Question 1

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

Accepted Answer

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

Question 2

Describe the major functions of the pancreas.

Accepted Answer

The pancreas has two major functions: exocrine function, which produces enzymes and bicarbonate necessary for digestion, and endocrine function, which produces hormones to regulate the use of body fuels.

Question 3

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

Accepted Answer

A) True 
 B)False  False

Question 4

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

Accepted Answer

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

Question 5

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.

$ \mathrm{Ht}: 5^{\prime} 11^{\prime \prime} \quad $ Wt: $ 145 \quad \#$ UBW: $ 163 \# $
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension

Labs:
$ \begin{array}{lrrlcll}\text { Na: } 134 & \text { Cl: } 101 & \text { BUN: } 4 & \text { Alb: } 2.3 & \text { TG: } 305 & \text { Transferrin: } 101 & \text { NH4: } \ 53 & \text { Glu: } 139 & \text { AST: } 45 & \text { ALT } 48 & \text { Alk Phos: } 40 & \text { Bilirubin: } 2.1 & \ \text { K: } 5.2 & \text { CO2: } 25 & \text { Cr: } 1.8 & \text { H/H: } 11 / 35 & & \end{array} $

Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan

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

Accepted Answer

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 
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 6

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

Accepted Answer

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 
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 7

Alcohol causes increased urinary excretion of which nutrient?

Accepted Answer

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

Question 8

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.

Accepted Answer

The answer of Small crystals of cholesterol on the surface...

Question 9

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

Accepted Answer

A) True 
 B)False

Question 10

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

Accepted Answer

The answer of _______________ is defined as the replacement of...

Question 11

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

Accepted Answer

Pancreatitis, an inflammation of the pan

Question 12

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

Accepted Answer

The answer of The pancreas is the only organ of...

Question 13

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

Accepted Answer

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

Question 14

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.

$ \mathrm{Ht}: 5^{\prime} 11^{\prime \prime} \quad $ Wt: $ 145 \quad \#$ UBW: $ 163 \# $
Dx: End-stage liver cirrhosis, dysphagia
PMH: alcoholic cirrhosis, portal hypertension

Labs:
$ \begin{array}{lrrlcll}\text { Na: } 134 & \text { Cl: } 101 & \text { BUN: } 4 & \text { Alb: } 2.3 & \text { TG: } 305 & \text { Transferrin: } 101 & \text { NH4: } \ 53 & \text { Glu: } 139 & \text { AST: } 45 & \text { ALT } 48 & \text { Alk Phos: } 40 & \text { Bilirubin: } 2.1 & \ \text { K: } 5.2 & \text { CO2: } 25 & \text { Cr: } 1.8 & \text { H/H: } 11 / 35 & & \end{array} $

Diet: NPO
Meds: Neomycin, Aldactone, Lasix, Reglan

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

Accepted Answer

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

Question 15

The cause of fatty liver after alcohol ingestion is:

Accepted Answer

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 
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 16

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 _______________.

Accepted Answer

The answer of The hepatic duct descends to the right...

Question 17

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

Accepted Answer

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

Question 18

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.

Accepted Answer

The answer of The basic functional unit of the liver...

Question 19

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

Accepted Answer

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

Question 20

Which organ stores bile that is produced in the liver?

Accepted Answer

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

Exam 16: Diseases of the Liver Gallbladder and Exocrine Pancreas

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

Describe the major functions of the pancreas.

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

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

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

Alcohol causes increased urinary excretion of which nutrient?

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.

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

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

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

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

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

The cause of fatty liver after alcohol ingestion is:

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 _______________.

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

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.

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

Which organ stores bile that is produced in the liver?

Role of the Registered Dietitian Nutritionist in the Health Care System

Overview the Nutrition Care Process

Nutrition Assessment Foundation of the Nutrition Care Process

Nutrition Intervention Nutrition Monitoring and Evaluation

Enteral and Parenteral Nutrition Support

Nutrition Informatics and Documentation of the Nutrition Care Process

Fluid and Electrolyte Balance

Acid Base Balance

Cellular and Physiological Response to Injury the Role of the Immune System

Nutritional Genomics

Pharmacology

Diseases and Disorders of Energy Imbalance

Diseases of the Cardiovascular System

Diseases of the Upper Gastrointestinal Tract

Diseases of the Lower Gastrointestinal Tract

Diseases of the Endocrine System

Diseases of the Renal System

Diseases of the Hematological System

Diseases and Disorders of the Neurological System

Diseases of the Respiratory System

Metabolic Stress and the Critically Ill

Neoplastic Disease

Diseases of the Musculoskeletal System

Metabolic Disorders

Filters

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