Hepatic Diseases Flashcards
Mr. Brown, a 58-year-old male with a history of chronic alcohol use, has been diagnosed with cirrhosis and presents with ascites and peripheral edema. His lab results show low serum albumin and elevated INR.
Which dietary recommendation is most appropriate for Mr. Brown to manage ascites?
a) High-protein, high-sodium diet
b) Low-protein, low-sodium diet
c) High-protein, low-sodium diet
d) Low-protein, high-fat diet
c) High-protein, low-sodium diet
Mr. Brown, a 58-year-old male with a history of chronic alcohol use, has been diagnosed with cirrhosis and presents with ascites and peripheral edema. His lab results show low serum albumin and elevated INR.
What is the recommended sodium restriction to manage ascites effectively?
a) 6 g/day
b) 4 g/day
c) 2 g/day
d) 1 g/day
2 g/day
Mr. Brown, a 58-year-old male with a history of chronic alcohol use, has been diagnosed with cirrhosis and presents with ascites and peripheral edema. His lab results show low serum albumin and elevated INR.
Which of the following interventions reduces the risk of hepatic encephalopathy in cirrhosis?
a) Restricting protein to 0.6 g/kg/day
b) Increasing intake of branched-chain amino acids (BCAAs)
c) Providing a low-fat ketogenic diet
d) Administering iron supplements
b) Increasing intake of branched-chain amino acids (BCAAs)
Mr. Brown, a 58-year-old male with a history of chronic alcohol use, has been diagnosed with cirrhosis and presents with ascites and peripheral edema. His lab results show low serum albumin and elevated INR.
What is the preferred method of nutrition support if Mr. Brown becomes unable to meet his nutritional needs orally?
a) Parenteral nutrition with high glucose content
b) Nasogastric tube feeding with high-protein formula
c) Total parenteral nutrition with low-protein content
d) NPO with IV fluids until ascites resolves
b) Nasogastric tube feeding with high-protein formula
Ms. Johnson, a 62-year-old female with decompensated cirrhosis, has been admitted due to altered mental status. She has asterixis and confusion, suggesting Grade II hepatic encephalopathy.
What is the primary nutrition goal for Ms. Johnson during hepatic encephalopathy?
a) Restrict protein to prevent ammonia buildup
b) Maintain adequate protein intake to prevent muscle catabolism
c) Provide a ketogenic diet to reduce glucose metabolism
d) Increase fat intake to replace carbohydrates
b) Maintain adequate protein intake to prevent muscle catabolism
Ms. Johnson, a 62-year-old female with decompensated cirrhosis, has been admitted due to altered mental status. She has asterixis and confusion, suggesting Grade II hepatic encephalopathy.
Which type of protein is best tolerated in patients with hepatic encephalopathy?
a) Casein-based protein
b) Branched-chain amino acids (BCAAs)
c) Soy-based protein
d) Collagen hydrolysates
b) Branched-chain amino acids (BCAAs)
Ms. Johnson, a 62-year-old female with decompensated cirrhosis, has been admitted due to altered mental status. She has asterixis and confusion, suggesting Grade II hepatic encephalopathy.
Which medication is commonly used to manage hyperammonemia in hepatic encephalopathy?
a) Furosemide
b) Lactulose
c) Metronidazole
d) Octreotide
b) Lactulose
Alex, a 45-year-old male with obesity, type 2 diabetes, and dyslipidemia, has been diagnosed with non-alcoholic fatty liver disease (NAFLD). His BMI is 33 kg/m², and his ALT and AST are mildly elevated.
What is the most effective nutrition intervention to improve Alex’s NAFLD?
a) Low-fat, high-protein diet
b) Mediterranean diet with caloric restriction
c) High-fat, low-carb ketogenic diet
d) Gluten-free diet with increased fiber
b) Mediterranean diet with caloric restriction
Alex, a 45-year-old male with obesity, type 2 diabetes, and dyslipidemia, has been diagnosed with non-alcoholic fatty liver disease (NAFLD). His BMI is 33 kg/m², and his ALT and AST are mildly elevated.
What is the target weight loss percentage to improve liver histology in NAFLD?
a) 2-3% of body weight
b) 5-10% of body weight
c) 15% of body weight
d) 20% of body weight
Answer: b) 5-10% of body weight
Alex, a 45-year-old male with obesity, type 2 diabetes, and dyslipidemia, has been diagnosed with non-alcoholic fatty liver disease (NAFLD). His BMI is 33 kg/m², and his ALT and AST are mildly elevated.
Which of the following is a key component of the Mediterranean diet?
a) High intake of saturated fats
b) Emphasis on red meats and dairy
c) High intake of fruits, vegetables, and olive oil
d) Low intake of fiber and legumes
Answer: c) High intake of fruits, vegetables, and olive oil
A 45-year-old patient with cirrhosis and ascites requires dietary management. Which of the following recommendations is most appropriate?
A) Low-protein, low-sodium diet
B) High-protein, low-sodium diet with fluid restriction
C) High-fat, low-sodium diet with increased fluids
D) Low-protein, high-sodium diet with no fluid restriction
B) High-protein, low-sodium diet with fluid restriction
For a patient with hepatic encephalopathy, which of the following dietary interventions is recommended to prevent catabolism?
A) Restrict protein to 0.6 g/kg to reduce ammonia production
B) Provide 1.2-1.5 g/kg of protein, emphasizing plant-based proteins
C) Limit dietary fat to prevent steatorrhea
D) Increase carbohydrate intake to prevent hypoglycemia
B) Provide 1.2-1.5 g/kg of protein, emphasizing plant-based proteins
A patient with non-alcoholic fatty liver disease (NAFLD) is seeking advice on lifestyle changes. Which of the following is the most evidence-based recommendation?
A) Follow a ketogenic diet to reduce fat accumulation in the liver
B) Lose 5-10% of body weight through a calorie-controlled diet
C) Avoid all carbohydrates to prevent insulin resistance
D) Increase saturated fat intake to promote bile production
B) Lose 5-10% of body weight through a calorie-controlled diet
Which of the following vitamins is most likely to be deficient in a patient with chronic cholestatic liver disease?
A) Vitamin C
B) Vitamin B12
C) Vitamin K
D) Vitamin B6
C) Vitamin K
A patient with Wilson’s disease requires dietary modifications to reduce copper absorption. Which of the following foods should be limited?
A) White rice and bananas
B) Shellfish and organ meats
C) Dairy products and eggs
D) Leafy green vegetables and citrus fruits
B) Shellfish and organ meats
52-year-old male with decompensated cirrhosis and ascites
Complains of early satiety and decreased oral intake
Current medications include lactulose and spironolactone
Lab Values:
Albumin: 2.8 g/dL
Sodium: 130 mEq/L
INR: 1.8
Question:
What is the most appropriate nutrition intervention for this patient?
A) Low-protein, high-carbohydrate diet with fluid restriction
B) High-protein, low-sodium diet with small, frequent meals
C) Low-fat, low-sodium diet with oral supplements
D) High-protein, high-sodium diet to prevent hyponatremia
B) High-protein, low-sodium diet with small, frequent meals
65-year-old female with hepatic encephalopathy (grade II) and unintentional weight loss
Currently receiving lactulose to manage ammonia levels
Lab Values:
Ammonia: Elevated
Albumin: 3.0 g/dL
BMI: 22.0 kg/m²
Question:
Which of the following dietary approaches is most appropriate for this patient?
A) Restrict protein to prevent further encephalopathy
B) Provide high-protein diet (1.2-1.5 g/kg) with emphasis on plant-based sources
C) Initiate parenteral nutrition due to poor oral intake
D) Increase dietary fat to provide additional calories
B) Provide high-protein diet (1.2-1.5 g/kg) with emphasis on plant-based sources
40-year-old male with newly diagnosed non-alcoholic steatohepatitis (NASH)
BMI: 32.0 kg/m², reports sedentary lifestyle and high intake of processed foods
Lab Values:
ALT: Elevated
AST: Elevated
HbA1c: 6.3%
Question:
What is the best initial intervention for this patient?
A) Encourage weight loss of 5-10% through a calorie-controlled diet and increased physical activity
B) Recommend a ketogenic diet to improve glycemic control
C) Prescribe a high-protein diet to preserve lean body mass
D) Advise a low-fat, high-carbohydrate diet to reduce liver fat
A) Encourage weight loss of 5-10% through a calorie-controlled diet and increased physical activity
55-year-old female with primary biliary cholangitis (PBC) and vitamin deficiencies
Complains of fatigue and pruritus
Lab Values:
Albumin: 3.5 g/dL
INR: 1.2
Vitamin D: Deficient
Question:
Which of the following interventions is most appropriate?
A) Provide fat-soluble vitamin supplementation and a low-fat diet
B) Increase dietary fiber to reduce pruritus
C) Recommend a low-sodium diet to prevent fluid retention
D) Initiate enteral feeding to prevent malnutrition
A) Provide fat-soluble vitamin supplementation and a low-fat diet
48-year-old male with Wilson’s disease, recently diagnosed
Reports fatigue and mild abdominal discomfort
Lab Values:
Serum copper: Elevated
Ceruloplasmin: Low
AST/ALT: Mildly elevated
Question:
What is the most appropriate dietary modification for this patient?
A) Restrict high-copper foods such as shellfish and organ meats
B) Increase high-protein foods to support liver regeneration
C) Provide a high-zinc diet to promote copper excretion
D) Initiate a gluten-free diet to reduce inflammation
A) Restrict high-copper foods such as shellfish and organ meats
A patient with cirrhosis and ascites has been prescribed spironolactone and furosemide. What is the most appropriate dietary recommendation to manage ascites?
A) Increase fluid and sodium intake to prevent dehydration
B) Limit sodium intake to ≤2000 mg/day and consider fluid restriction if hyponatremia develops
C) Encourage a high-protein, high-sodium diet to support muscle preservation
D) Restrict fluid to 500 mL/day and provide high-carbohydrate meal
B) Limit sodium intake to ≤2000 mg/day and consider fluid restriction if hyponatremia develops
Which of the following is a key goal in the nutrition management of a patient with alcoholic hepatitis?
A) Restrict dietary protein to reduce ammonia production
B) Provide 1.5-2.0 g/kg protein and 35-40 kcal/kg to promote liver regeneration
C) Emphasize a low-fat diet to prevent steatosis
D) Recommend vitamin C supplementation to prevent oxidative stress
B) Provide 1.5-2.0 g/kg protein and 35-40 kcal/kg to promote liver regeneration
A patient with hepatic encephalopathy is not responding well to lactulose therapy. What additional nutritional intervention may be beneficial?
A) Increase protein intake from animal sources
B) Supplement with branched-chain amino acids (BCAAs)
C) Provide a low-protein diet with fat as the main calorie source
D) Limit all dietary fiber to reduce ammonia production
B) Supplement with branched-chain amino acids (BCAAs)
For a patient with non-alcoholic fatty liver disease (NAFLD), which of the following is the most effective dietary strategy?
A) Follow a high-protein, low-carbohydrate diet to prevent insulin resistance
B) Achieve a 7-10% weight loss through calorie reduction and increased physical activity
C) Restrict all sources of fructose to prevent liver fat accumulation
D) Adopt a Mediterranean diet with low fat and high fiber
B) Achieve a 7-10% weight loss through calorie reduction and increased physical activity
Which of the following is a common complication in patients with cholestatic liver disease that impacts nutritional status?
A) Hyperglycemia due to insulin resistance
B) Protein malabsorption due to bile acid deficiency
C) Deficiency of fat-soluble vitamins (A, D, E, K)
D) Iron deficiency due to impaired absorption
C) Deficiency of fat-soluble vitamins (A, D, E, K)
In a patient with primary sclerosing cholangitis (PSC), which nutrient deficiency is most likely to occur?
A) Vitamin B12
B) Vitamin C
C) Vitamin E
D) Folate
C) Vitamin E
A patient with Wilson’s disease requires dietary copper restriction. Which food should be avoided?
A) Beef
B) Legumes
C) Shellfish
D) Citrus fruits
C) Shellf
In patients with cirrhosis and sarcopenia, what is the most appropriate nutritional intervention?
A) High-protein diet with late-night snacks to prevent catabolism
B) Low-fat, high-carbohydrate diet to prevent steatorrhea
C) Low-protein, low-sodium diet to manage ascites
D) Vitamin C and zinc supplementation to prevent oxidative stress
A) High-protein diet with late-night snacks to prevent catabolism
58-year-old female with decompensated cirrhosis and moderate ascites
Complains of fatigue, poor appetite, and early satiety
Medications: Spironolactone, furosemide, lactulose
Lab Values:
Serum sodium: 128 mEq/L
Albumin: 2.5 g/dL
INR: 1.9
Question:
What is the most appropriate dietary intervention for this patient?
A) Low-protein, low-sodium diet with fluid restriction
B) High-protein, low-sodium diet with frequent, small meals and possible fluid restriction
C) Low-carbohydrate, high-fat diet with vitamin supplementation
D) Low-protein, high-sodium diet with oral nutrition supplements
B) High-protein, low-sodium diet with frequent, small meals and possible fluid restriction
47-year-old male with newly diagnosed non-alcoholic steatohepatitis (NASH)
BMI: 35 kg/m²
Reports high intake of refined carbohydrates and sedentary lifestyle
Lab Values:
ALT: 85 U/L
AST: 78 U/L
HbA1c: 6.5%
Question:
Which of the following interventions is most appropriate for this patient?
A) Recommend 7-10% weight loss through calorie reduction and increased physical activity
B) Initiate a ketogenic diet to improve glycemic control and liver health
C) Prescribe a high-protein, low-carbohydrate diet to prevent fatty liver progression
D) Encourage a low-fat diet with vitamin supplementation
A) Recommend 7-10% weight loss through calorie reduction and increased physical activity
63-year-old female with primary biliary cholangitis (PBC) and steatorrhea
Complains of fatigue, pruritus, and unintentional weight loss
Lab Values:
Albumin: 3.1 g/dL
INR: 1.3
Vitamin D: Low
Question:
What is the most appropriate nutritional intervention?
A) Provide fat-soluble vitamin supplementation and medium-chain triglycerides (MCTs)
B) Restrict dietary fat and provide vitamin B12 supplementation
C) Encourage high-fiber diet to alleviate pruritus
D) Limit protein intake to reduce nitrogen load
A) Provide fat-soluble vitamin supplementation and medium-chain triglycerides (MCTs)
50-year-old male with cirrhosis and mild hepatic encephalopathy
On lactulose but experiencing persistent confusion and drowsiness
Lab Values:
Ammonia: Elevated
Albumin: 3.0 g/dL
BMI: 24 kg/m²
Question:
What is the best nutritional intervention for this patient?
A) Restrict protein to reduce ammonia production
B) Provide 1.2-1.5 g/kg of protein with emphasis on plant-based sources
C) Increase carbohydrate intake and limit fat to prevent steatosis
D) Initiate enteral feeding due to poor oral intake
B) Provide 1.2-1.5 g/kg of protein with emphasis on plant-based sources
42-year-old female with Wilson’s disease
Complains of mild fatigue and occasional abdominal pain
Lab Values:
Serum copper: Elevated
Ceruloplasmin: Low
Question:
What dietary change should be prioritized?
A) Increase zinc intake to promote copper excretion
B) Reduce intake of high-copper foods such as shellfish and organ meats
C) Limit protein intake to prevent further liver damage
D) Encourage vitamin C supplementation to support antioxidant activity
B) Reduce intake of high-copper foods such as shellfish and organ meats
55-year-old male with alcoholic cirrhosis and sarcopenia
Experiencing significant muscle wasting and fatigue
Lab Values:
Albumin: 2.9 g/dL
Sodium: 135 mEq/L
INR: 1.5
Question:
What is the most appropriate nutritional intervention for this patient?
A) Provide a high-protein diet (1.5-2.0 g/kg) with late-night snacks
B) Restrict protein to prevent hepatic encephalopathy
C) Limit fat intake and increase carbohydrate consumption
D) Initiate parenteral nutrition due to sarcopenia
A) Provide a high-protein diet (1.5-2.0 g/kg) with late-night snacks
