Mnt Hepatobiliary Disorder

Front 1

largest gland in the body that is integral to most body functions

Back 1

liver

Front 2

True or False. 1500mL of blood/min circulates through the liver and exits via the hepatic veins into the inferior vena cava

Back 2

True

Front 3

Bile if formed in the __________ and exits through a system of ducts into the __________ for storage

A) liver; heart
B) heart; stomach
C) blood, liver
D) liver, gallbladder

Back 3

D. liver; gallbladder

Front 4

True or False. The liver performs more than 500 tasks related to metabolism

Back 4

True

Front 5

True or False. You can survive without a liver because only 10-20% of function is needed to sustain life

Back 5

False, you CANNOT survive without a liver, but only 10-20% of function is needed to sustain life

Front 6

Which of the following statements are false about the liver?

A) The liver is integral tom most body functions
B) You can not survive without the liver
C) The liver has the ability to regenerate
D) The liver is the smallest gland in the body
E) The liver performs more than 500 tasks related to metabolism

Back 6

D. The liver is the smallest gland in the body

Front 7

Which of the following is not a function of the liver?

A) Metabolism of macronutrients and steroids
B) activation and storage of vitamins and minerals; conversion of ammonia and urea
C) formation and excretion of bile
D) filter and blood chamber
E) all of the above

Back 7

E. all of the above

Front 8

Which of the following is a marker for specific liver diseases?

A) serium ferritin
B) ceruloplasmin
C) alpha fetoprotein
D) a1-antitrypsin
E) all of the above

Back 8

E) all of the above

Front 9

Which of the following is not a disease of the liver?

A) acute viral hepatitis
B) fulminant hepatitis
C) chronic hepatitis
D) non-alcoholic and alcoholic liver disease
E) all of the above

Back 9

E) all of the above

Front 10

Widespread inflammation of the liver that is caused by hepatitis viruses A, B, C, D, E

A) acute viral hepatitis
B) alcoholic liver disease
C) Wilson's disease
D) Cholestatic liver disease

Back 10

A) acute viral hepatitis

Front 11

Which hepatitis is spread by fecal-oral route?

A) hepatitis A and B
B) hepatitis E and A
C) hepatitis C, D, E
D) hepatitis B and D

Back 11

B. hepatitis E and A

Front 12

Which hepatitis is caused by blood and body fluids?

A. hepatitis A and E
B. hepatitis B, C, and D
C) hepatitis A, B, C, and D
D) hepatitis D

Back 12

B. hepatitis B, C, and D

Front 13

What are the four phases of symptoms for acute viral hepatitis?

A. prodromal phase, preicteric phase, icteric phase, convalescent phase
B. icteric phase, preicteric phase, convalescent phase, prodromal phase
C. preicteric phase, convalescent phase, icteric phase, prodromal phase
D. none of the above

Back 13

A. prodromal phase, preicteric phase, icteric phase, convalescent

Front 14

Fever, arthralgia, arthritis, rash, and angioedema (AAAFR) are all symptoms of which phase for acute viral hepatitis?

A) preicteric
B) convalescent
C) prodromal
D) icteric

Back 14

C. prodromal phase

Front 15

Malaise, fatigue, mylagia, anorexia, nausea, and vomiting occur in which phase of acute viral hepatitis?

A) convalescent
B) prodromal
C) icteric
D) none of the above

Back 15

D. none of the above

It occurs in the preicteric phase

Front 16

True or False. Jaundice typically occurs in the icteric phase of acute viral hepatitis

Back 16

True

Front 17

Jaundice and other symptoms begin to subside in which phase

A. prodromal phase
B. convalescent
C. icteric
D. preicteric

Back 17

B. convalescent

Front 18

Syndrome in which severe liver dysfunction is accompanied by hepatic encephalopathy; acute liver disease

Back 18

fulminant hepatitis

Front 19

True or False. Hepatic encephalopathy is a syndrome characterized by mental status deterioration and neuromuscular symptoms

Back 19

True

Front 20

True or False. Chronic hepatitis is the development of hepatic encephalopathy within 2-8 weeks of the onset of the illness

Back 20

False, fulminant liver disease is the development of hepatic encephalopathy within 2-8 weeks of the onset of the illness

Front 21

True or False. Viral is the cause of 70% cases of fulminant hepatitis

Back 21

True

Front 22

True or False. Extrahepatic complications of fulminant hepatitis includes cerebral edema, coagulopathy and bleeding, cardiovascular abdnormalities, renal failure, pulmonary complications, acid-base disturbances, electrolyte imbalances, sepsis, and pancreatitis

Back 22

True

Front 23

What is the 1st stage of hepatic encephalopathy?

Back 23

Mild confusion, agitation, irritability, sleep disturbances, decreased attention

Front 24

What is the 2nd stage of hepatic encephalopathy?

Back 24

lethargy, disorientation, inappropriate behavior, drowsiness

Front 25

What is the 3rd stage of hepatic encephalopathy?

Back 25

Somnolence but arousable, incomprehensible speech, confusion, aggression when awake

Front 26

What is the 4th stage of hepatic encephalopathy?

Back 26

coma

Front 27

True of False. Chronic hepatitis is due to at least 6month course of hepatitis

Back 27

True

Front 28

Causes may include autoimmune, viral, metabolic, medicines, or toxins

Back 28

chronic hepatitis

Front 29

Most common causes viral causes of hepatitis are ________

A. hepatitis A
B. hepatitis B and C
C. hepatitis C
D. hepatitis D and E

Back 29

B. hepatitis B and C

*remember that hepatitis E usually doesn't turn into chronic hepatitis

Front 30

True or False. Symptoms of chronic hepatitis are usually nonspecific, intermittent , and mild

Back 30

True

Front 31

Symptoms of acute chronic hepatitis include:

A. fatigue, sleep disturbance
B. difficulty concentrating
C. mild right upper quadrant pain
D. all of the above

Back 31

D. all of the above

Front 32

Symptoms of severe or advanced chronic hepatitis include:

A. jaundice, muscle wasting
B. tea colored urine, ascites
C. edmea
D. hepatic encephalopathy and GI bleeding
E. all of the above

Back 32

E. all of the above

Front 33

Nonalcoholic fatty liver disease includes:

Back 33

steatosis and steatohepatitis

Front 34

Accumulation of fat in liver

A. steaohepatitis
B. steatosis
C. chronic hepatitis
D. alcoholic liver disease

Back 34

B. steatosis

Front 35

Accumulation of fibrous tissue in liver

Back 35

steatohepatitis

Front 36

True or False. Nonalcoholic Fatty Liver disease can progress into chronic liver disease and cirrhosis

Back 36

True

Front 37

Accumulation of fat droplets in hepatocytes leading to fibrosis, cirrhosis, and cancer

Back 37

nonalcoholic fatty liver disease

Front 38

Drugs, inborn errors of metabolism, and acquired metabolic disorders such as obesity and type 2 diabetes all can cause:

A. chronic hepatitis
B. Wilson's diseas
C. Nonalcoholic Fatty liver disease
D. Alcoholic liver disease

Back 38

C. nonalcoholic fatty liver disease

Front 39

What are treatments of nonalcoholic fatty liver?

A. weight loss
B. insulin-sensitizing drugs
C. treatment of dyslipidemia
D. all of the above

Back 39

D. all of the above

Front 40

Disease resulting form excessive alcohol ingestion characterized by fatty liver (hepatic steatosis), hepatitis, or cirrhosis

Back 40

alcoholic liver disease

Front 41

True or False. Alcoholic liver disease is the most common liver disease in the U.S.

Back 41

True

Front 42

What are some factor that predispose an individual to alcoholic liver disease?

A. poor nutrition, immunologic factors, gender
B. alcohol-metabolizing enzymes
C. hepatotrophic virus infections
D. simultaneous exposure to other drugs
E. all of the above

Back 42

E. all of the above

Front 43

What are the three stages of alcoholic liver disease?

Back 43

1. hepatic steatosis
2. alcoholic hepatitis
3. cirrhosis

Front 44

Cirrhosis is the ______ stage of alcoholic liver disease

A. first
B. second
C. third

Back 44

C. third

Front 45

True or False. Cirrhosis is reversible

Back 45

False, Cirrhosis is not reversible

Front 46

True or False. Hepatic steatosis the first stage of alcoholic liver disease is not reversible with abstinence of alcohol

Back 46

False. Hepatic steatosis the first stage of alcoholic liver disease is reversible with abstinence of alcohol

Front 47

True or False. Alcoholic hepatitis may resolve with abstinence of alcohol

Back 47

True

Front 48

True or False. Prognosis of cirrhosis depends on abstinence from alcohol and extent of complications

Back 48

True

Front 49

True or False. Cirrhosis may lead to GI bleeding, hepatic encephalopathy, portal hypertension, ascites

Back 49

True

Front 50

What are the three inherited liver disorders

Back 50

hemochromatosis
wilson's disease
a1-antitrypsin deficiency

Front 51

Inherited disease of iron overload

A. hemochromatosis
B. wilson's disease
C. a1-antitrypsin deficiency

Back 51

A. Hemochromatosis

Front 52

absorb excessive iron from the gut and store more than normal

A. hemochromatosis
B. wilson's disease
C. a1-antitrypsin deficiency

Back 52

A. hemochromatosis

Front 53

Hemochromatosis may lead to...

Back 53

-hepatomegaly
-esophageal bleeding
-ascites
-impaired intolerance
-cardiac problems
-hypogonadism
-arthropathy
-hepatocellular carcinoma
-cirrhosis

Front 54

phlebotomy treatment

Back 54

hemochromatosis

Front 55

autosomal recessive disorder associated with impaired biliary copper excretion and subsequent copper accumulation in tissues

A. hemochromatosis
B. wilson's disease
C. a1-antitrypsin deficiency

Back 55

B. wilson's disease

Front 56

Cause Katser-Fleischer rings: yellow green rings encircling cornea

A. hemochromatosis
B. wilson's disease
C. a1-antitrypsin deficiency

Back 56

B. wilson's disease

Front 57

Treatment is copper chelating agents and zinc supplementation

Back 57

Wilson's disease

Front 58

glycoprotein found in serum and body fluids that inhibits neutrophil proteases

Back 58

a1-antitrypsin

Front 59

inherited disorder that causes cholestasis or cirrhosis and can cause liver and lung cancer

Back 59

a1-antitrypsin deficiency

Front 60

Treatment of a1-antitrypson deficiency

Back 60

none except transplantation

Front 61

True or False. People with Wilson's disease require a low copper diet

Back 61

False they do not require a low copper diet

Front 62

What are other causes of liver disease?

Back 62

-liver tumors (hepatoceulluar carcinoma)
-systemic disease such as rheumatoid arthritis)
-acute ischemic and chronic congestive hepatopathy
-parasitic, bacterial, fungal, and granulomatous liver disease

Front 63

What is are the two forms of cholestatic liver disease?

Back 63

-Primary biliary cirrhosis
-Sclerosing cholangitis

Front 64

True or False. Primary biliary cirrhosis is a chronic cholestatic disease.

Back 64

True

Front 65

Progressive destruction of small and intermediate sized intrahepatic bile ducts

A. primary biliary cirrhosis
B. sclerosing cholangitis
C. alcoholic liver disease
D. hemochromatosis

Back 65

A. primary biliary cirrhosis

Front 66

Inflammation of segments of extrahepatic bile ducts with or without the involvement of intrahepatic ducts.

A. primary biliary cirrhosis
B. sclerosing cholangitis
C. alcoholic liver disease
D. hemochromatosis

Back 66

B. sclerosing cholangitis

Front 67

True or False. 95% case of primary biliary cirrhosis are women

Back 67

True

Front 68

True or False. Elevated levels of liver enzymes are signs of primary biliary cirrhosis

Back 68

True

Front 69

Pruitus and fatigue are symptoms of

A. primary biliary cirrhosis
B. sclerosing cholangitis
C. alcoholic liver disease
D. hemochromatosis

Back 69

A. primary biliary cirrhosis

Front 70

Osteopenia, hypercholesterdemia, and fat-soluble deficiencies are some nutritional complications

A. primary biliary cirrhosis
B. sclerosing cholangitis
C. alcoholic liver disease
D. hemochromatosis

Back 70

A. primary biliary cirrhosis

Front 71

______________ may lead to portal hypertension, hepatic failure, and cholangiocarcinoma; usually associated with IBD ulcerative colitis

A. primary biliary cirrhosis
B. sclerosing cholangitis
C. alcoholic liver disease
D. hemochromatosis

Back 71

B. sclerosing cholangitis

Front 72

Malnutrition, ascites, hyponatremia, hepatic encephalopathy, glucose alterations, fat malabsorption, hepatorenal syndrome, and osteopenia are some clinical manifestation of

A. cancer
B. cirrhosis
C. non alcoholic liver disease

Back 72

B. cirrhosis

Front 73

energy requirement for cirrhosis

Back 73

120-140% of REE (25-35kcal/kg body weight)

Front 74

Anorexia, nausea, dysgeusia, and other GI symptoms are some feeding problems of

Back 74

cirrhosis

Front 75

25-40% of kcal as _____________ is recommended

A. fat
B. carbs
C. protein

Back 75

A. fat

Front 76

0.8-1.0g/kg body weight for nitrogen balance

1.2-1.3 g/kg body weight for positive balance

1.5g/kg body weight in stress such as alcoholic hepatitis, sepsis, infection, GI bleeding, or severe ascites

Back 76

protein requirement in cirrhosis

Front 77

Why is vitamin/mineral supplementation needed in patients with cirrhosis

Back 77

supplementation is needed due to the role of the liver in nutrient transport, storage, and metabolism and side effects of drugs

Front 78

liver injury may be caused by black cohosh, kava, ephedra

herbs used in liver disease treatment include milk thistle and S-adenosyl-L-methionine (SAMe)

Back 78

herbal supplements

Front 79

Portal hypertension, ascites, and hyponatremia are other aspects of cirrhosis

Back 79

Other aspects of cirrhosis

Front 80

Portal hypertension

Back 80

increase blood flow and results in varices in GIT which often bleed

Front 81

accumulation in abdominal cavity caused by portal hypertension, hypoalbuminemia, lymphatic obstruction, and renal retention of sodium and fluid

sodium restriction (2g/day), diuretic therapy

Back 81

ascites

Front 82

caused by decreased ability to excrete water resulting from persistent release of antidiuretic hormone, sodium losses via paracentesis, excessive diuretic use, or overly aggressive sodium retention

fluid retention (1-1.5L/day) and moderate sodium intake

Back 82

hyponatremia

Front 83

Consider major causes of encephalopathy
-GI bleeding
-fluid and electrolye abnormalities
-uremia
use of sedatives
-acidosis

Back 83

end of stage liver disease: hepatic encephalopathy

Front 84

Medications used in treatment of hepatic encephalopathy

Back 84

lactulose: non absorbable disaccharide and acts as an osmotic laxative to remove ammonia

-neomycin: antibiotic with low absorption

Front 85

Ensure that adequate diet is consumed and DO NOT restrict protein in someone with

Back 85

end of stage liver disease: hepatic encephalopathy

Front 86

MNT for end of stage liver disease

Back 86

-avoid protein restriction
-probiotic and synbiotics
-glucose alterations: treat as diabetes
-fat malabsorption: use MCT's and low fat diet
-renal sufficiency and hepatorenal syndrom
-osteopenia: weight maintenance; high calcium (1500mg/day) and avoid ALCOHOL duh!

Front 87

malnutrition is common in

Back 87

liver transplantation

Front 88

MNT for someone who has had liver transplantation and is having malnutrition

Back 88

small, frequent nutrient dense meals
oral nutrition supplements
enteral/pn may be necessary

Front 89

Guidelines for pretransplantation

Back 89

-high kcal
-1-1.5g/kg bw protein
-reduced simple CHO
-2g/day sodium
-1000-1500ml/day fluids
-800-1200mg/day calcium
-supplement

Front 90

Guidelines for immediate posttransplantation

Back 90

-moderate kcal (basal+15-30% or more)
-high protein 1.2-1.75g/kg bw
-2-4g/day sodium
-800-1200mg/day calcium
-supplement

Front 91

Long term posttransplantation

Back 91

-weight maintenance (basal+10-20% or more)
-mod protein 1g/kg/bw
-reduced simple CHO
-mod fat 30% of kcal
-2-4g/ day sodium
-fluid as needed
-1200-1500mg/day
-supplement