Deck 20: Nutrition Therapy for Liver and Gallbladder Diseases

Question 1

A patient with cirrhosis may present with no symptoms. ​

Answer 1

True

Question 2

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

Answer 2

False

Question 3

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

Answer 3

True

Question 4

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 5

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

Question 6

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 7

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 8

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

Question 9

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 10

People with protein-energy malnutrition may experience fatty liver.

Question 11

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

Question 12

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 13

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

Question 14

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

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

Question 15

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 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

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

Question 19

Hepatitis patients should avoid:

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

Question 20

When triglycerides accumulate in the liver, the liver:

A)becomes smaller.
B)turns into scar tissue.
C)becomes inflamed.
D)becomes  enlarged.
E)decreases metabolism.

Question 21

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 22

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 23

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

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

Question 24

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 25

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 26

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 27

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 28

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 29

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 30

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 31

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 32

A patient in the middle stage of hepatic encephalopathy may exhibit:

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

Question 33

Which condition is not a consequence of cirrhosis? ​

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

Question 34

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 35

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 36

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 37

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 38

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 39

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 40

Cirrhosis is treated by all of these drugs EXCEPT:

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

Question 41

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 42

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 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

Case Study Questions ​
Use this case study to answer the following questions.
Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse. Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss. A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis. He is 5'10" tall and currently weighs 145 pounds (66 kilograms).
​
​
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 45

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 46

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 47

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 48

Which substance is not a component of bile? ​

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

Question 49

Case Study Questions ​
Use this case study to answer the following questions.
Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse. Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss. A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis. He is 5'10" tall and currently weighs 145 pounds (66 kilograms).
​
​
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 50

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 51

Case Study Questions ​
Use this case study to answer the following questions.
Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse. Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss. A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis. He is 5'10" tall and currently weighs 145 pounds (66 kilograms).
​
​
To improve Mr. Jamison's appetite, his physician may prescribe:

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

Question 52

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 53

Case Study Questions ​
Use this case study to answer the following questions.
Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse. Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss. A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis. He is 5'10" tall and currently weighs 145 pounds (66 kilograms).
​
​
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 54

Case Study Questions ​
Use this case study to answer the following questions.
Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse. Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss. A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis. He is 5'10" tall and currently weighs 145 pounds (66 kilograms).
​
​
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

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 56

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 57

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 58

Patients with ascites generally must restrict their intake of:

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

Question 59

Case Study Questions ​
Use this case study to answer the following questions.
Andrew Jamison is a 47-year-old construction worker with a long history of alcohol abuse. Recently he has been experiencing fatigue, weakness, loss of appetite, and weight loss. A visit to his physician and laboratory testing confirmed a diagnosis of cirrhosis. He is 5'10" tall and currently weighs 145 pounds (66 kilograms).
​
​
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 60

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 61

People with diabetes who abuse alcohol are at risk of developing:

A)hypoglycemia.
B)hyperglycemia.
C)hyponatremia.
D)hypernatremia.
E)anemia.

Question 63

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 64

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

A)4
B)6
C)10
D)12
E)18

Question 67

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 71

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 72

The main product of alcohol metabolism is:

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

Question 73

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

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

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

Alcohol abuse affects all of these organs except the:

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

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.