Question 1

Enteral nutrition is preferred over parenteral nutrition when treating patients with severe, acute pancreatitis because:

Accepted Answer

The optimal route of nutrition in acute pancreatitis has been the subject of much controversy over the years.Failure to use the GI tract in patients with acute pancreatitis may exacerbate the stress response and disease severity, leading to more complications and prolonged hospitalization; thus, enteral nutrition is preferred for nutrition therapy.The cause of pseudocysts is unclear.

Question 2

Which of the following may be provided to a patient with chronic pancreatitis to minimize steatorrhea?

Accepted Answer

Pancreatic enzyme replacement therapy provides dosages of lipase that are consumed at meal times.This allows for the lipase to aid in the digestion of fat in the diet to promote improved absorption, thus reducing steatorrhea.Fat-soluble vitamins are supplemented in water-soluble form to ensure against potential deficiencies.Because pancreatic bicarbonate secretion is impaired, antacids and proton pump inhibitors may be provided to reduce or neutralize stomach acids to restore the optimal pH in the duodenum for digestive enzyme actions.

Question 3

Which of the following is characterized by the presence of gallstones in the common bile duct?

Accepted Answer

Choledocholithiasis occurs when stones slip from the gallbladder into the bile ducts.Cholangitis or inflammation of the bile ducts can occur as a result of choledocholithiasis.Cholecystitis is an inflammation of the gallbladder, which can also be caused by gallstones.Cirrhosis is the final stage of liver deterioration, which involves the scarring and formation of fibrous tissue that interferes with the liver's normal structure.

Question 4

Increased serum aromatic amino acids and decreased serum branched-chain amino acids is associated with

Accepted Answer

A plasma amino acid imbalance exists in end-stage liver disease in which the branched-chain amino acids are decreased and aromatic amino acids are increased.It has been hypothesized that this imbalance is responsible for hepatic encephalopathy because high levels of aromatic amino acids may limit cerebral uptake of branched-chain amino acids.It is known as the false neurotransmitter theory.

Question 5

How is serum alkaline phosphatase used to diagnose liver disease

Accepted Answer

Serum alkaline phosphatase is an enzyme that is widely distributed in the liver, bone, placenta, intestine, kidneys, and leukocytes.Increased levels suggest cholestasis but can also be increased with bone disorders, pregnancy, normal growth, and some malignancies.Prothrombin time is used to assess bleeding time.

Question 6

Which of the following laboratory measures is NOT included in Ranson's criteria to classify severity of pancreatitis?

Accepted Answer

In pancreatitis, the serum amylase level may appear normal.Ranson's criteria include an increase in the white blood cell count and the blood glucose level caused by the inflammatory process occurring in pancreatitis, which could impair insulin production and secretion.A decrease in serum calcium is also one of the Ranson's criteria caused by possible hypoalbuminemia and third spacing of fluid.

Question 7

Which of the following, when consumed by a patient with chronic pancreatitis, may cause symptoms to worsen?

Accepted Answer

For both chronic and acute pancreatitis, the introduction of food should be done in a manner to minimize pain, nausea, and vomiting.Smaller meals with minimal fat content are better tolerated and less likely to promote symptoms.Alcohol is avoided because it is commonly associated with the development and progression of pancreatitis.

Question 8

A deficiency of which nutrient is associated with Wernicke's encephalopathy?

Accepted Answer

Wernicke's encephalopathy is a common side effect of alcoholism and involves damage to the central nervous system caused by thiamin deficiency.The classic triad of disturbances includes encephalopathy, nystagmus (constant, involuntary movement of the eyeball), and ataxia (impaired muscular movement or gait).

Question 9

Which of the following foods would be recommended to be avoided by a patient with Wilson's disease, in which excretion of copper from the body becomes impaired?

Accepted Answer

Foods high in copper include shellfish, pork, game birds, soy protein, organ meats, avocado, chocolate, dried beans, wheat germ, sweet potatoes, mushrooms, nectarines, dried fruits, and Brewer's yeast.

Question 10

Which of the following is a common sign of portal hypertension secondary to cirrhosis?

Accepted Answer

Portal hypertension occurs secondary to cirrhosis because of obstruction of blood flow through the liver.With a decreased production of albumin by the liver, the increased pressure within the circulatory system can force fluid into the peritoneal cavity, resulting in ascites development.Cardiac arrhythmias can be affected by changes in the blood pressure, but this is not specific to portal hypertension.Pulmonary complications can result from hepatitis.

Question 11

Which type of immunosuppressant drug used in the treatment of liver transplant is most likely to promote sodium retention, hyperglycemia, and impaired absorption of calcium?

Accepted Answer

Use of glucocorticoids has the side effects of sodium retention, hyperglycemia, hyperlipidemia, false hunger, protein wasting, and decreased absorption of calcium and phosphorus.Use of azathioprine can cause macrocytic anemia, mouth sores, nausea, vomiting, diarrhea, anorexia, sore throat, stomach pain, and decreased taste acuity.Cyclosporine can cause sodium retention, hyperkalemia, hyperglycemia, hyperlipidemia, decreased serum magnesium, hypertension, nausea, and vomiting.Tacrolimus promotes hyperglycemia, hyperkalemia, nausea, and vomiting.

Question 12

Which of the following symptoms appears when pancreatitis progresses to where the ability to secrete a sufficient quantity of enzymes is impaired?

Accepted Answer

Steatorrhea occurs as a result of inadequate production of pancreatic lipase.This results in malabsorption of fats, leading to excessive fat in the stool.Constipation may result from motility problems with the colon, but this is not affected by pancreatic function.Because vitamin A is a fat-soluble vitamin, deficiency caused by malabsorption is more likely to occur secondary to pancreatitis than a condition of hypervitaminosis.Serum ammonia levels increase as a result of impaired liver function.

Question 13

Which of the following herbal supplements is used to treat liver disease?

Accepted Answer

Milk thistle is popular among those with viral hepatitis and alcoholic liver disease.The active component is silymarin.It is proposed to reduce free radical production and lipid peroxidation.Centella asiatica, black cohosh, and Kava have been implicated in liver injury.

Question 14

Which of the following biochemical measures is a test of the liver's excretion?

Accepted Answer

Direct serum or conjugated bilirubin is a measure of the liver's excretory function.Levels increase when liver function and excretion are impaired.Serum alkaline phosphatase is an indicator of cholestasis.Alanine aminotransferase is hepatocyte cytosolic enzyme.Levels of ALT increase when liver cells are damaged.Prothrombin time is a measure of the liver's protein synthesis.

Question 15

Which of the following, when eaten by a patient with cholecystitis, may cause pain?

Accepted Answer

A diet limited in fat is used when a patient has cholecystitis because fat intake stimulates the contraction of the gallbladder.When this occurs, the patient experiences pain.Presence of fat in the bowel stimulates release of cholecystokinin, which triggers the release of bile acids from the gallbladder.

Question 16

Which is the most common hepatitis virus that is primarily transmitted by blood and body fluids?

Accepted Answer

Hepatitis B and C are transmitted via blood, blood products, semen, and saliva.Hepatitis D also may be transported by blood and body fluids; however, it is rare in the United States and depends on hepatitis B virus for survival and propagation in humans.Hepatitis A and E are the infectious forms that are transmitted by the fecal-oral route.

Question 17

Which of the following recommendations should be included in the nutrition care plan for a patient in the acute post liver transplant phase?

Accepted Answer

In the acute posttransplant phase, nutrient needs are increased to promote healing, deter infection, provide energy for recovery, and replenish depleted body stores.Nitrogen requirements are elevated.

Question 18

Which of the following is used in the medical treatment of ascites?

Accepted Answer

Paracentesis is a procedure used to treat ascites that involves removing fluid from the abdominal cavity with a needle.Radiologic or surgical placement of a shunt may be used to treat esophageal varices.The Whipple procedure is a surgical pancreaticoduodenectomy performed in the treatment of pancreatic cancer.Shock-wave lithotripsy is a method of breaking apart gallstones through use of sonic waves.

Question 19

In liver disease, which factor(s) affect the interpretation of serum albumin values?

Accepted Answer

Liver disease affects albumin in several ways.Primarily, as the liver produces albumin, liver disease causes a decrease in its production.As liver disease progresses to cirrhosis, alterations in the structure of the liver affect blood flow to the liver.This leads to portal hypertension.A consequence of both the increased blood pressure and the decreased albumin production is a forcing of fluid into the interstitial and third spaces.The reduced fluid in the blood may falsely concentrate the serum albumin level.

Question 20

Which of the following parameters is included in Subjective Global Assessment?

Accepted Answer

Subjective Global Assessment is reliable and valid technique for assessing a patient's nutritional status without relying on biochemical measures or tests.The patient completes a short history regarding changes in weight, appetite, taste, intake, and gastrointestinal problems.A medical practitioner evaluates the patient physically for muscle wasting, fat stores, and the presence of edema or ascites.Then with knowledge of the patient's medical condition, a nutritional rating is assigned to the patient regarding whether the patient is well nourished, moderately malnourished, or severely malnourished.

Quiz 30: Medical Nutrition Therapy for Liver, Biliary System, and Exocrine Pancreas Disorders