Deck 16: Diseases of the Liver Gallbladder and Exocrine Pancreas

Question 1

Which treatment is used in the management of both hepatitis B and hepatitis C?

A) neomycin
B) spironolactone
C) prednisone
D) interferon
E) famotidine

Answer 1

D

Question 2

Bile salts aid in the absorption of fatty acids through the formation of which substance?

A) micelles
B) chylomicrons
C) acetyl CoA
D) prothrombin
E) mucoproteins

Answer 2

A

Question 3

Which of the following statements best describes hepatobiliary scintigraphy?

A) A noninvasive test produces cross-section images of parts of the body.
B) A gamma camera takes pictures of a radioactive compound as the bile moves through the liver, bile ducts, gallbladder, and small intestine.
C) An endoscope is inserted down the throat, through the stomach, and into the small intestine to view internal structures.
D) A noninvasive X-ray produces three-dimensional pictures of parts of the body.
E) The patient is injected with a small amount of radioactive material that is absorbed by the gallbladder, which is then stimulated to contract.

Answer 3

B

Question 4

Which condition is most commonly associated with nonalcoholic steatohepatitis (NASH)?

A) obesity
B) high blood glucose
C) celiac disease
D) hypothyroidism
E) anorexia

Question 5

Which of the following statements is true of alcoholism in older adults?

A) Approximately 20% of people over 65 abused alcohol.
B) Most adults become addicted to alcohol later in life in response to problems.
C) Older adults are even more susceptible to nutrient deficiencies when they abuse alcohol.
D) Most primary care providers identify alcohol abuse in older adults because of routine assessments.
E) Alcohol abuse among older adults is one of the most commonly identified problems of aging.

Question 6

Which type of hepatitis is most commonly transmitted through the fecal-oral route?

A) hepatitis A
B) hepatitis B
C) hepatitis C
D) hepatitis D
E) hepatitis E

Question 7

Which hormone is secreted by the delta cells of the islets of Langerhans?

A) thyroid stimulating hormone
B) luteinizing hormone
C) somatostatin
D) amylase
E) testosterone

Question 8

Which medication is most commonly used in the treatment of hepatic encephalopathy?

A) manganese
B) tyramine
C) lactulose
D) octopamine
E) phenylethanolamine

Question 9

Which factor in a laboratory test is most likely to be elevated in a patient with fatty liver?

A) serum albumin
B) glucose
C) red blood cells
D) cortisol
E) serum transaminase

Question 10

Common manifestations of all types of hepatitis include jaundice, fatigue, vomiting, and:

A) epigastric pain
B) dark urine
C) diarrhea
D) generalized rash
E) dilated pupils

Question 11

The cause of fatty liver after alcohol ingestion is:

A) greater amounts of glucagon secretion and enhanced gluconeogenesis from amino acids
B) elevated tryptophan levels and the formation of serotonin
C) the increased availability of fatty acids in the liver
D) esterification of fatty acids
E) the increased production and absorption of ammonia

Question 12

Increased destruction of red blood cells with rapid release of bilirubin into the blood is known as:

A) obstructive jaundice
B) bilirubin conjugation
C) post-hepatic jaundice
D) hemolytic jaundice
E) bilirubin dissection

Question 13

Ammonia is absorbed and transported in the intestinal venous blood to the liver, where it is metabolized into which substance?

A) amino acids
B) urea
C) fatty acids
D) glucose
E) glycogen

Question 14

The most common nutrient-drug interactions that occur with mycophenolate (purine synthesis inhibitor) are:

A) high cholesterol and hypertriglyceridemia
B) dyspepsia, abdominal pain, and diarrhea
C) hematochezia and iron deficiency anemia
D) muscle cramps, joint pain, and fever
E) headache, dizziness, and confusion

Question 15

Hepatitis C is most commonly transmitted through which route?

A) exposure to blood or body fluids from an infected person
B) the fecal-oral route
C) excessive alcohol intake
D) contaminated drinking water
E) sewage

Question 16

Which organ stores bile that is produced in the liver?

A) pancreas
B) kidney
C) spleen
D) gallbladder
E) stomach

Question 17

When ascites is present, which nutrition modification is typically necessary?

A) low sodium
B) decreased fluid intake
C) increased vitamin K
D) low fiber
E) decreased protein

Question 18

A syndrome of impaired mental status and abnormal neuromuscular function that results from liver failure is known as:

A) hepatic stenosis
B) jaundice
C) hepatic encephalopathy
D) fulminant hepatitis
E) hepatomegaly

Question 19

At which level of serum bilirubin does the skin begin to appear jaundiced?

A) 1.0-1.1 mg/dL
B) 1.5-1.9 mg/dL
C) 2.1-2.4 mg/dL
D) 2.5-3.0 mg/dL
E) 3.3-3.5 mg/dL

Question 20

A patient with hepatic encephalopathy is being assessed according to the Adapted West Haven Criteria. The patient has marked somnolence, psychomotor agitation, and his speech is difficult to understand. At which stage of the disease is the patient?

A) 0
B) 1
C) 2
D) 3
E) 4

Question 21

Symptoms associated with acute pancreatitis include:

A) diarrhea, bloody stools, and abdominal cramping
B) epigastric pain and ascites
C) flatulence, diarrhea, and abdominal distention
D) fever and headache
E) abdominal pain, nausea, and vomiting

Question 22

JB is a 53-year-old male who has recently divorced. He has experienced periods of depression and decreased appetite. His family reports a history of heavy drinking habits and a 15 kg weight loss. He was previously diagnosed with cirrhosis and portal hypertension. Paracentesis and TIPS procedures were performed. JB's condition seems to have worsened; he complains of stomach pains, nausea, and vomiting at times. His abdomen is sore to touch and feels swollen. JB has developed ascites and pedal edema. His urinary output has decreased, and he continues to lose weight. JB also complains of pain when swallowing food. Because of JB's persistent symptoms, he's been admitted to a hospital. A referral to the SLP for an MBS was also ordered and resulted in dysphagia for which pureed diet was recommended. On day 2, JB still complains of nausea and no per os intake has been reported. The MD prescribed a dietary consultation. An RD is required to assess the patient and recommend alternate means of nutrition support, currently NPO.

The RD recommends sodium restriction because of JB's ascites. How much sodium should the RD initially recommend to JB each day?

A) 500 mg/day
B) 1000 mg/day
C) 2000 mg/day
D) 3000 mg/day
E) 3500 mg/day

Question 23

The most common cause of cirrhosis in the United States is:

A) alcohol abuse
B) hepatitis B
C) nonalcoholic fatty liver disease
D) hepatitis C
E) biliary colic

Question 24

A patient with hepatic encephalopathy is being assessed according to the Adapted West Haven Criteria. The patient is unable to perform easy mental tests and is awake but inattentive. The patient's speech is difficult to understand. Identify the stage of encephalopathy that has these characteristics.

A) 0
B) 1
C) 2
D) 3
E) 4

Question 25

Astrocytes are the specialized phagocytic cells of the reticuloendothelial system found on the luminal surface of the hepatic sinusoids.

Question 26

JB is a 53-year-old male who has recently divorced. He has experienced periods of depression and decreased appetite. His family reports a history of heavy drinking habits and a 15 kg weight loss. He was previously diagnosed with cirrhosis and portal hypertension. Paracentesis and TIPS procedures were performed. JB's condition seems to have worsened; he complains of stomach pains, nausea, and vomiting at times. His abdomen is sore to touch and feels swollen. JB has developed ascites and pedal edema. His urinary output has decreased, and he continues to lose weight. JB also complains of pain when swallowing food. Because of JB's persistent symptoms, he's been admitted to a hospital. A referral to the SLP for an MBS was also ordered and resulted in dysphagia for which pureed diet was recommended. On day 2, JB still complains of nausea and no per os intake has been reported. The MD prescribed a dietary consultation. An RD is required to assess the patient and recommend alternate means of nutrition support, currently NPO.

How much protein consumption will the registered dietitian recommend to JB?

A) 0.8-1.0 g/kg
B) 1.0-1.1 g/kg
C) 1.2-1.5 g/kg
D) 1.8-2.0 g/kg
E) 2.0-2.2 g/kg

Question 27

What complication most commonly occurs with folate deficiency?

A) reduced bone formation and mineralization
B) villus shortening in the intestine
C) retrograde amnesia
D) ataxia and sensory neuropathy
E) pancreatic insufficiency

Question 28

JB is a 53-year-old male who has recently divorced. He has experienced periods of depression and decreased appetite. His family reports a history of heavy drinking habits and a 15 kg weight loss. He was previously diagnosed with cirrhosis and portal hypertension. Paracentesis and TIPS procedures were performed. JB's condition seems to have worsened; he complains of stomach pains, nausea, and vomiting at times. His abdomen is sore to touch and feels swollen. JB has developed ascites and pedal edema. His urinary output has decreased, and he continues to lose weight. JB also complains of pain when swallowing food. Because of JB's persistent symptoms, he's been admitted to a hospital. A referral to the SLP for an MBS was also ordered and resulted in dysphagia for which pureed diet was recommended. On day 2, JB still complains of nausea and no per os intake has been reported. The MD prescribed a dietary consultation. An RD is required to assess the patient and recommend alternate means of nutrition support, currently NPO.

Because of JB's history of alcohol abuse, he is most likely at risk of which nutrient deficiency?

A) potassium
B) vitamin A
C) sodium
D) vitamin B₆
E) vitamin E

Question 29

JB is a 53-year-old male who has recently divorced. He has experienced periods of depression and decreased appetite. His family reports a history of heavy drinking habits and a 15 kg weight loss. He was previously diagnosed with cirrhosis and portal hypertension. Paracentesis and TIPS procedures were performed. JB's condition seems to have worsened; he complains of stomach pains, nausea, and vomiting at times. His abdomen is sore to touch and feels swollen. JB has developed ascites and pedal edema. His urinary output has decreased, and he continues to lose weight. JB also complains of pain when swallowing food. Because of JB's persistent symptoms, he's been admitted to a hospital. A referral to the SLP for an MBS was also ordered and resulted in dysphagia for which pureed diet was recommended. On day 2, JB still complains of nausea and no per os intake has been reported. The MD prescribed a dietary consultation. An RD is required to assess the patient and recommend alternate means of nutrition support, currently NPO.

How would the registered dietitian determine JB's caloric needs in this situation?

A) 15-20 kcal/kg IBW
B) 20-25 kcal/kg IBW
C) 25-30 kcal/kg IBW
D) 30-35 kcal/kg current body weight
E) 35-40 kcal/kg current body weight

Question 30

Wernicke-Korsakoff syndrome is associated with excessive alcohol intake and a deficiency of which nutrient?

A) thiamin
B) vitamin B₁₂
C) vitamin D
D) folate
E) vitamin B₆

Question 31

Which condition is commonly associated with chronic pancreatitis?

A) celiac disease
B) anorexia
C) diabetes
D) renal failure
E) atrial fibrillation

Question 32

Alcohol causes increased urinary excretion of which nutrient?

A) folate
B) vitamin B₁₂
C) magnesium
D) chloride
E) sodium

Question 33

JB is a 53-year-old male who has recently divorced. He has experienced periods of depression and decreased appetite. His family reports a history of heavy drinking habits and a 15 kg weight loss. He was previously diagnosed with cirrhosis and portal hypertension. Paracentesis and TIPS procedures were performed. JB's condition seems to have worsened; he complains of stomach pains, nausea, and vomiting at times. His abdomen is sore to touch and feels swollen. JB has developed ascites and pedal edema. His urinary output has decreased, and he continues to lose weight. JB also complains of pain when swallowing food. Because of JB's persistent symptoms, he's been admitted to a hospital. A referral to the SLP for an MBS was also ordered and resulted in dysphagia for which pureed diet was recommended. On day 2, JB still complains of nausea and no per os intake has been reported. The MD prescribed a dietary consultation. An RD is required to assess the patient and recommend alternate means of nutrition support, currently NPO.

Following the paracentesis, the nutritionist might recommend what component to the nutrition prescription?

A) vitamin B₁₂
B) protein
C) hypertonic fluid
D) vitamin D
E) potassium

Question 34

Identify the enzyme that hydrolyzes interior peptide bonds to form polypeptides.

A) lipase
B) amylase
C) chymotrypsin
D) ribonuclease
E) renin

Question 35

When steatorrhea associated with pancreatitis occurs, what intervention should follow?

A) administration of pancreatic digestive enzymes
B) early initiation (within 48 hours) of enteral nutrition
C) a low-carbohydrate nutrition prescription with modest protein
D) calcium supplements along with a multivitamin
E) fluid and sodium restriction

Question 36

Which nutrition intervention is appropriate for a patient with an acute attack of cholangitis?

A) a low-fat diet
B) decreased fluid intake
C) supplementation with vitamin B₆
D) enteral nutrition
E) increased carbohydrate intake

Question 37

Nutrition interventions for a client with alcoholic hepatitis include a diet that is:

A) low in carbohydrates
B) high in saturated fat
C) low in artificial sugars
D) low in protein
E) high in carbohydrates

Question 38

The recommended daily protein intake for a patient with alcoholic hepatitis would be:

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
E) 2.5-3.0 grams/kilogram

Question 39

Which type of food would the dietitian most likely recommend to a patient with nonalcoholic fatty liver disease (NAFLD)?

A) whole yogurt
B) lean pork
C) egg noodles
D) corn chips
E) chocolate milk

Question 40

The liver receives blood from two sources: the hepatic portal vein and the hepatic artery.

Question 41

_______________ is a manifestation of thiamin deficiency usually seen in individuals suffering from alcoholism.

Question 42

Standard medical treatments for hepatic encephalopathy are primarily directed at reducing the amount of circulating ammonia.

Question 43

Forty percent of acute pancreatitis cases are due to a gallstone passing into the bile duct and temporarily lodging at the sphincter of Oddi.

Question 44

The basic functional unit of the liver is the _______________, which is a cylindrical structure several millimeters in length and 0.8-2 mm in diameter.

Question 45

_______________ is defined as the replacement of functional hepatocytes by fibrotic cells.

Question 46

Red blood cells, alkaline phosphatase, and serum glucose are generally elevated with hepatitis.

Question 47

_______________ or steatosis occurs in about 25-30% of the general U.S. population and 90% of chronic alcohol abusers.

Question 48

_______________ presents as small, brief, intermittent movements of individual fingers and may be seen in patients with hepatic encephalopathy.

Question 49

The pancreas is the only organ of the body that has both _______________ and _______________ functions.

Question 50

The hepatic duct descends to the right for a few inches and is then joined by the cystic duct from the gallbladder to form the _______________.

Question 51

The _______________ is a surgical procedure for ascites that reroutes blood flow to the liver and reduces pressure in all auxiliary veins.

Question 52

The most common clinical sign of fatty liver is _______________.

Question 53

Ethanol and acetaldehyde have a hepatotoxic effect that interferes with metabolism and activation of vitamins by liver cells.

Question 54

Prolonged parenteral nutrition and short bowel syndrome can cause biliary stasis and therefore increase the risk of gallstones.

Question 55

The most common causes of cirrhosis are chronic HCV and alcoholism, and 95% of heavy drinkers develop the disease.

Question 56

Withdrawal of fluid from the abdomen via a catheter, often used as treatment for ascites, is called _______________.

Question 57

The hepatotoxic alcohol threshold at which ALD may develop is 20 g (two drinks) daily for men.

Question 58

_______________ causes a liver disorder that is uncommon in the United States and requires HBV to replicate.

Question 59

Autodigestion of the pancreas is prevented by storing the digestive enzymes in their inactive forms as zymogens.

Question 60

_______________ is a form of toxic liver injury associated with chronic ethanol consumption.

Question 61

Explain why malnutrition is prominent in a patient with alcoholism or alcoholic hepatitis.

Question 62

Define the functions of the gallbladder.

Question 63

Describe the major functions of the pancreas.

Question 64

A patient's eligibility to be placed on the waiting list for a liver transplant is determined based on the _______________ scoring system.

Question 65

_______________ is an inflammation of the biliary ducts, usually secondary to obstruction of the common bile duct leading to infection.

Question 66

The liver is the source of bile, but bile's composition is further modified by the _______________.

Question 67

An estimated dosage range would be _______________ IU of lipase per meal for a patient with chronic pancreatitis.

Question 68

Describe the possible complications associated with thiamin deficiency in a patient with alcohol dependency.

Question 69

Which surgical procedure is used to detect and remove bile duct stones?

A) magnetic resonance cholangiopancreatography
B) percutaneous transhepatic cholangiography
C) hepatobiliary scintigraphy
D) magnetic resonance imaging
E) endoscopic retrograde cholangiopancreatography

Question 70

Small crystals of cholesterol on the surface of the inflamed mucosa of the gallbladder act as _______________ (points of origin) for further precipitation of cholesterol, and the crystals grow larger and larger.

Question 71

Give three examples of possible nutrition diagnoses associated with acute hepatitis.

Question 72

Describe the differences between hepatitis A, B, and C, including their methods of transmission, clinical manifestations, and modes of treatment.

Question 73

Describe the differences between acute and chronic pancreatitis, including causes, manifestations, and nutrition intervention.

Question 74

When a gallstone passes from the gallbladder through the cystic duct and lodges in the common bile duct or in the head of the pancreas, the condition is called _______________.

Question 75

Describe a basic nutrition assessment for a patient with gallbladder disease.

Question 76

Briefly describe the impairment of neurotransmission involved with hepatic encephalopathy.

Question 77

List three different causes of cirrhosis found in the United States.

Question 78

Which group of people is most commonly infected with chronic hepatitis B virus in the United States?

A) Native Americans
B) Hispanic/Latinos
C) Caucasians
D) African Americans
E) Pacific Islanders

Question 79

Fat malabsorption with chronic pancreatitis results in _______________.

Question 80

_______________ is the formation of calculi within the gallbladder or biliary duct system.