1. a replication of hepatitis B and can be

      1.   Why doesportal hypertension occur secondary to cirrhosis? What is ascites? Pg. 568 Portal hypertension occurssecondary to cirrhosis in the human body due to an increase in blood flow. Thiscondition results in varices, which are swollen veins (1). Ascites are theaccumulation of fluids within the abdominal region and occurs because of liverdisease (1).       2.   What are each of theseconditions? Pg.

577, 579  a. Cholangitis à It is known as the inflammation of the bile ducts (1). A crucial precaution of observing this condition is that is could result in sepsis and liver failure, therefore healthcare professionals must assess and monitor adequately (1). b.

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Cholecystitis à It is known as the inflammation of the gallbladder, a condition caused by gallstones obstructing the bile ducts (1). c. Choledocholithiasisà refers to the presence of gallstones in the bile duct (1). d. Cirrhosis à refers to the scarring and damage of the tissue of the liver (1).

       3.   What are the differenttypes of hepatitis you might see in a hospitalized patient? How is eachtransmitted and treated? Pg. 564      I.         Hepatitis A à are transmitted viafecal-oral route, i.e. in contaminated water, food supplies, and sewage (1).

Currently,there is no treatment or “cure” for Hep. A    II.         Hepatitis B and Càare transmitted viablood, blood products, semen, and saliva (1). It is treated through a series ofantiviral medications. III.         Hepatitis D à are transmitted via areplication of hepatitis B and can be transmitted through contact blood or anybodily fluids (1). Currently, no effective medication are used to treat Hep D.

  IV.         Hepatitis E à is transmitted incontaminated water via fecal matter and is treated with medication (ribavirin ~approx. 21 days) (2).      4.

   What is Wernicke’sencephalopathy and what nutrient deficiency might lead to it? Pg. 574 Wernicke’s encephalopathyis a serious neurological condition that can result from a vitamin B-1 (thiamin)deficiency (1) and is more prevalently seen in alcoholics.          5.   Consumption of whatfoods when eaten by a patient with cholecystitis, may cause pain?Consumption of what foodswhen consumed by a patient with chronic pancreatitis, may cause symptoms toworsen? Pg. 579, pg. 582 Individuals with chroniccholecystitis are required to follow a long-term and low-fat diet (1) due tothe gallbladder disorder which affects how fat is digested and absorbed.

If alow-fat diet is not monitored patients may feel discomfort and experience flatulenceand or bloating (1). Consumption of foods highin fats in patients with chronic pancreatitis may cause the symptoms to worsen(1). Malabsorption of fats may be seen in a condition called steatorrhea (1). Alongwith limiting the consumption of foods high in fat, patients are also requiredto abstain from consuming alcohol (1).    6. What do each of these lab tests tell us about the liver? Pg.

561            a. Serum alkaline phosphatase à increased levels ofthis suggest the condition of cholestasis (1).           b. Direct serum bilirubin à Liver damage is an indicatorof increased direct serum bilirubin (1).            c. Alanine aminotransferase à is an enzyme locatedin the cytosol of the hepatocyte that indicated cell damage (1).           d. Prothrombin time à This serum protein indicates a vitamin K deficiency,a consequence of a decrease in this serum increases risks of bleeding (1).

 7. What is steatorrhea and why is it seen in a patient with pancreaticinsufficiency?  Steatorrhea is defined asthe presence of fat in the stool, most commonly seen in patients with cirrhosis(1). Steatorrhea is seen in patients with pancreatic insufficiency because ofan injury or obstruction of the bile duct, thus causing fatty stools (1).  8. Why are children with CF often very thin? What can be done to helpthem with their weight? Pg. 683-685 Children suffering from CFare often thin due to the defect in transportation of chloride, sodium, andbicarbonate (1). Such defect in transportation produces thick and stickysecretions that may disrupt how nutrients are being absorbed in the pancreas,liver, and intestines (1). Also, due to the increased susceptibility of chroniccough, dyspnea, and respiratory complications children suffering from CF will exhibita variety of complications such as growth failure, increased caloric/energyneeds and malabsorption (1) leading to a thin complexion.

Health carepractitioners will address and correct the malabsorption and maldigestion inhopes to correct the weight discrepancy (1). 9. What should be avoided in the diet of an individual with Wilson’sdisease? Why? In the initial stages oftreating Wilson’s disease, meals/ supplements containing copper should beavoided (1).   10. In liver disease, which factor(s) affect the interpretation of serumalbumin values? Testing serum albumin levelsare an indicator of assessing plasma oncotic pressure (1). If a patient is assessedfor low serum albumin, it indicative of liver failure such as cirrhosis (1).

  11. Why is enteral nutrition is preferred over parenteral nutritionwhen treating patients with severe, acute pancreatitis? Pg. 582 Enteral nutrition ispreferred over parenteral nutrition when treating patients with severe acutepancreatitis because enteral nutrition reduces the incidence of septicinfections and complications (1). Along with lowering morbidity and mortalityassociated with septic infections, enteral nutrition also proves to be costefficient (1) in terms of length of stay at the hospital (1). For most patients,enteral nutrition is better tolerated as it is placed as the jejunal feedingsand increases how nutrients are being absorbed (1).  12. What should be included in the nutrition care plan for a patient inthe acute post liver transplant phase? Pg. 575 A major nutrient ofconcern after liver transplant is protein and energy needs.

Health carepractitioners, especially registered dietitians will advise the patient to eatsmall, frequent, and nutrient dense foods (1). A patient in the acute postliver transplant phase will be required to monitor nitrogen requirements (1).Along with protein, nitrogen, and energy needs, the health care practitionerswill monitor: protein, fat, CHO, sodium, fluid intake, calcium as a precautionto lower the risk of problems such as obesity, hyperlipidemia, hypertension,diabetes mellitus, and osteopenia (1).      13. What is the relationship with BCAA and hepatic encephalopathy? Pg.569 The relationship betweenBCAA and hepatic encephalopathy is the protein intolerance as branched-chainamino acids are crucial as they provide thirty percent of energy that isrequired for skeletal muscle, heart and brain to function properly (1).  Depending on the release of plasma amino acidsresult in how much is released into circulation and taken up by the muscles andliver (1).

Studies demonstrate a correlation in the ratio of branched-chainamino acids and plasma amino acids and the development of hepaticencephalopathy (1).   14. Explain Ranson’scriteria. Pg. 580 Ranson’s criteria is anassessment to classify the severity of the condition pancreatitis (1). This is consistingof the following parameters: –  Age of 55 or older- White blood cell count>16,000m^3-Blood glucose level >200mg/100Ml-Lactic dehydrogenase >350 units/L-Aspartate transaminase >250 units/l(1) 15. What can be done for a patient with chronic pancreatitis to minimizesteatorrhea? Pg. 582 Health care practitionerswill attempt to lower frequency of steatorrhea through minimizing the stimulationof CCK levels in pancreas by recommending a lower fat diet (1).

This will allowfor proper enzymatic reactions to take place and lower the incidence of malabsorptionof protein and fat (1).  16. These drugs are commonly given following liver transplant. What arethe nutrition-related side effects you might have to deal with as an RD for apatient using: Pg. 725, 794-795  a. Azathioprine? à causes loss of appetite, nausea or vomiting (1) b. Cyclosporine? à causes loss of appetite and nausea (1) c. Glucocorticoid? à causes negative nitrogen balance, hypercalciuria and risks for deficiencies in calcium and vitamin D (1).

d. Tacrolimus? à  cause accelerated protein catabolism, hyperlipidemia, sodium retention, weight gain, osteoporosis, and electrolyte disturbances (1).           17. Seek out some credible information on the herbal supplements MilkThistle in relation to liver disease. Would you recommend it to a family memberor close friend? Why or why not? Pg. 574 Milk thistle is used inrelation to liver disease because of its ability to reduce free radical production(1).

 Despite its poplar use, there islittle to no evidence suggesting the effectiveness and benefits on individualswith liver disease (1). Because there is no solid evidence suggesting thebenefits or contraindications, as a registered dietitian I would not recommendto a family member or a close friend. 18. A patient wants to try a liver cleanse to treat hepatitis. How doyou respond? Pg. 564 As a healthcare practitionerI would not advise a patient to try a liver cleanse to treat hepatitis becauseof the serious complications that may arise. Depending which type of hepatitisthe patient is suffering from will dictate the treatment (1). I will educatethe patient on the different forms of hepatitis and the treatments for each ones.

  19. Describe each of the following: pg. 583, 569, 577            a. Shunt placementà is a surgical procedurethat relieves the pressure on the brain cause by fluid accumulating (***)            b. Whipple procedure à also called pancreaticoduodenectomy,a surgical procedure that is used when a patient is suffering from pancreaticcarcinoma (1).

It refers to the removal of the head of the pancreas and theduodenum (1).           c. Paracentesis à refers tothe procedure in which a needle is inserted to remove excess fluids from the peritonealcavity (1)           d. Shock-wave lithotripsy à is a surgicalprocedure that destroys kidney stones (1) by sending shock waves to the kidneys.  20.

A patient has to gether gall bladder removed and is worried that she will never be able to eat foodthat contains fat again. How do you respond?  As a registered dietitian Iwould emphasize on the importance of avoiding an excess amount of fats in thediet, however, I would educate the patient that she can consume small andadequate amounts of fat in her diet and that there is no need to be concerned. Asan RD I will educate the patient on foods to avoid GI tract distress such as bloating,diarrhea, abdominal cramps, and flatulence. Such foods as spicy and high-fatand processed food groups as red meats, starchy vegetables like potatoes.