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

Which of the following is not one of the four major hypotheses for the etiology of hepatic encephalopathy?

Case Study 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	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:

Which type of hepatitis is usually transmitted by the fecal-oral route?

Case Study 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	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?

When someone experiences acute cholangitis, nutrition therapy should include:

Bile salts aid the absorption of fatty acids by forming _____, which are soluble in the chyme

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?

Alcohol increases the excretion of which of the following vitamins?

Case Study 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	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

The most common clinical manifestations of hepatitis include all of the following except:

What is the recommended daily protein intake for patients with alcohol dependency?

Hemolytic jaundice in characterized by a(n):

When serum NH3 is high, which of the following medications is used to assist in lowering the level?

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

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?

The liver stores carbohydrate as _____ The symptom of _____ commonly occurs in liver disorders because of the limited storage of this nutrient

The alcoholic is at risk for malnutrition because of all of the following except:

Case Study 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	Cr: 1.8	H/H: 11/35

Diet: NPO Meds: Neomycin, Aldactone, Lasix, Reglan -What will the registered dietitian recommend for JB's ascites?