatorrhoea or a concurrent disease which necessitates this – they provide a ready source of energy as well as fat-soluble vitamins. Dietary fat also helps to prevent the catabolism of lean tissue which generates ammonia.

Adequate protein should be fed to support the regeneration of hepatocytes, while avoiding excess which could contribute towards hepatic encephalopathy. Protein sources should be of high quality and highly digestible. Monitoring of blood proteins will help to watch out for hypoalbuminaemia, which is a frequent problem with chronic liver cases. Adding in sources of good quality protein, such as cottage cheese, chicken or soya, can help to counter this. Having a source of digestible carbohydrate and some fermentable fibre (which decreases ammonia reabsorption in the bowel) is also helpful.

Feeding a specially formulated liver diet, such as Hill’s Prescription Diet 1/d, will address all of these important considerations whilst also providing the benefits of increased zinc and vitamin K levels, as well as reduced levels of copper. The addition of L-carnitine helps to improve fat metabolism and spares lean tissue.

For further help in devising an appropriate diet for liver disease, visit www.hillsproducts.com or speak to our technical vet on 01923 814444.

End-stage liver disease. Image courtesy of Hills Pet Nutrition

Author

Tim Dobbins BVM&S CertSAM MRCVS 

Veterinary Nursing Journal• VOL 26 • August 2011 •