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

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Question
When ascites is present, which nutrition modification is typically used?

A)fluid restriction
B)low sodium
C)low protein
D)high vitamin K
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Question
Nonalcoholic fatty liver disease is mostly related to which of the following conditions?

A)obesity
B)diabetes
C)consumption of polyunsaturated fatty acids
D)anorexia
Question
When glucose levels fall, the liver also produces additional glucose through the conversion of amino acids to glucose, which is called _____

A)ketosis
B)gluconeogenesis
C)glycogenolysis
D)glycogenesis
Question
The _____ store(s) bile that is produced in the liver

A)pancreas
B)gallbladder
C)kidneys
D)spleen
Question
Which of the following values is typically elevated among patients with fatty liver?

A)serum albumin
B)red blood cell count
C)blood sugar levels
D)serum transaminases
Question
Hemolytic jaundice in characterized by a(n):

A)increased destruction of albumin with the accumulation of bilirubin.
B)decreased destruction of albumin with the accumulation of bilirubin.
C)increased destruction of RBCs with the accumulation of bilirubin.
D)decreased destruction of RBCs with the accumulation of bilirubin.
Question
Bile salts aid the absorption of fatty acids by forming _____, which are soluble in the chyme

A)micelles
B)chylomicrons
C)soaps
D)acids
Question
The liver is responsible for the conversion of _____ to urea

A)ammonia
B)glucose
C)amino acids
D)fatty acids
Question
What treatment can we use for both HBV and HCV?

A)steroids
B)immunosuppressants
C)interferon
D)neomycin
Question
Delta cells of the pancreas are responsible for secreting:

A)somatostatin.
B)glucagon.
C)insulin.
D)amylase.
Question
Which type of hepatitis is usually transmitted by the fecal-oral route?

A)HAV
B)HBV
C)HCV
D)HEV
Question
In end stages of liver disease, hepatic encephalopathy occurs Which of the following is not among the symptoms associated with this condition?

A)congestive heart failure
B)asterixis
C)confusion
D)coma
Question
The most common clinical manifestations of hepatitis include all of the following except:

A)jaundice.
B)hepatomegaly.
C)elevated blood glucose levels.
D)elevated bilirubin levels.
Question
Which of the following is not one of the four major hypotheses for the etiology of hepatic encephalopathy?

A)the ammonia hypothesis
B)the synergistic neurotoxin hypothesis
C)the false neurotransmitter hypothesis
D)the viral hypothesis
Question
Which of the following symptoms would not typically be experienced by the individual with hepatitis?

A)anorexia
B)nausea and vomiting
C)light-colored urine
D)jaundice
Question
The leading cause of liver transplantation is:

A)hepatitis A.
B)hepatitis B.
C)hepatitis C.
D)hepatitis D.
Question
When serum NH3 is high, which of the following medications is used to assist in lowering the level?

A)neomycin
B)lactulose
C)anti-NH3 metabolite
D)vitamin K
Question
Jaundice is usually caused by which of the following?

A)high levels of albumin
B)low levels of albumin
C)high levels of bilirubin
D)low levels of bilirubin
Question
Hepatitis A, the most common form of hepatitis, is generally transmitted via:

A)the oral/fecal route.
B)blood.
C)parenteral nutrition.
D)excessive ETOH intake.
Question
_____ is a syndrome of impaired mental status and abnormal neuromuscular function resulting from major failure of liver function

A)Hepatic stenosis
B)Hepatic encephalopathy
C)Fulminant hepatic failure
D)Hepatomegaly
Question
In the liver, ethanol is metabolized to _____ that is then converted to _____

A)acetate, alcohol
B)acetaldehyde, acetate
C)alcohol, acetaldehyde
D)acetaldehyde, alcohol
Question
The most common sign of folate deficiency is:

A)microcytic anemia.
B)megaloblastic anemia.
C)pernicious anemia.
D)hemolytic anemia.
Question
Theoretically, it is thought that certain types of amino acids are better utilized in hepatic encephalopathy Which amino acids are recommended to be avoided when the client is potentially encephalopathic?

A)sulfur-containing amino acids
B)aromatic amino acids
C)branched-chain amino acids
Question
All of the following are pathways in the liver that metabolize alcohol except _____

A)the ADH pathway in the cytosol
B)the MEOS pathway in the endoplasmic reticulum
C)catalase in peroxisomes
D)lysosome activity in the cytosol
Question
Cholelithiasis is:

A)an infection of the gallbladder.
B)a complication that occurs when the sphincter of Oddi fails to open properly.
C)the formation of gallstones.
Question
In the absence of encephalopathy, what daily protein range is appropriate in liver failure?

A)0.8-1 g/kg of dry body weight
B)1.0-1.2 g/kg of dry body weight
C)1.2-1.5 g/kg of dry body weight
D)2 g/kg of dry body weight
Question
The liver stores carbohydrate as _____ The symptom of _____ commonly occurs in liver disorders because of the limited storage of this nutrient

A)glycogen, hyperglycemia
B)glycogen, hypoglycemia
C)triglycerides, ketosis
D)triglycerides, ascites
Question
When someone experiences acute cholangitis, nutrition therapy should include:

A)a low-fat diet.
B)small, frequent meals.
C)a diet high in soluble fiber.
D)an NPO order.
Question
Wernicke-Korsakoff syndrome is associated with excessive alcohol intake and a deficiency of which of the following vitamins?

A)thiamin
B)vitamin B12
C)folate
D)vitamin B6
Question
An appropriate recommendation for a patient with chronic cholecystitis is to:

A)consume a liberal diet.
B)decrease fat intake.
C)lower sodium intake.
D)decrease protein intake.
Question
When the biliary tract is obstructed, the bile flow is interrupted What symptoms result?

A)jaundice and bloody stools
B)pale stools and jaundice
C)bloody stools and ascites
D)ascites and pale stools
Question
Major complications that are associated with cirrhosis include all of the following except:

A)portal HTN.
B)ascites.
C)hepatic encephalopathy.
D)hepatic stenosis.
Question
The alcoholic is at risk for malnutrition because of all of the following except:

A)impaired digestion and absorption.
B)replacement of food by alcohol.
C)altered metabolism of some nutrients.
D)decreased excretion of some vitamins.
Question
Alcohol increases the excretion of which of the following vitamins?

A)vitamin K
B)vitamin B12
C)vitamin B6
D)vitamin C
Question
A chronic liver disease in which healthy tissue is replaced by scar tissue is known as which of the following?

A)steatosis
B)cirrhosis
C)encephalopathy
D)hepatomegaly
Question
Cystic fibrosis is an inherited disorder of epithelial transport and is one of the most common lethal inherited disorders of which ethnic group?

A)Caucasians
B)African-Americans
C)Hispanics
D)Native-Americans
Question
The overall 5-year patient survival rate for a liver transplant is _____

A)86%
B)55%
C)73%
D)29%
Question
Your patient has ascites due to cirrhosis The treatment consists of all of the following except:

A)restricting the daily sodium intake to less than 2 g/day.
B)adequate kcal to meet energy requirements.
C)diuretics.
D)decreasing intake of protein.
Question
Gallstones are made of

A)protein, bilirubin, and calcium salts.
B)triglycerides, bilirubin, and calcium salts.
C)cholesterol, bilirubin, and calcium salts.
Question
What is the recommended daily protein intake for patients with alcohol dependency?

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
Question
In a hospital that follows the traditional practice, the initial diet order for someone with acute pancreatitis is most likely to be

A)low fat.
B)clear liquids.
C)NPO.
D)high fiber.
Question
What medication is given with meals to assist with malabsorption?

A)insulin
B)glucagon
C)pancreatic enzymes
D)medium-chain triglycerides
Question
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
What will the registered dietitian recommend for JB's ascites?

A)high-fiber foods
B)high-fat foods
C)fluid and sodium restrictions
D)fluid restriction only
Question
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
The registered dietitian can attempt to introduce an oral diet when what changes in SB's case?

A)patient verbalizes desire to eat
B)there is no more fat in the stool
C)albumin normalizes
D)amylase and lipase normalize
Question
Which of the following is typically elevated as a result of pancreatitis?

A)weight
B)serum amylase and lipase
C)serum ammonia
D)urine output
Question
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
What would be the best way to feed her?

A)gastrostomy
B)jejunostromy
C)nasogastric
D)PN
Question
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
SB has now progressed to chronic pancreatitis and is malabsorbing fat The registered dietitian has decided to initiate PN In his/her calculations for the PN prescription, how much fat should the dietitian recommend?

A)15-30% of kcal
B)30-40% of kcal
C)70-80 grams/day
D)110 grams/day
Question
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
In addition to the above, what nutrient supplement will the RD prescribe for SB now that she has chronic pancreatitis?

A)calcium
B)iron
C)vitamin C
D)vitamin B12
Question
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
How will the registered dietitian determine JB's caloric needs?

A)20-25 kcal/kg IBW
B)25-30 kcal/kg UBW
C)30-35 kcal/kg current body weight
D)35-40 kcal/kg current body weight
Question
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
The registered dietitian has performed a complete nutrition assessment Which of the following nutrition assessment parameters is going to be invalid due to JB's condition?

A)AST/ALT
B)weight
C)patient intake history
D)triglycerides
Question
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
Following the paracentesis, the registered dietitian might add additional _____ to his/her nutrition prescription

A)vitamins
B)fluids
C)protein
D)minerals
Question
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
Due to JB's history, the registered dietitian might be concerned with status of all of the following except:

A)thiamin.
B)vitamin E.
C)vitamin C.
D)folic acid.
Question
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
SB is not tolerating gastric feeds What will the registered dietitian now attempt?

A)nasojejunal EN
B)PN
C)NPO
D)nasogastric feedings with motility agent
Question
Traditionally, we have made the patient with pancreatitis NPO in order to minimize the stimulation to the pancreas Recent research indicates that enteral feeding during pancreatitis may be beneficial Why?

A)promote negative nitrogen balance
B)reduce complications and infections
C)decrease release of pancreatic enzymes
D)all of the above
Question
The primary cause of chronic pancreatitis in US adults is

A)diabetes.
B)cystic fibrosis.
C)alcohol ingestion.
D)smoking.
Question
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
What type of formula would you choose in order to minimally stimulate the pancreas?

A)MCT oil
B)fat-free elemental
C)intact
D)high-protein
Question
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
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)>2.0 g/kg
Question
Pancreatitis is characterized by all of the following except _____

A)edema
B)fat necrosis
C)hypertension
D)fat necrosis
Question
Match between columns
paracentesis
phenylalanine, tyrosine, and tryptophan
paracentesis
leucine, isoleucine, and valine
paracentesis
liver cirrhosis in which there is interference with intrahepatic bile flow
paracentesis
surgical removal of the gallbladder
paracentesis
inflammation of the gallbladder
paracentesis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
paracentesis
the presence or formation of gallstones
paracentesis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
paracentesis
a syndrome characterized by central nervous system dysfunction in association with liver failure
paracentesis
inflammation of the pancreas
paracentesis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
AAA
phenylalanine, tyrosine, and tryptophan
AAA
leucine, isoleucine, and valine
AAA
liver cirrhosis in which there is interference with intrahepatic bile flow
AAA
surgical removal of the gallbladder
AAA
inflammation of the gallbladder
AAA
gallstones that are present in the common bile duct but are usually formed in the gallbladder
AAA
the presence or formation of gallstones
AAA
the severe impairment of hepatic functions in the absence of pre-existing liver disease
AAA
a syndrome characterized by central nervous system dysfunction in association with liver failure
AAA
inflammation of the pancreas
AAA
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
choledocholithiasis
phenylalanine, tyrosine, and tryptophan
choledocholithiasis
leucine, isoleucine, and valine
choledocholithiasis
liver cirrhosis in which there is interference with intrahepatic bile flow
choledocholithiasis
surgical removal of the gallbladder
choledocholithiasis
inflammation of the gallbladder
choledocholithiasis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
choledocholithiasis
the presence or formation of gallstones
choledocholithiasis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
choledocholithiasis
a syndrome characterized by central nervous system dysfunction in association with liver failure
choledocholithiasis
inflammation of the pancreas
choledocholithiasis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
cholelithiasis
phenylalanine, tyrosine, and tryptophan
cholelithiasis
leucine, isoleucine, and valine
cholelithiasis
liver cirrhosis in which there is interference with intrahepatic bile flow
cholelithiasis
surgical removal of the gallbladder
cholelithiasis
inflammation of the gallbladder
cholelithiasis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
cholelithiasis
the presence or formation of gallstones
cholelithiasis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
cholelithiasis
a syndrome characterized by central nervous system dysfunction in association with liver failure
cholelithiasis
inflammation of the pancreas
cholelithiasis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
fulminant hepatic failure
phenylalanine, tyrosine, and tryptophan
fulminant hepatic failure
leucine, isoleucine, and valine
fulminant hepatic failure
liver cirrhosis in which there is interference with intrahepatic bile flow
fulminant hepatic failure
surgical removal of the gallbladder
fulminant hepatic failure
inflammation of the gallbladder
fulminant hepatic failure
gallstones that are present in the common bile duct but are usually formed in the gallbladder
fulminant hepatic failure
the presence or formation of gallstones
fulminant hepatic failure
the severe impairment of hepatic functions in the absence of pre-existing liver disease
fulminant hepatic failure
a syndrome characterized by central nervous system dysfunction in association with liver failure
fulminant hepatic failure
inflammation of the pancreas
fulminant hepatic failure
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
BCAA
phenylalanine, tyrosine, and tryptophan
BCAA
leucine, isoleucine, and valine
BCAA
liver cirrhosis in which there is interference with intrahepatic bile flow
BCAA
surgical removal of the gallbladder
BCAA
inflammation of the gallbladder
BCAA
gallstones that are present in the common bile duct but are usually formed in the gallbladder
BCAA
the presence or formation of gallstones
BCAA
the severe impairment of hepatic functions in the absence of pre-existing liver disease
BCAA
a syndrome characterized by central nervous system dysfunction in association with liver failure
BCAA
inflammation of the pancreas
BCAA
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
cholecystitis
phenylalanine, tyrosine, and tryptophan
cholecystitis
leucine, isoleucine, and valine
cholecystitis
liver cirrhosis in which there is interference with intrahepatic bile flow
cholecystitis
surgical removal of the gallbladder
cholecystitis
inflammation of the gallbladder
cholecystitis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
cholecystitis
the presence or formation of gallstones
cholecystitis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
cholecystitis
a syndrome characterized by central nervous system dysfunction in association with liver failure
cholecystitis
inflammation of the pancreas
cholecystitis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
pancreatitis
phenylalanine, tyrosine, and tryptophan
pancreatitis
leucine, isoleucine, and valine
pancreatitis
liver cirrhosis in which there is interference with intrahepatic bile flow
pancreatitis
surgical removal of the gallbladder
pancreatitis
inflammation of the gallbladder
pancreatitis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
pancreatitis
the presence or formation of gallstones
pancreatitis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
pancreatitis
a syndrome characterized by central nervous system dysfunction in association with liver failure
pancreatitis
inflammation of the pancreas
pancreatitis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
hepatic encephalopathy
phenylalanine, tyrosine, and tryptophan
hepatic encephalopathy
leucine, isoleucine, and valine
hepatic encephalopathy
liver cirrhosis in which there is interference with intrahepatic bile flow
hepatic encephalopathy
surgical removal of the gallbladder
hepatic encephalopathy
inflammation of the gallbladder
hepatic encephalopathy
gallstones that are present in the common bile duct but are usually formed in the gallbladder
hepatic encephalopathy
the presence or formation of gallstones
hepatic encephalopathy
the severe impairment of hepatic functions in the absence of pre-existing liver disease
hepatic encephalopathy
a syndrome characterized by central nervous system dysfunction in association with liver failure
hepatic encephalopathy
inflammation of the pancreas
hepatic encephalopathy
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
cholecystectomy
phenylalanine, tyrosine, and tryptophan
cholecystectomy
leucine, isoleucine, and valine
cholecystectomy
liver cirrhosis in which there is interference with intrahepatic bile flow
cholecystectomy
surgical removal of the gallbladder
cholecystectomy
inflammation of the gallbladder
cholecystectomy
gallstones that are present in the common bile duct but are usually formed in the gallbladder
cholecystectomy
the presence or formation of gallstones
cholecystectomy
the severe impairment of hepatic functions in the absence of pre-existing liver disease
cholecystectomy
a syndrome characterized by central nervous system dysfunction in association with liver failure
cholecystectomy
inflammation of the pancreas
cholecystectomy
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
biliary cirrhosis
phenylalanine, tyrosine, and tryptophan
biliary cirrhosis
leucine, isoleucine, and valine
biliary cirrhosis
liver cirrhosis in which there is interference with intrahepatic bile flow
biliary cirrhosis
surgical removal of the gallbladder
biliary cirrhosis
inflammation of the gallbladder
biliary cirrhosis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
biliary cirrhosis
the presence or formation of gallstones
biliary cirrhosis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
biliary cirrhosis
a syndrome characterized by central nervous system dysfunction in association with liver failure
biliary cirrhosis
inflammation of the pancreas
biliary cirrhosis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
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Deck 16: Diseases of the Liver, Gallbladder, and Exocrine Pancreas
1
When ascites is present, which nutrition modification is typically used?

A)fluid restriction
B)low sodium
C)low protein
D)high vitamin K
B
2
Nonalcoholic fatty liver disease is mostly related to which of the following conditions?

A)obesity
B)diabetes
C)consumption of polyunsaturated fatty acids
D)anorexia
A
3
When glucose levels fall, the liver also produces additional glucose through the conversion of amino acids to glucose, which is called _____

A)ketosis
B)gluconeogenesis
C)glycogenolysis
D)glycogenesis
B
4
The _____ store(s) bile that is produced in the liver

A)pancreas
B)gallbladder
C)kidneys
D)spleen
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5
Which of the following values is typically elevated among patients with fatty liver?

A)serum albumin
B)red blood cell count
C)blood sugar levels
D)serum transaminases
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6
Hemolytic jaundice in characterized by a(n):

A)increased destruction of albumin with the accumulation of bilirubin.
B)decreased destruction of albumin with the accumulation of bilirubin.
C)increased destruction of RBCs with the accumulation of bilirubin.
D)decreased destruction of RBCs with the accumulation of bilirubin.
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7
Bile salts aid the absorption of fatty acids by forming _____, which are soluble in the chyme

A)micelles
B)chylomicrons
C)soaps
D)acids
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8
The liver is responsible for the conversion of _____ to urea

A)ammonia
B)glucose
C)amino acids
D)fatty acids
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9
What treatment can we use for both HBV and HCV?

A)steroids
B)immunosuppressants
C)interferon
D)neomycin
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10
Delta cells of the pancreas are responsible for secreting:

A)somatostatin.
B)glucagon.
C)insulin.
D)amylase.
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11
Which type of hepatitis is usually transmitted by the fecal-oral route?

A)HAV
B)HBV
C)HCV
D)HEV
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12
In end stages of liver disease, hepatic encephalopathy occurs Which of the following is not among the symptoms associated with this condition?

A)congestive heart failure
B)asterixis
C)confusion
D)coma
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13
The most common clinical manifestations of hepatitis include all of the following except:

A)jaundice.
B)hepatomegaly.
C)elevated blood glucose levels.
D)elevated bilirubin levels.
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14
Which of the following is not one of the four major hypotheses for the etiology of hepatic encephalopathy?

A)the ammonia hypothesis
B)the synergistic neurotoxin hypothesis
C)the false neurotransmitter hypothesis
D)the viral hypothesis
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15
Which of the following symptoms would not typically be experienced by the individual with hepatitis?

A)anorexia
B)nausea and vomiting
C)light-colored urine
D)jaundice
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16
The leading cause of liver transplantation is:

A)hepatitis A.
B)hepatitis B.
C)hepatitis C.
D)hepatitis D.
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17
When serum NH3 is high, which of the following medications is used to assist in lowering the level?

A)neomycin
B)lactulose
C)anti-NH3 metabolite
D)vitamin K
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18
Jaundice is usually caused by which of the following?

A)high levels of albumin
B)low levels of albumin
C)high levels of bilirubin
D)low levels of bilirubin
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19
Hepatitis A, the most common form of hepatitis, is generally transmitted via:

A)the oral/fecal route.
B)blood.
C)parenteral nutrition.
D)excessive ETOH intake.
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20
_____ is a syndrome of impaired mental status and abnormal neuromuscular function resulting from major failure of liver function

A)Hepatic stenosis
B)Hepatic encephalopathy
C)Fulminant hepatic failure
D)Hepatomegaly
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21
In the liver, ethanol is metabolized to _____ that is then converted to _____

A)acetate, alcohol
B)acetaldehyde, acetate
C)alcohol, acetaldehyde
D)acetaldehyde, alcohol
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22
The most common sign of folate deficiency is:

A)microcytic anemia.
B)megaloblastic anemia.
C)pernicious anemia.
D)hemolytic anemia.
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23
Theoretically, it is thought that certain types of amino acids are better utilized in hepatic encephalopathy Which amino acids are recommended to be avoided when the client is potentially encephalopathic?

A)sulfur-containing amino acids
B)aromatic amino acids
C)branched-chain amino acids
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24
All of the following are pathways in the liver that metabolize alcohol except _____

A)the ADH pathway in the cytosol
B)the MEOS pathway in the endoplasmic reticulum
C)catalase in peroxisomes
D)lysosome activity in the cytosol
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25
Cholelithiasis is:

A)an infection of the gallbladder.
B)a complication that occurs when the sphincter of Oddi fails to open properly.
C)the formation of gallstones.
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26
In the absence of encephalopathy, what daily protein range is appropriate in liver failure?

A)0.8-1 g/kg of dry body weight
B)1.0-1.2 g/kg of dry body weight
C)1.2-1.5 g/kg of dry body weight
D)2 g/kg of dry body weight
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27
The liver stores carbohydrate as _____ The symptom of _____ commonly occurs in liver disorders because of the limited storage of this nutrient

A)glycogen, hyperglycemia
B)glycogen, hypoglycemia
C)triglycerides, ketosis
D)triglycerides, ascites
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28
When someone experiences acute cholangitis, nutrition therapy should include:

A)a low-fat diet.
B)small, frequent meals.
C)a diet high in soluble fiber.
D)an NPO order.
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29
Wernicke-Korsakoff syndrome is associated with excessive alcohol intake and a deficiency of which of the following vitamins?

A)thiamin
B)vitamin B12
C)folate
D)vitamin B6
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30
An appropriate recommendation for a patient with chronic cholecystitis is to:

A)consume a liberal diet.
B)decrease fat intake.
C)lower sodium intake.
D)decrease protein intake.
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31
When the biliary tract is obstructed, the bile flow is interrupted What symptoms result?

A)jaundice and bloody stools
B)pale stools and jaundice
C)bloody stools and ascites
D)ascites and pale stools
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32
Major complications that are associated with cirrhosis include all of the following except:

A)portal HTN.
B)ascites.
C)hepatic encephalopathy.
D)hepatic stenosis.
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33
The alcoholic is at risk for malnutrition because of all of the following except:

A)impaired digestion and absorption.
B)replacement of food by alcohol.
C)altered metabolism of some nutrients.
D)decreased excretion of some vitamins.
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34
Alcohol increases the excretion of which of the following vitamins?

A)vitamin K
B)vitamin B12
C)vitamin B6
D)vitamin C
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35
A chronic liver disease in which healthy tissue is replaced by scar tissue is known as which of the following?

A)steatosis
B)cirrhosis
C)encephalopathy
D)hepatomegaly
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36
Cystic fibrosis is an inherited disorder of epithelial transport and is one of the most common lethal inherited disorders of which ethnic group?

A)Caucasians
B)African-Americans
C)Hispanics
D)Native-Americans
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37
The overall 5-year patient survival rate for a liver transplant is _____

A)86%
B)55%
C)73%
D)29%
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38
Your patient has ascites due to cirrhosis The treatment consists of all of the following except:

A)restricting the daily sodium intake to less than 2 g/day.
B)adequate kcal to meet energy requirements.
C)diuretics.
D)decreasing intake of protein.
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39
Gallstones are made of

A)protein, bilirubin, and calcium salts.
B)triglycerides, bilirubin, and calcium salts.
C)cholesterol, bilirubin, and calcium salts.
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40
What is the recommended daily protein intake for patients with alcohol dependency?

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
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41
In a hospital that follows the traditional practice, the initial diet order for someone with acute pancreatitis is most likely to be

A)low fat.
B)clear liquids.
C)NPO.
D)high fiber.
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42
What medication is given with meals to assist with malabsorption?

A)insulin
B)glucagon
C)pancreatic enzymes
D)medium-chain triglycerides
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43
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
What will the registered dietitian recommend for JB's ascites?

A)high-fiber foods
B)high-fat foods
C)fluid and sodium restrictions
D)fluid restriction only
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44
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
The registered dietitian can attempt to introduce an oral diet when what changes in SB's case?

A)patient verbalizes desire to eat
B)there is no more fat in the stool
C)albumin normalizes
D)amylase and lipase normalize
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45
Which of the following is typically elevated as a result of pancreatitis?

A)weight
B)serum amylase and lipase
C)serum ammonia
D)urine output
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46
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
What would be the best way to feed her?

A)gastrostomy
B)jejunostromy
C)nasogastric
D)PN
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47
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
SB has now progressed to chronic pancreatitis and is malabsorbing fat The registered dietitian has decided to initiate PN In his/her calculations for the PN prescription, how much fat should the dietitian recommend?

A)15-30% of kcal
B)30-40% of kcal
C)70-80 grams/day
D)110 grams/day
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48
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
In addition to the above, what nutrient supplement will the RD prescribe for SB now that she has chronic pancreatitis?

A)calcium
B)iron
C)vitamin C
D)vitamin B12
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49
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
How will the registered dietitian determine JB's caloric needs?

A)20-25 kcal/kg IBW
B)25-30 kcal/kg UBW
C)30-35 kcal/kg current body weight
D)35-40 kcal/kg current body weight
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50
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
The registered dietitian has performed a complete nutrition assessment Which of the following nutrition assessment parameters is going to be invalid due to JB's condition?

A)AST/ALT
B)weight
C)patient intake history
D)triglycerides
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51
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
Following the paracentesis, the registered dietitian might add additional _____ to his/her nutrition prescription

A)vitamins
B)fluids
C)protein
D)minerals
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52
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
Due to JB's history, the registered dietitian might be concerned with status of all of the following except:

A)thiamin.
B)vitamin E.
C)vitamin C.
D)folic acid.
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53
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
SB is not tolerating gastric feeds What will the registered dietitian now attempt?

A)nasojejunal EN
B)PN
C)NPO
D)nasogastric feedings with motility agent
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54
Traditionally, we have made the patient with pancreatitis NPO in order to minimize the stimulation to the pancreas Recent research indicates that enteral feeding during pancreatitis may be beneficial Why?

A)promote negative nitrogen balance
B)reduce complications and infections
C)decrease release of pancreatic enzymes
D)all of the above
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55
The primary cause of chronic pancreatitis in US adults is

A)diabetes.
B)cystic fibrosis.
C)alcohol ingestion.
D)smoking.
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56
SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:
Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%
Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3
TG: 387 mg/dL
Meds: Demerol
Diet: NPO
What type of formula would you choose in order to minimally stimulate the pancreas?

A)MCT oil
B)fat-free elemental
C)intact
D)high-protein
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57
Case Study Multiple Choice
JB is a 53 yo male who was recently divorced.He has experienced periods of depression and decreased appetite.Family reports history of heavy drinking habits and 15# weight lost.He was previously diagnosed with cirrhosis and portal hypertension and paracentesis and TIPS procedures were performed.Mr.JB's condition seems to have worsened; he c/o stomach pains, nausea, and vomiting at times.His abdomen is sore to touch and feels swollen.Mr.JB has developed ascites and pedal edema; his urinary output has decreased and he continues to lose weight.Mr.JB also c/o pain when swallowing food.Because of JB's persistent symptoms, he's been admitted to the hospital.
A referral to the SLP for a MBS was also ordered and resulted in dysphagia, pureed diet recommended.By day 2 Mr.JB still c/o of nausea and no po intake has been reported.The MD rx'd dietary consult: RD to assess patient and recommend alternate means of nutrition support, currently NPO.
Ht: 5'11'' Wt: 145# UBW: 163#
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension
Labs:
Na: 134 Cl: 101 BUN: 4 Alb: 2.3 TG: 305 Transferrin: 101 NH4: 53
Glu: 139 AST: 45 ALT 48 Alk Phos: 40 Billirubin: 2.1
K: 5.2 CO₂: 25 Cr: 1.8 H/H: 11/35
Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan
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)>2.0 g/kg
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58
Pancreatitis is characterized by all of the following except _____

A)edema
B)fat necrosis
C)hypertension
D)fat necrosis
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59
Match between columns
paracentesis
phenylalanine, tyrosine, and tryptophan
paracentesis
leucine, isoleucine, and valine
paracentesis
liver cirrhosis in which there is interference with intrahepatic bile flow
paracentesis
surgical removal of the gallbladder
paracentesis
inflammation of the gallbladder
paracentesis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
paracentesis
the presence or formation of gallstones
paracentesis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
paracentesis
a syndrome characterized by central nervous system dysfunction in association with liver failure
paracentesis
inflammation of the pancreas
paracentesis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
AAA
phenylalanine, tyrosine, and tryptophan
AAA
leucine, isoleucine, and valine
AAA
liver cirrhosis in which there is interference with intrahepatic bile flow
AAA
surgical removal of the gallbladder
AAA
inflammation of the gallbladder
AAA
gallstones that are present in the common bile duct but are usually formed in the gallbladder
AAA
the presence or formation of gallstones
AAA
the severe impairment of hepatic functions in the absence of pre-existing liver disease
AAA
a syndrome characterized by central nervous system dysfunction in association with liver failure
AAA
inflammation of the pancreas
AAA
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
choledocholithiasis
phenylalanine, tyrosine, and tryptophan
choledocholithiasis
leucine, isoleucine, and valine
choledocholithiasis
liver cirrhosis in which there is interference with intrahepatic bile flow
choledocholithiasis
surgical removal of the gallbladder
choledocholithiasis
inflammation of the gallbladder
choledocholithiasis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
choledocholithiasis
the presence or formation of gallstones
choledocholithiasis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
choledocholithiasis
a syndrome characterized by central nervous system dysfunction in association with liver failure
choledocholithiasis
inflammation of the pancreas
choledocholithiasis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
cholelithiasis
phenylalanine, tyrosine, and tryptophan
cholelithiasis
leucine, isoleucine, and valine
cholelithiasis
liver cirrhosis in which there is interference with intrahepatic bile flow
cholelithiasis
surgical removal of the gallbladder
cholelithiasis
inflammation of the gallbladder
cholelithiasis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
cholelithiasis
the presence or formation of gallstones
cholelithiasis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
cholelithiasis
a syndrome characterized by central nervous system dysfunction in association with liver failure
cholelithiasis
inflammation of the pancreas
cholelithiasis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
fulminant hepatic failure
phenylalanine, tyrosine, and tryptophan
fulminant hepatic failure
leucine, isoleucine, and valine
fulminant hepatic failure
liver cirrhosis in which there is interference with intrahepatic bile flow
fulminant hepatic failure
surgical removal of the gallbladder
fulminant hepatic failure
inflammation of the gallbladder
fulminant hepatic failure
gallstones that are present in the common bile duct but are usually formed in the gallbladder
fulminant hepatic failure
the presence or formation of gallstones
fulminant hepatic failure
the severe impairment of hepatic functions in the absence of pre-existing liver disease
fulminant hepatic failure
a syndrome characterized by central nervous system dysfunction in association with liver failure
fulminant hepatic failure
inflammation of the pancreas
fulminant hepatic failure
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
BCAA
phenylalanine, tyrosine, and tryptophan
BCAA
leucine, isoleucine, and valine
BCAA
liver cirrhosis in which there is interference with intrahepatic bile flow
BCAA
surgical removal of the gallbladder
BCAA
inflammation of the gallbladder
BCAA
gallstones that are present in the common bile duct but are usually formed in the gallbladder
BCAA
the presence or formation of gallstones
BCAA
the severe impairment of hepatic functions in the absence of pre-existing liver disease
BCAA
a syndrome characterized by central nervous system dysfunction in association with liver failure
BCAA
inflammation of the pancreas
BCAA
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
cholecystitis
phenylalanine, tyrosine, and tryptophan
cholecystitis
leucine, isoleucine, and valine
cholecystitis
liver cirrhosis in which there is interference with intrahepatic bile flow
cholecystitis
surgical removal of the gallbladder
cholecystitis
inflammation of the gallbladder
cholecystitis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
cholecystitis
the presence or formation of gallstones
cholecystitis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
cholecystitis
a syndrome characterized by central nervous system dysfunction in association with liver failure
cholecystitis
inflammation of the pancreas
cholecystitis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
pancreatitis
phenylalanine, tyrosine, and tryptophan
pancreatitis
leucine, isoleucine, and valine
pancreatitis
liver cirrhosis in which there is interference with intrahepatic bile flow
pancreatitis
surgical removal of the gallbladder
pancreatitis
inflammation of the gallbladder
pancreatitis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
pancreatitis
the presence or formation of gallstones
pancreatitis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
pancreatitis
a syndrome characterized by central nervous system dysfunction in association with liver failure
pancreatitis
inflammation of the pancreas
pancreatitis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
hepatic encephalopathy
phenylalanine, tyrosine, and tryptophan
hepatic encephalopathy
leucine, isoleucine, and valine
hepatic encephalopathy
liver cirrhosis in which there is interference with intrahepatic bile flow
hepatic encephalopathy
surgical removal of the gallbladder
hepatic encephalopathy
inflammation of the gallbladder
hepatic encephalopathy
gallstones that are present in the common bile duct but are usually formed in the gallbladder
hepatic encephalopathy
the presence or formation of gallstones
hepatic encephalopathy
the severe impairment of hepatic functions in the absence of pre-existing liver disease
hepatic encephalopathy
a syndrome characterized by central nervous system dysfunction in association with liver failure
hepatic encephalopathy
inflammation of the pancreas
hepatic encephalopathy
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
cholecystectomy
phenylalanine, tyrosine, and tryptophan
cholecystectomy
leucine, isoleucine, and valine
cholecystectomy
liver cirrhosis in which there is interference with intrahepatic bile flow
cholecystectomy
surgical removal of the gallbladder
cholecystectomy
inflammation of the gallbladder
cholecystectomy
gallstones that are present in the common bile duct but are usually formed in the gallbladder
cholecystectomy
the presence or formation of gallstones
cholecystectomy
the severe impairment of hepatic functions in the absence of pre-existing liver disease
cholecystectomy
a syndrome characterized by central nervous system dysfunction in association with liver failure
cholecystectomy
inflammation of the pancreas
cholecystectomy
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
biliary cirrhosis
phenylalanine, tyrosine, and tryptophan
biliary cirrhosis
leucine, isoleucine, and valine
biliary cirrhosis
liver cirrhosis in which there is interference with intrahepatic bile flow
biliary cirrhosis
surgical removal of the gallbladder
biliary cirrhosis
inflammation of the gallbladder
biliary cirrhosis
gallstones that are present in the common bile duct but are usually formed in the gallbladder
biliary cirrhosis
the presence or formation of gallstones
biliary cirrhosis
the severe impairment of hepatic functions in the absence of pre-existing liver disease
biliary cirrhosis
a syndrome characterized by central nervous system dysfunction in association with liver failure
biliary cirrhosis
inflammation of the pancreas
biliary cirrhosis
a procedure in which fluid is withdrawn from a body cavity via a trocar and cannula, needle, or other hollow instrument
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