Deck 25: Liver Disease and Gallstones

Question 1

Liver inflammation associated with fatty liver disease is known as ____.

A) hepatomegaly
B) steatohepatitis
C) steatorrhea
D) hepatic encephalopathy

Answer 1

B

Question 2

Hepatitis B has infected as much as _____ of the world's population.

A) less than 10%
B) one-quarter
C) one-third
D) one-half

Answer 2

D

Question 3

A number of herbal remedies are reported to cause hepatitis, including ____.

A) St. John's wort
B) ma huang
C) echinacea
D) ginseng

Answer 3

B

Question 4

Which blood vessel is responsible for returning blood to the heart from the liver?

A) hepatic artery
B) hepatic vein
C) GI tract vein
D) portal vein

Question 5

Outbreaks of hepatitis ____ are often associated with natural disasters such as floods.

A) A
B) B
C) C
D) D

Question 6

What diet recommendation is most appropriate for a patient with hepatitis who is experiencing abdominal discomfort?

A) regular diet
B) small frequent meals
C) high-kcalorie tube feedings
D) NPO (nothing by mouth)

Question 7

Diets for persons with cirrhosis should include ____ grams of protein per kilogram of body weight each day.

A) 0.5 to 0.8
B) 0.8 to 1.0
C) 1.0 to 1.5
D) 1.5 to 1.9

Question 8

Laboratory tests indicators associated with fatty liver include ____.

A) decreased creatinine and ammonia
B) elevated blood urea nitrogen and low bilirubin
C) decreased white blood cells and high albumin
D) elevated alanine and aspartate aminotransferases

Question 9

The characteristic yellowing of the skin associated with jaundice is caused by the accumulation of ____ in the blood.

A) bilirubin
B) bile
C) triglycerides
D) alkaline phosphatase

Question 10

The primary treatment for fatty liver is ____.

A) eliminating causative factors that are responsible for the fatty liver disease
B) surgically resecting the damaged portions of the liver
C) administering anti-inflammatory drugs
D) administering frequent transfusions of packed red blood cells

Question 11

The normal range for bilirubin in the bloodstream is ____ mg/dL.

A) 0 to 2.0
B) 3.4 to 4.8
C) 15 to 45
D) > 55

Question 12

What percentage of U.S. adults is estimated to be affected by fatty liver?

A) 5
B) 10
C) 15
D) 24

Question 13

Normal blood ammonia levels are ____ µg/dL.

A) 15 to 45
B) 45 to 60
C) 60 to 75
D) >75

Question 14

The most metabolically active organ is the ____.

A) heart
B) brain
C) liver
D) stomach

Question 15

The blood vessel that conducts nutrient-rich blood from the digestive tract to the liver is the ____.

A) hepatic portal vein
B) hepatic vein
C) hepatic artery
D) gastrointestinal tract veins

Question 16

When foodservice workers do not follow good hygiene practices, which strain of hepatitis virus can be transmitted?

A) hepatitis A virus
B) hepatitis B virus
C) hepatitis C virus
D) hepatitis D virus

Question 17

One of the two most common causes of cirrhosis in the United States is ____.

A) bile duct blockage
B) heart disease
C) environmental toxins
D) hepatitis C infection

Question 18

Patients with fat malabsorption who are experiencing steatorrhea should limit fat intake to less than ____ percent of total kcalories.

A) 10
B) 20
C) 30
D) 40

Question 19

The hepatic portal vein and hepatic arteries together supply approximately ____ mL of blood each minute to the liver.

A) 100
B) 500
C) 900
D) 1500

Question 20

If bile obstruction occurs with cirrhosis, the patient will most likely develop ____.

A) hypertension
B) pruritus
C) diaphoresis
D) urinary retention

Question 21

John has severe ascites due to advanced cirrhosis. He is scheduled to undergo a procedure that will use a surgical puncture to draw excess fluid out of his abdomen. What is this procedure called?

A) shock-wave lithotripsy
B) paracentesis
C) peritoneovenous shunt
D) peristenotic aspiration

Question 22

A patient with ascites should decrease the intake of ____ in his diet.

A) sodium
B) potassium
C) calcium
D) magnesium

Question 23

Advanced cirrhosis is usually associated with malnutrition. It can disrupt functions of which of the following organs?

A) heart, spleen, and pancreas
B) kidney, lungs, and brain
C) gallbladder, heart, and appendix
D) colon, stomach, and rectum

Question 24

Which nutritional intervention should be encouraged for a client with cirrhosis and steatorrhea?

A) increasing intake of polyunsaturated fat
B) reducing kcalorie intake by 20%
C) limiting vitamin B intake
D) limiting fat intake and using medium-chain triglyceride (MCT) oil.

Question 25

Which clinical feature is associated with severe hepatic encephalopathy?

A) somnolence
B) shortened attention span
C) slight tremor
D) mood changes

Question 26

In patients with cirrhosis, the restricted blood flow within the liver stimulates the release of ____ in nearby arterioles, which leads to a greater volume of portal blood.

A) vasodilators
B) bile acids
C) insulin
D) pancreatic enzymes

Question 27

A patient has severe liver damage that has led to reduced serum levels of branched-chain amino acids (BCAAs). What are the three essential BCAAs for which the patient should receive supplements?

A) leucine, isoleucine, and valine
B) proline, tyrosine, and leucine
C) phenylalanine, tryptophan, and glutamine
D) cysteine, methionine, and valine

Question 28

Vitamin ____ status may be affected by steatorrhea related to liver damage.

A) C
B) A
C) B ₁₂
D) B ₆

Question 29

The blood loss associated with ruptured varices in patients with cirrhosis is ____.

A) rarely serious
B) common but rarely clinically important
C) less problematic given current treatment regimens
D) exacerbated by the liver's reduced production of clotting factors

Question 30

When blood flow through the hepatic portal vein is obstructed, the diverted blood travels through enlarged or newly formed vessels in the gastrointestinal tract called ____.

A) ascites
B) collaterals
C) bypass
D) varices

Question 31

What condition is thought to play a key role in hepatic encephalopathy?

A) elevated blood ammonia levels
B) prolonged plasma prothrombin time
C) decreased levels of alkaline phosphatase
D) increased blood urea nitrogen levels

Question 32

In a cirrhotic liver, portal hypertension is the result of ____.

A) increased pressure in the hepatic artery
B) increased pressure in the hepatic portal vein
C) jaundice caused by excessive bilirubin
D) extended blood-clotting time

Question 33

Within 10 years after the onset of cirrhosis, approximately ____ percent of patients will develop ascites.

A) 10
B) 35
C) 50
D) 80

Question 34

Which type of medication would most likely be administered to a patient with cirrhosis to control ascites?

A) diuretics
B) anti-inflammatories
C) antibiotics
D) pancreatic enzyme supplements

Question 35

Which clinical serum test may be normal or low in patients with liver disease?

A) ammonia
B) bilirubin
C) blood urea nitrogen
D) alanine aminotransferase

Question 36

What type of dietary interaction has been seen with the appetite stimulants dronabinol?

A) Licorice root interferes with its effects.
B) It potentiates the effects of alcohol.
C) Grapefruit juice can raise its concentrations.
D) Its effectiveness may be reduced by calcium and magnesium supplements.

Question 37

Isabella is being evaluated for liver transplant surgery. The dietitian finds it difficult to assess her anthropometric values in order to evaluate nutritional needs because ____.

A) she may have edema or ascites
B) her intake may be inadequate due to esophageal varices
C) she is receiving nutrients via parenteral nutrition
D) she is suffering from steatorrhea

Question 38

Mild hepatic encephalopathy is characterized by clinical symptoms, including:

A) forgetfulness and personality changes
B) shortened attention span and impaired mental abilities
C) inappropriate behavior and slurred speech
D) staggering gait and muscle rigidity

Question 39

Branched-chain amino acids may be supplemented in the diets of patients with hepatic encephalopathy because they ____.

A) increase the synthesis of albumin
B) reduce bilirubin levels
C) may improve neurological functioning
D) prevent a false positive test for occult blood in stool

Question 40

Patients with stable cirrhosis usually require ____ kcal/kg of body weight of energy per day.

A) 5 to 15
B) 15 to 20
C) 25 to 40
D) 45 to 50

Question 41

A type of anemia that results in premature destruction of red blood cells (RBCs) is ____, which results in shortened RBC lifespan and fewer RBCs.

A) aplastic anemia
B) anemia of chronic disease
C) macrocytic anemia
D) hemolytic anemia

Question 42

Where does erythropoiesis take place?

A) in the stomach
B) in the small intestines
C) in the bone marrow
D) in the large intestine

Question 43

The majority of gallstones are composed primarily of ____.

A) cholesterol
B) bile pigment
C) chloride salts
D) uric acid

Question 44

A patient who has undergone cholecystectomy is at risk for ____ owing to an increased amount of bile in the large intestine.

A) constipation
B) dyspepsia
C) diarrhea
D) jaundice

Question 45

The nonsurgical procedure that uses high-amplitude sound waves to fragment gallstones or kidney stones is called ______.

A) colectomy
B) lithotripsy
C) cholecystectomy
D) cholecystitis

Question 46

Which type of anemia is characterized by failure of stem cells to develop into RBCs and may be due to immune disease, viruses, drugs and toxins, or genetic defects?

A) aplastic anemia
B) macrocytic anemia
C) hemolytic anemia
D) thalassemia

Question 47

One of the role of stem cells in the bone marrow is ________

A) to differentiate into red blood cells
B) to secrete erythropoietin
C) to aid in the production of additional vitamin B ₁₂
D) to carry hemoglobin and oxygen to body tissues

Question 48

The dietitian evaluates a patient whose status is post-liver transplant. In addition to a high-kcalorie, high-protein diet, the nutrition education plan should include information on ____.

A) food safety
B) blood glucose monitoring
C) portion control
D) hepatitis information

Question 49

The 5-year survival rate for patients who have undergone liver transplantation may be as high as ____ percent.

A) 50 to 60
B) 65 to 70
C) 75 to 80
D) 85 to 90

Question 50

Pigment gallstones are made up primarily of which substance?

A) the calcium salt of bilirubin
B) excess pancreatic enzymes
C) phospholipids
D) inorganic salts

Question 51

In what ways do immunosuppressant drugs given after liver transplant impact nutrition?

A) by increasing sodium excretion
B) by causing gastroparesis
C) by causing abdominal pain and mouth sores
D) by altering calcium absorption

Question 52

Recurrence rates after pharmacologic dissolution of stones are as high as ____ percent within 3 to 5 years after treatment.

A) 10 to 20
B) 30 to 50
C) 55 to 60
D) 70 to 75

Question 53

Which test is used to study abnormalities in red blood cells, including their numbers and shapes?

A) peripheral blood smear
B) hemoglobin
C) mean corpuscular volume
D) hematocrit

Question 54

Pharmacological management of gallstones with ursodeoxycholic acid may require continued treatment for ____, until the cholesterol crystals dissolve.

A) 3 to 6 weeks
B) 6 to 10 weeks
C) 3 to 6 months
D) 6 to 18 months

Question 55

Black pigment gallstones are caused primarily by ____.

A) bacterial infection
B) collections of concentrated bile
C) excessive red blood cell breakdown
D) rapid weight loss following gastric bypass

Question 56

Elizabeth had a liver transplant 2 weeks ago. She is on immunosuppressive therapy. What side effect of these medications might interfere with her nutrition status?

A) steatorrhea
B) orthostatic hypotension
C) gastroesophageal reflux
D) abdominal pain

Question 57

The most common type of anemia affecting those with long-term illness is ____.

A) aplastic anemia
B) macrocytic anemia
C) anemia of chronic disease
D) iron-deficiency anemia

Question 58

Which ethnic group is at much higher risk of developing cholesterol gallstones than any other?

A) Asian American
B) Native Hawaiian/Pacific Islander
C) African American
D) Native American

Question 59

Serum levels of the transport form of iron (i.e., transferrin) is altered in both iron-deficiency anemia and anemia of chronic disease. What will lab tests for serum transferrin typically reflect in these two anemias, respectively?

A) Low; low
B) High; low
C) High; high
D) Low; high

Question 60

A patient presents with megaloblastic anemia, which is characterized by large immature red blood cells. Which are the two nutrient deficiencies that cause this type of anemia?

A) vitamin C and D
B) vitamins E and K
C) folate and vitamin B₁₂
D) biotin and niacin

Question 61

An appropriate treatment for Ms. Riley-O'Brien based on current symptoms would be ____.

A) hormone replacement
B) a low-fat/low-cholesterol diet
C) laparoscopic cholecystectomy
D) cholesterol-lowering medications

Question 63

Which factor places Ms. Riley-O'Brien most at risk for gallstones?

A) African American race
B) relatively young age
C) recent pregnancy
D) normal weight

Question 64

Explain the importance of adequate nutrition support for patients before and following a liver transplant.

Question 65

List the complications of gallstones that are not well managed or treated.

Question 66

Identify the etiology of the three common strains of the hepatitis virus. Describe the treatments and medical nutrition therapy for hepatitis.

Question 67

Discuss the types of blood-related drug-nutrient interactions and anemias that can occur as a result of medication use. List some examples of the effects of medications and resulting anemia.

Question 68

Explain how cirrhosis leads to portal hypertension, esophageal varices, and ascites.

Question 69

In addition to the risk posed by her recent pregnancy, what other risk factor does Ms. Riley-O'Brien have that increases her risk for gallstones?

A) young age
B) African-American ethnicity
C) normal weight
D) high triglyceride level

Question 70

Veronica Riley-O'Brien is a 30-year-old African-American woman and a mother of two young boys (Tyler, 4 years old, and Ethan, 1 month old). Veronica is 5 ft 4 in. tall and weighs 126 lb. She is quite healthy except for a 3-year history of hypertriglyceridemia. Lately, she is having difficulty sleeping because of pain in her abdomen and back. She calls her doctor this morning because the pain has intensified. Riley-O'Brien is diagnosed with gallstones. In addition to abdominal pain, what other symptom might she experience?

A) edema
B) confusion
C) headache
D) vomiting

Question 71

What is a complication of gallstones that can lead to infection?

A) cirrhosis
B) ascites
C) edema
D) cholecystitis

Question 72

A patient is informed that she has microcytic hypochromic anemia. What will be the characteristics of the blood cells that are "microcytic and hypochromic"?

A) blood cells are large and purplish in color
B) blood cells are immature and red in color
C) blood cells are small and pale in color
D) blood cells are small and bright red in color