Deck 20: Nutrition Therapy for Liver and Gallbladder Diseases

Question 1

Many patients with cirrhosis require medication or insulin to control hyperglycemia.​

Answer 1

True

Question 2

Rapid weight loss aids in the recovery from liver disease.​

Answer 2

False

Question 3

Strict dietary sodium restriction is part of the treatment for ascites.​

Answer 3

False

Question 4

When triglycerides accumulate in the liver, the liver _____.

A) ​becomes smaller
B) ​turns into scar tissue
C) ​becomes inflamed
D) ​becomesenlarged
E) ​decreases metabolism

Question 5

The most common cause of chronic liver disease in the U.S. is _____.​

A) ​vitamin B₁₂ deficiency
B) ​alcoholism
C) ​hepatitis C infection
D) ​protein deficiency
E) ​HIV

Question 6

Eating well and taking supplements of protein, vitamins, and minerals protect the body from the harmful effects of alcohol.

Question 7

A patient with cirrhosis may present with no symptoms.​

Question 8

The most appropriate dietary intervention for a malnourished person with cirrhosis is _____.​

A) ​a low-protein diet
B) ​adequate energy and protein
C) ​tube feeding
D) ​fluid and electrolyte replacement
E) ​a high-fiber, high-fat diet

Question 9

In cases unrelated to alcohol, the primary cause of fatty liver is _____.

A) ​high cholesterol
B) ​celiac disease
C) ​malnutrition
D) ​obesity
E) ​insulin resistance

Question 10

Which condition is caused by bilirubin accumulation in the bloodstream?​

A) ​jaundice
B) ​ascites
C) ​hepatic coma
D) mental disturbances​
E) ​cirrhosis

Question 11

Hepatitis patients should avoid _____.​

A) ​fried foods
B) ​high-protein foods
C) ​excessive intakes of sodium
D) ​alcohol
E) ​sexual contact

Question 12

Nutrients are carried from the digestive tract to the liver via small blood vessels called collaterals.

Question 13

The three most important risk factors for gallstones are low body weight, gender, and tobacco use.

Question 14

The most common cause of hepatitis A virus infection is _____.​

A) ​exposure to infected blood
B) ​jaundice
C) ​fecal-oral contamination
D) ​sexual contact
E) ​contaminated food

Question 15

Moderate use of alcohol has been shown to reduce deaths from coronary heart disease in middle-aged and older adults.

Question 16

Hepatomegaly refers to a surgical puncture of a body cavity with an aspirator to draw out excess fluid.

Question 17

Which statement characterizes fatty liver?

A) ​It is a clinical finding common to many conditions.
B) ​It usually results in liver failure.
C) ​It cannot be reversed.
D) ​It is diagnosed by decreased levels of liver enzymes.
E) ​It is another term for cirrhosis.

Question 18

Blood flow is impeded in a cirrhotic liver, causing _____.​

A) ​portal hypertension
B) ​elevated cholesterol levels
C) ​jaundice
D) ​fatty liver
E) ​biliary cirrhosis

Question 19

Which laboratory finding is not associated with fatty liver?​

A) ​elevated HDL
B) ​elevated ALT and AST
C) ​elevated glucose
D) ​elevated triglycerides
E) ​elevated cholesterol

Question 20

People with protein-energy malnutrition may experience fatty liver.

Question 21

Persons using potassium-sparing diuretics should be cautioned about consuming _____.

A) ​salt substitutes
B) ​herbs and spices
C) ​soft drinks
D) ​dairy foods
E) ​licorice

Question 22

Which laboratory test is prolonged in a patient with liver disease?​

A) ​bilirubin clearance
B) ​albumin production
C) ​ammonia secretion
D) ​AST synthesis
E) ​prothrombin time

Question 23

What is ascites?​

A) ​yellowing of the sclera of the eyes, skin, and mucous membranes
B) ​fluid accumulation in the abdomen
C) ​inflammation of the liver
D) ​elevated blood ammonia levels
E) ​caused by elevated blood bilirubin

Question 24

Collaterals are _____.​

A) ​small blood vessels in the intestines
B) ​blood vessels that enlarge in order to allow an alternate path for blood flow
C) ​induced by fatty liver disease
D) ​hemorrhages in the esophagus
E) ​an abnormal growth of blood vessels in response to disease

Question 25

Furosemide is a(n) _____ often used to treat the symptoms of cirrhosis.​

A) ​appetite stimulant
B) ​diuretic
C) ​laxative
D) ​antiviral
E) ​immunosuppressant

Question 26

A patient with cirrhosis who develops changes in personality and motor function may be exhibiting early symptoms of _____.​

A) ​fatigue
B) ​hepatic regression
C) ​hepatitis
D) ​hepatic encephalopathy
E) ​senile dementia

Question 27

Which clinical feature is associated with the later stages of hepatic encephalopathy?​

A) ​muscle tremor
B) ​short attention span
C) ​lethargy
D) ​sleep disturbances
E) ​coma

Question 28

To add energy but not protein to the diet, you would add _____.​

A) ​butter
B) ​milkshakes
C) ​vegetables
D) ​hard-boiled eggs
E) ​chopped nuts

Question 29

To help reduce ammonia production in the colon, patients with cirrhosis may be given a(n) _____.​

A) ​antibiotic
B) ​appetite stimulant
C) ​enema
D) ​diuretic
E) ​antiviral

Question 30

Ascites is exacerbated by _____.​

A) ​low plasma albumin levels
B) ​abdominal pressure
C) ​hyperglycemia
D) ​amino acid imbalances
E) ​increased blood flow through the liver

Question 31

The daily protein intake for a patient with cirrhosis is _____ grams/kg dry body weight.​

A) ​0.5-1.0
B) ​1.0-1.5
C) ​1.5-2.0
D) ​2.0-2.5
E) ​2.5-3.0

Question 32

In liver disease, blood ammonia levels rise because the liver cannot convert the ammonia to _____.

A) ​nitrogen
B) ​amino acids
C) ​urea
D) ​sodium
E) ​cholesterol

Question 33

A patient in the middle stage of hepatic encephalopathy may exhibit _____.​

A) ​confusion
B) ​lethargy
C) ​depression
D) ​short attention span
E) ​amnesia

Question 34

Severe liver damage may lead to _____.​

A) ​reduced levels of aromatic amino acids
B) ​reduced levels of cholesterol
C) ​reduced levels of bilirubin
D) ​elevated levels of albumin
E) ​reduced levels of branched-chain amino acids

Question 35

Cirrhosis is treated by all of these drugs except _____.​

A) ​antibiotics
B) ​appetite stimulants
C) ​immunosuppressants
D) ​diuretics
E) ​antihypertensives

Question 36

Albumin is not always a good indicator of nutrition status in patients with liver disease because _____.

A) ​the damaged liver cannot synthesize adequate plasma proteins
B) ​it is degraded by elevated liver enzymes
C) ​liver disease causes elevated levels of albumin
D) ​ammonia levels affect albumin levels
E) ​albumin is removed by ascites

Question 37

Among patients with liver disease, _____ may be to blame if malnutrition develops.​

A) ​low-sodium diets
B) ​jaundice
C) ​lactulose
D) ​impaired memory
E) ​bilirubin clearance

Question 38

All of these factors contribute to the development of ascites except _____.​

A) ​portal hypertension
B) ​reduced albumin synthesis
C) ​sodium and water retention by the kidneys
D) ​obesity
E) ​liver damage

Question 39

Which condition is not a consequence of cirrhosis?​

A) ​esophageal varices
B) ​portal hypertension
C) ​ascites
D) ​disorientation
E) ​pruritis

Question 40

Patients with cirrhosis require _____ in order to prevent wasting.​

A) ​adequate fluid
B) ​adequate kcalories
C) ​high-fat diets
D) ​six large meals per day
E) ​immunosuppressants

Question 41

A gallstone lodged in the _____ can obstruct bile flow and causes cholecystitis.​

A) ​common bile duct
B) ​pancreatic duct
C) ​duodenum
D) ​common hepatic duct
E) ​cystic duct

Question 42

In the future, Mr. Jamison may face all of these complications except _____.

A) ​ascites
B) ​portal hypertension
C) ​gastroesophageal varices
D) ​kidney cancer
E) ​jaundice

Question 43

If the patient with cirrhosis develops fat malabsorption and requires extra kcalories, these should be provided by _____.​

A) ​carbohydrates
B) ​sugars
C) ​MCT oil
D) ​fruits and vegetables
E) ​butter

Question 44

All of these factors must be considered in medical nutrition therapy following liver transplant except _____.​​

A) ​oral supplements
B) ​low-protein diet
C) ​food safety education
D) ​vitamin and mineral supplements
E) ​high-kcalorie snacks

Question 45

To improve Mr. Jamison's appetite, his physician may prescribe _____.​

A) ​megestrol acetate
B) ​spironolactone
C) ​rifaximin
D) ​propranolol
E) ​furosemide

Question 46

A feeding tube used for a patient with esophageal varices should be _____.

A) ​wide and rigid
B) ​narrow and flexible
C) ​able to deliver insulin to maintain proper blood glucose levels
D) ​short and rigid
E) ​wide and flexible

Question 47

Patients with ascites generally must restrict their intake of _____.​

A) ​fat
B) ​carbohydrates
C) ​sodium
D) ​iron
E) ​potassium

Question 48

Left untreated for years, a blocked bile duct may lead to _____.​

A) ​liver damage
B) ​kidney failure
C) ​neuropathy
D) ​gastritis
E) ​pancreatic cancer

Question 49

The diet of a patient with cirrhosis who has severe steatorrhea may need to be supplemented with all of these nutrients except _____.​

A) ​B vitamins
B) ​calcium
C) ​magnesium
D) ​zinc
E) ​vitamin D

Question 50

Which individual is at highest risk of developing gallstones?​

A) ​a female athlete with anemia
B) ​a menopausal woman who uses estrogen replacement therapy
C) ​a 30 year old African-American male
D) ​a male patient on long-term tube feeding
E) ​a 25-year old non-pregnant female

Question 51

Which substance is not a component of bile?​

A) ​bile salts
B) ​cholesterol
C) ​bilirubin
D) ​lectithin
E) ​lipase

Question 52

Which factor does not increase the risk of developing gallstones?​

A) ​long-term parenteral nutrition.
B) ​youth
C) ​clofibrate use for treatment of heart disease
D) ​rapid weight loss
E) ​obesity

Question 53

What is the daily sodium restriction for a patient with ascites?​

A) ​1000 mg
B) ​1200 mg
C) ​1500 mg
D) ​1800 mg
E) ​2000 mg

Question 54

Of the following laboratory tests performed on Mr. Jamison, which one would you expect to see elevated?​

A) ​albumin
B) ​transferrin
C) ​ammonia
D) ​HDL
E) ​erythropoetin

Question 55

Cirrhosis patients frequently develop insulin resistance and consequently must follow a diet that _____.

A) ​maintains blood glucose control
B) ​is low in fiber
C) ​provides consistent vitamin K intake
D) ​is low in sodium
E) ​is low in protein

Question 56

Mr. Jamison begins experiencing hyperglycemia as his disease progresses. The appropriate diet for him is _____.​

A) ​low protein
B) ​carbohydrate controlled
C) ​low sodium
D) ​fat controlled
E) ​high fiber, high carbohydrate

Question 57

Which method for treating gallstones relies on medications to dissolve gallstones?​

A) ​cholecystectomy
B) ​administration of ursodiol
C) ​a sodium-controlled diet
D) ​shock-wave lithotripsy
E) ​laparoscopic procedures

Question 58

The dietitian assesses Mr. Jamison's protein needs, and based on his weight, estimates that he requires approximately _____ grams of protein per day for proper nitrogen balance.​

A) ​25-30
B) ​50-60
C) ​65-100
D) ​100-150
E) ​125-175

Question 59

Performing a nutrition assessment on a patient who is a candidate for liver transplant is complicated by all of these factors except _____.​

A) ​liver dysfunction and malnutrition have similar metabolic effects
B) ​fluid retention can mask weight loss
C) ​fluid retention can alter lab values
D) ​fluid retention can alter anthropometric values
E) ​supplements may mask underlying nutrient deficiencies

Question 60

Gallstone disease affects about _____ percent of the adult population in the United States.

A) ​1-2
B) ​10-15
C) ​20-25
D) ​30-35
E) ​35-40

Question 61

Mrs. Juarez is diagnosed with cirrhosis and has developed ascites. Her appetite is poor and she is losing weight. What would you encourage her to do to minimize the risk for malnutrition?​

A) ​Eat four to six times per day.
B) ​Try to eat three large meals per day.
C) ​Consume a liquid nutritional supplement with each meal.
D) ​Drink more fruit juice.
E) ​Avoid alcoholic beverages.

Question 62

The most common complication of alcohol abuse is _____.​

A) ​chronic pancreatitis
B) ​alcoholic liver disease
C) ​chronic renal failure
D) ​heart arrhythmias
E) ​neuromuscular dysfunction

Question 63

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
portal hypertension​

Question 64

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
VLDL

Question 65

Deficiency of _____ in a person who abuses alcohol can result in malabsorption of other nutrients, as well.​

A) ​folate
B) ​thiamin
C) ​vitamin A
D) ​sodium
E) ​potassium

Question 66

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
collaterals

Question 67

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
cirrhosis

Question 68

One standard vodka drink (1.5 ounces) is equivalent to _____ ounces of beer.​

A) ​4
B) ​6
C) ​10
D) ​12
E) ​18

Question 69

People with diabetes who abuse alcohol are at risk of developing _____.​

A) ​hypoglycemia
B) ​hyperglycemia
C) ​hyponatremia
D) ​hyponatremia
E) ​anemia

Question 70

The main product of alcohol metabolism is _____.

A) ​VLDL
B) ​acetaldehyde
C) ​bilirubin
D) ​ethanol
E) ​acetate

Question 71

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
jaundice

Question 72

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
hepatomegaly

Question 73

Mr. Jamison eventually receives a liver transplant. Due to the risk of foodborne illness, Mr. Jamison should avoid all of these foods except _____.​

A) ​rare steak
B) ​sushi
C) ​unpasteurized milk
D) ​canned vegetables
E) ​unwashed fresh fruit

Question 74

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
fatty liver

Question 75

Alcohol abuse affects all of these organs except the _____.​

A) ​lungs
B) ​liver
C) ​GI tract
D) ​heart
E) ​pancreas

Question 76

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
steatohepatitis

Question 77

A patient is admitted to the hospital with decreased albumin, elevated alkaline phosphatase, and elevated bilirubin. These clinical findings are evidence of _____.​

A) ​portal hypertension
B) ​liver disease
C) ​esophageal varices
D) ​hepatic coma
E) ​gallstones

Question 78

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
ascites

Question 79

The beneficial effects of moderate alcohol intake are mainly seen in _____.​

A) ​women who have type 1 diabetes
B) ​people with risk factors for liver disease
C) ​older people with risk factors for heart disease
D) ​men with cirrhosis
E) ​men who suffer from prostate disease

Question 80

Matching
a. an accumulation of fat in the liver
b. enlargement of the liver
c. an advanced stage of liver disease in which extensive scarring replaces healthy liver tissue, causing impaired liver function and liver failure
d. elevated blood pressure in the portal vein due to obstructed blood flow through the liver
e. blood vessels that enlarge in order to allow an alternative pathway for diverted blood
f. abnormally dilated blood vessels
g. yellow discoloration of the skin and eyes due to an accumulation of bilirubin
h. liver inflammation that is associated with fatty liver
i. an abnormal accumulation of fluid in the abdominal cavity
j. excess triglycerides packaged and exported to the blood
varices