Deck 29: Medical Nutrition Therapy for Hepatobiliary and Pancreatic Disorders

Question 1

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

A) Shunt placement
B) Whipple procedure
C) Paracentesis
D) Shock-wave lithotripsy

Answer 1

C
Explanation: 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 2

Which of the following herbal supplements is popular for treating liver disease?

A) Milk thistle
B) Centella asiatica
C) Ephedra
D) Kava

Answer 2

A
Explanation: 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; there is insufficient evidence to support their use.

Question 3

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

A) sclerosing cholangitis.
B) acute pancreatitis.
C) hepatic encephalopathy.
D) cholecystitis.

Answer 3

C
Explanation: 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 4

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

A) Water-soluble form of fat-soluble vitamins
B) Pancreatic enzyme replacements
C) Antacids
D) Proton pump inhibitors

Question 5

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

A) Fried foods, foods with a high sucrose content, and caffeine
B) Carbohydrates, low-fat dairy products, and coffee
C) Large meals, fatty foods, and alcohol
D) Red meat, sweets, and coffee

Question 6

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

A) Dried beans, dried fruits, and shellfish
B) Eggs, milk, and cheese
C) Sweet potato, rice, and oatmeal
D) Butter, cream, oil, and salad dressing

Question 7

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

A) Calorie restriction
B) Increased sodium
C) Decreased protein
D) Increased protein

Question 8

A deficiency of which nutrient is associated with Wernicke encephalopathy?

A) Copper
B) Essential fatty acid
C) Tryptophan
D) Thiamin

Question 9

How is serum alkaline phosphatase used to diagnose liver disease?

A) It is decreased in cholestasis.
B) It is increased in cholestasis.
C) It indicates prolonged bleeding time.
D) It precedes jaundice.

Question 10

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

A) enteral nutrition is more expensive.
B) enteral nutrition can prevent pseudocysts from developing.
C) failure to use the gastrointestinal tract exacerbates the stress response.
D) it is not the preferred route of nutrition.

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?

A) Azathioprine
B) Cyclosporine
C) Glucocorticoid
D) Tacrolimus

Question 12

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

A) Ascites
B) Cardiac arrhythmias
C) Increased gastrointestinal motility and peristalsis
D) Pulmonary fibrosis

Question 13

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

A) Constipation
B) Hypervitaminosis A
C) Steatorrhea
D) Elevated serum ammonia

Question 14

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

A) High-protein foods
B) High-fat foods
C) Complex carbohydrates
D) Simple carbohydrates

Question 15

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

A) WBC
B) Blood glucose
C) Serum calcium
D) Serum amylase

Question 16

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

A) Cholangitis
B) Cholecystitis
C) Choledocholithiasis
D) Cirrhosis

Question 17

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

A) Serum alkaline phosphatase
B) Direct serum bilirubin
C) Alanine aminotransferase
D) Prothrombin time

Question 18

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

A) Change in weight
B) Nitrogen balance
C) Fluid intake and output
D) Liver enzyme levels

Question 19

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

A) Hepatitis A
B) Hepatitis B
C) Hepatitis D
D) Hepatitis E

Question 20

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

A) Increased synthesis of albumin by the liver
B) Increased synthesis of albumin by the liver and increased nitrogen retention
C) Decreased synthesis of albumin by the liver and increased urinary nitrogen excretion
D) Decreased synthesis of albumin by the liver and the presence of edema and ascites