Deck 16: Diseases of the Liver - Gallbladder - and Exocrine Pancreas

Question 1

A syndrome of impaired mental status and abnormal neuromuscular function that results from liver failure is known as:​

A) ​hepatic stenosis.
B) ​jaundice.
C) ​hepatic encephalopathy.
D) ​fulminant hepatitis.
E) ​hepatomegaly.

Answer 1

C

Question 2

Which type of hepatitis is most commonly transmitted through the fecal-oral route?​

A) ​hepatitis A
B) ​hepatitis B
C) ​hepatitis C
D) ​hepatitis D
E) ​hepatitis E

Answer 2

A

Question 3

When ascites is present, which nutrition modification is typically necessary?​

A) ​low sodium
B) ​decreased fluid intake
C) ​increased vitamin K
D) ​low fiber
E) ​decreased protein

Answer 3

A

Question 4

Which condition is most commonly associated with non-alcoholic steatohepatitis (NASH)?​

A) ​obesity
B) ​high blood glucose
C) ​celiac disease
D) ​hypothyroidism
E) ​anorexia

Question 5

Increased destruction of red blood cells with rapid release of bilirubin into the blood is known as:​

A) ​obstructive jaundice.
B) ​bilirubin conjugation.
C) ​post-hepatic jaundice.
D) ​hemolytic jaundice.
E) ​bilirubin dissection.

Question 6

The cause of fatty liver after alcohol ingestion is:​

A) ​greater amounts of glucagon secretion and enhanced gluconeogenesis from amino acids.
B) ​elevated tryptophan levels and the formation of serotonin.
C) ​increased availability of fatty acids in the liver.
D) ​esterification of fatty acids.
E) ​increased production and absorption of ammonia.

Question 7

Bile salts aid in the absorption of fatty acids through the formation of which substance?​

A) ​micelles
B) ​chylomicrons
C) ​acetyl CoA
D) ​prothrombin
E) ​mucoproteins

Question 8

Common manifestations of all types of hepatitis include jaundice, fatigue, vomiting, and:​

A) ​epigastric pain.
B) ​dark urine.
C) ​diarrhea.
D) ​generalized rash.
E) ​dilated pupils.

Question 9

Ammonia is absorbed and transported in the intestinal venous blood to the liver, where it is metabolized into what substance?

A) ​amino acids
B) ​urea
C) ​fatty acids
D) ​glucose
E) ​glycogen

Question 10

The most common nutrient-drug interactions that occur with antiviral medications are:​

A) ​high cholesterol and hypertriglyceridemia.
B) ​dyspepsia, abdominal pain, and diarrhea.
C) ​hematochezia and iron deficiency anemia.
D) ​muscle cramps, joint pain, and fever.
E) ​headache, dizziness, and confusion.

Question 11

A patient with hepatic encephalopathy is being assessed according to the Adapted West Haven Criteria. The patient has marked somnolence, psychomotor agitation, and his speech is difficult to understand. In which stage would this patient be classified?​

A) ​0
B) ​1
C) ​2
D) ​3
E) ​4

Question 12

Which best describes hepatobiliary scintigraphy?​

A) ​A non-invasive test produces cross-section images of parts of the body.
B) ​A gamma camera takes pictures of a radioactive compound as the bile moves through the liver, bile ducts, and gallbladder.
C) ​An endoscope is inserted down the throat, through the stomach, and into the small intestine to view internal structures.
D) ​A non-invasive X-ray produces three-dimensional pictures of parts of the body.
E) ​The patient is injected with a small amount of radioactive material that is absorbed by the gallbladder, which stimulates it to contract.

Question 13

Which organ stores bile that is produced in the liver?​

A) ​pancreas
B) ​kidney
C) ​spleen
D) ​gallbladder
E) ​stomach

Question 14

At which level of serum bilirubin does the skin begin to appear jaundiced?​

A) ​1.0-1.1 mg/dL
B) ​1.5-1.9 mg/dL
C) ​2.1-2.4 mg/dL
D) ​2.5-3.0 mg/dL
E) ​3.3-3.5 mg/dL

Question 15

What laboratory level is most likely to be elevated in a patient with fatty liver?​

A) ​serum albumin
B) ​glucose
C) ​red blood cells
D) ​cortisol
E) ​serum transaminase

Question 16

Which is a true statement regarding alcoholism in older adults?​

A) ​Approximately 20% of people over 65 abuse alcohol.
B) ​Most adults become addicted to alcohol later in life in response to problems.
C) ​Older adults are even more susceptible to nutrient deficiencies when they abuse alcohol.
D) ​Most primary care providers identify alcohol abuse in older adults because of routine assessments.
E) ​Alcohol abuse among older adults is one of the most commonly identified problems of aging.

Question 17

Delta cells of the pancreas are responsible for secreting:​

A) ​glucagon.
B) ​insulin.
C) ​somatostatin.
D) ​amylase.
E) ​cholecystokinin.

Question 18

What treatment is used in the management of both hepatitis B and hepatitis C?​

A) ​neomycin
B) ​spironolactone
C) ​prednisone
D) ​interferon
E) ​famotidine

Question 19

What medication is most commonly used in the treatment of hepatic encephalopathy?​

A) ​manganese
B) ​tyramine
C) ​lactulose
D) ​octopamine
E) ​phenylethanolamine

Question 20

Hepatitis C is most commonly transmitted through which route?

A) ​exposure to blood or body fluids from an infected person
B) ​the fecal-oral route
C) ​excessive alcohol intake
D) ​contaminated drinking water
E) ​sewage

Question 21

Because of JB's history of alcohol abuse, he is most likely at risk of which nutrient deficiency?​

A) ​potassium
B) ​vitamin A
C) ​sodium
D) ​vitamin B6
E) ​vitamin E

Question 22

Which condition is commonly associated with chronic pancreatitis?​

A) ​celiac disease
B) ​anorexia
C) ​diabetes
D) ​renal failure
E) ​atrial fibrillation

Question 23

Alcohol causes increased urinary excretion of which nutrient?

A) ​folate
B) ​vitamin B12
C) ​magnesium
D) ​chloride
E) ​sodium

Question 24

How would the registered dietitian determine JB's caloric needs in this situation?​

A) ​15-20 kcal/kg IBW
B) ​20-25 kcal/kg IBW
C) ​25-30 kcal/kg IBW
D) ​30-35 kcal/kg current body weight
E) ​35-40 kcal/kg current body weight

Question 25

When steatorrhea associated with pancreatitis occurs, what intervention should follow?​
​

A) ​Administration of pancreatic digestive enzymes
B) ​Early initiation (within 48 hours) of enteral nutrition
C) ​A low-carbohydrate nutrition prescription with modest protein
D) ​Calcium supplements along with a multivitamin
E) ​Fluid and sodium restriction

Question 26

Following the paracentesis, the nutritionist might recommend what component to the nutrition prescription?​

A) ​vitamin B12
B) ​protein
C) ​hypertonic fluid
D) ​vitamin D
E) ​potassium

Question 27

The liver receives blood from two sources: the hepatic portal vein and the hepatic artery.

Question 28

Cystic fibrosis is an inherited disorder of epithelial transport and is one of the most common lethal inherited disorders of which ethnic group?​

A) ​Asians
B) ​African Americans
C) ​Caucasians
D) ​Pacific Islanders
E) ​Native Americans

Question 29

What complication most commonly occurs with folate deficiency?​

A) ​reduced bone formation and mineralization
B) ​villous shortening in the intestine
C) ​retrograde amnesia
D) ​ataxia and sensory neuropathy
E) ​pancreatic insufficiency

Question 30

Which intervention is appropriate for a patient with an acute attack of cholangitis?​

A) ​A low-fat diet
B) ​Decreased fluid intake
C) ​Supplementation with vitamin B6
D) ​Enteral nutrition
E) ​Increased carbohydrate intake

Question 31

Nutrition interventions for a client with alcoholic hepatitis include a diet that is:​

A) ​low in carbohydrates.
B) ​high in saturated fat.
C) ​low in artificial sugars.
D) low in protein.
E) ​high in carbohydrates.

Question 32

Symptoms associated with acute pancreatitis include:​

A) ​diarrhea, bloody stools, and abdominal cramping.
B) ​epigastric pain and ascites.
C) ​flatulence, diarrhea, and abdominal distention.
D) ​fever and headache.
E) ​abdominal pain, nausea, vomiting.

Question 33

How will the registered dietitian determine JB's protein needs?​

A) ​0.8-1.0 g/kg
B) ​1.0-1.2 g/kg
C) ​1.4-1.6 g/kg
D) ​1.8-2.0 g/kg
E) ​> 2 g/kg

Question 34

There are three types of gallstones: cholesterol, pigment, and:​

A) ​bile.
B) ​mixed.
C) ​ammonia.
D) ​inflammatory.
E) ​phospholipid.

Question 35

Bile (or gall) is a bitter yellow, blue, and green fluid secreted by the liver and stored in the pancreas.

Question 36

Wernicke-Korsakoff syndrome is associated with excessive alcohol intake and a deficiency of which nutrient?​

A) ​thiamin
B) ​vitamin B12
C) ​vitamin D
D) ​folate
E) ​vitamin B6

Question 37

The most common cause of chronic pancreatitis in children is:​

A) ​phenylketonuria.
B) ​sickle cell anemia.
C) ​necrotizing enterocolitis.
D) ​cystic fibrosis.
E) ​hypothyroidism.

Question 38

The RD recommends sodium restriction because of JB's ascites. How much sodium should the RD initially recommend for JB each day?​

A) ​500 mg/day
B) ​1000 mg/day
C) ​2000 mg/day
D) ​3000 mg/day
E) ​3500 mg/day

Question 39

The recommended daily protein intake for a patient with alcoholic hepatitis would be:​

A) ​0.5-0.8 grams/kilogram
B) ​0.8-1.0 grams/kilogram
C) ​1.0-1.5 grams/kilogram
D) ​1.5-2.0 grams/kilogram
E) ​2.5-3.0 grams/kilogram

Question 40

The most common cause of cirrhosis in the United States is:​

A) ​alcohol abuse.
B) ​hepatitis B.
C) ​non-alcoholic fatty liver disease.
D) ​hepatitis C.
E) ​biliary colic.

Question 41

_______________ is a form of toxic liver injury associated with chronic ethanol consumption.

Question 42

The most deleterious complication of cystic fibrosis with cirrhosis is _______________.

Question 43

_______________ presents as small, brief, intermittent movements of individual fingers and may be seen in patients with hepatic encephalopathy.

Question 44

Prolonged parenteral nutrition and short bowel syndrome can cause biliary stasis and therefore increase risk of gallstones.

Question 45

The pancreas is the only organ of the body that has both _______________ and endocrine functions.

Question 46

Red blood cells, alkaline phosphatase, and serum glucose are generally elevated with hepatitis.

Question 47

Medical treatment for hepatoencephalopathy is primarily directed at reducing the amount of circulating ammonia.

Question 48

The basic functional unit of the liver is the _______________, which is a cylindrical structure several millimeters in length.

Question 49

The most common clinical sign of fatty liver is _______________.

Question 50

The hepatic duct descends to the right for a few inches and is then joined by the cystic duct from the gallbladder to form the _______________.

Question 51

Alcohol and acetaldehyde have a hepatotoxic effect that interferes with metabolism and activation of vitamins by liver cells.

Question 52

_______________ or steatosis occurs in about 25% of the general U.S. population and 90% of chronic alcohol abusers.

Question 53

_______________ is the development of renal failure in patients with advanced chronic liver disease.

Question 54

Forty percent of acute pancreatitis cases are due to a gallstone passing into the bile duct and temporarily lodging at the sphincter of Oddi.
​

Question 55

Autodigestion of the pancreas is prevented by storing the digestive enzymes in their inactive forms, as zymogens.

Question 56

_______________ is a liver disorder that uncommon in the United States and requires HBV to replicate.

Question 57

The most common causes of cirrhosis are chronic HCV and alcoholism, and 95% of heavy drinkers develop the disease.

Question 58

Withdrawal of fluid from the abdomen via a catheter, often used as treatment for ascites, is called _______________.

Question 59

_______________ is a manifestation of thiamin deficiency usually seen in individuals suffering from alcoholism.

Question 60

The hepatotoxic alcohol threshold at which ALD may develop is 20 g (two drinks) daily for men.

Question 61

Define the functions of the gallbladder.

Question 62

Describe the differences between hepatitis A, B, and C, including their methods of transmission, clinical manifestations, and modes of treatment.

Question 63

Fat malabsorption with chronic pancreatitis results in _______________.

Question 64

Describe possible complications associated with thiamin deficiency in the patient with alcohol dependency.

Question 65

An estimated dosage range would be _______________ IU of lipase per meal for the patient with acute pancreatitis.

Question 66

List three different causes of cirrhosis found in the United States.

Question 67

When a gallstone passes from the gallbladder through the cystic duct and lodges in the common bile duct or in the head of the pancreas, the condition is called _______________.

Question 68

The liver is the source of bile, but bile's composition is further modified by the _______________.

Question 69

A patient's eligibility to be placed on the waiting list for a liver transplant is determined based on the _______________ scoring system.

Question 70

Which people group is most commonly infected with chronic hepatitis B virus in the United States?​

A) ​Native Americans
B) ​Hispanic/Latinos
C) ​Caucasians
D) ​African Americans
E) ​Pacific Islanders

Question 71

Describe the major functions of the pancreas.

Question 72

Explain why malnutrition is prominent in the patient with alcoholism or alcoholic hepatitis.

Question 73

Briefly describe the three major hypotheses that explain the impairment of neurotransmission involved with hepatic encephalopathy.

Question 74

Small crystals of cholesterol on the surface of the inflamed mucosa of the gallbladder act as _______________ (points of origin) for further precipitation of cholesterol, and the crystals grow larger and larger.

Question 75

Describe the differences between acute and chronic pancreatitis, including causes, manifestations, and nutrition intervention.

Question 76

Describe a basic nutrition assessment for a patient with gallbladder disease.

Question 77

There are three major hypotheses that try to explain the impairment of neurotransmission during hepatic encephalopathy: the ammonia hypothesis, the synergistic neurotoxin hypothesis, and:​

A) ​the protein and pyramidine hypothesis.
B) ​the amino acid transamination hypothesis.
C) ​the detoxification hypothesis.
D) ​the neurosteroid hypothesis.
E) ​the false neurotransmitter hypothesis.

Question 78

Thirty percent of _______________ pancreatitis is of unknown origin, but it is now thought that up to 15% of cases are due to genetic defects.

Question 79

_______________ is an inflammation of the biliary ducts, usually secondary to obstruction of the common bile duct leading to infection.

Question 80

Give three examples of possible nutrition diagnoses associated with acute hepatitis.