Hepatobiliary

Question 1

Average alcohol content of beer

Answer 1

3.8%. 12oz. in serving

Question 2

Average alcohol content of unfortified wine

Answer 2

12-14%. 5oz.

Question 3

Average alcohol content of fortified wine?

Answer 3

Brandy, sherry, port 20%. 1.5 oz. in a serving

Question 4

Average alcohol content of distilled liquor

Answer 4

80 proof is 40%. 1 proof = .5%

Question 5

Conversion factor for mL to oz.

Answer 5

30mL = 1 oz.

Question 6

How to determine the grams of alcohol in a drink

Answer 6

X oz. × 30mL/oz. = YmL × Z% alcohol content = grams of alcohol

Question 7

Functions of the liver

Answer 7

CHO, lipid, protein, enzyme, vitamin, and bile acid metabolism. Heme metabolism. Storage.

Question 8

Liver function in carbohydrate metabolism

Answer 8

Glycogenesis, gluconeogenesis, oxidation via TCA cycle, glycogenolysis, glycolysis

Question 9

direct bilirubin

Answer 9

aka. conjugated bilirubin. 0.1-0.3mg. Indicates biliary tree obstruction

Question 10

hemolytic jaundice

Answer 10

Pre-hepatic. Increased destruction of RBCs with rapid release of bilirubin into the blood. Urine is dark, but the stool is normal in color because there is nothing wrong with the liver.

Question 11

hepatic jaundice

Answer 11

Decreased uptake of bilirubin &/or decreased liver function. Caused by damaged hepatocytes.

Question 12

post-hepatic jaundice

Answer 12

aka. obstruction jaundice. Obstruction of the bile ducts, which prevents excretion of bilirubin into the GI. Urine is dark, stools will be pale because bile is not reaching the GI tract.

Question 13

indirect bilirubin

Answer 13

aka unconjugated bilirubin. 0.1-0.5mg. Indicates RBC hemolysis or liver damage

Question 14

What lab values will be elevated in liver disease

Answer 14

Serum & urine bilirubin. Prothrombin time. ALT. AST. Alkaline phosphatase

Question 15

Prodromal period of hepatitis

Answer 15

Before jaundice occurs.

Question 16

Symptoms of the prodromal stage

Answer 16

Anorexia, fatigue, N/V

Question 17

Acute fulminant hepatitis

Answer 17

↓ gluconeognesis. Fluid & electrolyte imbalance. Prolonged PTT. Bilirubin > 20 mg/dL

Question 18

Medical treatment of Hepatitis

Answer 18

Bedrest. Corticosteroids. 3-MU Interferon α-2B. Rebetol.

Question 19

3-MU Interferon α-2b

Answer 19

parenteral antiviral - blocks translate of viral DNA

Question 20

Rebetol

Answer 20

RNA.e analog that inhibits replicate of Hepatitis C

Question 21

What are the nutritional implication of hepatitis?

Answer 21

Weight loss and nutritional deficiency

Question 22

What nutrients are needed for liver regeneration

Answer 22

High calorie, high CHO, 1.5-2g protein. Restrict fat if it causes N. Vitamins and minerals 2xRDA. No alcohol.

Question 23

Hepatic steatosis

Answer 23

fatty liver, stage 1 of alcoholic liver disease. AST and ALT elevated. Benign and reversible. Increase in mobilization of fatty acids. ↓ in fatty acid oxidation; ↑ i triglyceride production; triglycerides are trapped in liver.

Question 24

Alcoholic hepatitis

Answer 24

May be caused by a binge

Question 25

Alcohol metabolism

Answer 25

EthOH is absorbed throughout GI tract. Ethanol →Acetaldehyde →Acetate

Question 26

What are the two major enzyme systems that process alcohol?

Answer 26

Alcohol dehydrogenase. Microsomal ethanol oxidizing system (MEOS).

Question 27

Effect of alcohol on folic acid nutriture?

Answer 27

Consume folate deficient diets. Absorption is impaired - reduced carrier. Binds folate in the hepatocyte & decreases enterohepatic circulation of folate.

Question 28

Effect of alcohol on Thiamin status?

Answer 28

Thiamin deficient diet. Decreased uptake of thiamine from the GI. Impaired thiamin utilization. Activity level of 3-transketolase enzymes are ↓ - thiamin cannot be converted to TPP.

Question 29

MNT for Alcoholic hepatitis

Answer 29

Treat withdrawal symptoms. Correct deficiencies. Multivitamin and mineral.

Question 30

What micronutrients should be supplemented in Alcoholic hepatitis?

Answer 30

Thiamin 50-100mg/day - 14 day. Folic acid - 1mg. Vit C - 175-500mg. D 200-500IU. Selenium 5-50mcg. Mg - 100-400mg. All other RDA.

Question 31

What factors contribute to increased ammonia?

Answer 31

Normal: 19-60 µg/dL. AA form ammonia after deamination. Urine output is decreased & BUN (10-20mg/dL) is retained. ↓ hepatic function causes decreased urea production. ↓ urea synthesis leads to ↑ ammonia

Question 32

MNT for cirrhosis

Answer 32

Diruetic. Soft diet - varices. Moderate Na. 1-1.5g protein. 35-40kcal/kg. CHO spread out through day. Multi 2x RDA.

Question 33

Serum lipase

Answer 33

0-110 U/L. Usually rises 24-48 hours after onset of pancreatitis, remain elevated for 5-7 days. Preferred lab for diagnosis.

Question 34

Serum amylase

Answer 34

25-125 U/L. Highly sensitive but low specificity. Return to normal within 48-72 hours after acute insult - may remain normal in some pt.

Question 35

Medical treatment for pancreatitis

Answer 35

Aggressive hydration. H2-receptor antagonists. Somatostatin - inhibits release of pancreatic secretions.

Question 36

MNT for mild pancreatitis

Answer 36

Oral feeding of low-fat diet.

Question 37

MNT for sever acute pancreatitis

Answer 37

Early EN - 24-48 hours - assists with prevention of infectious complications. Continuous associated w/ less stimulation of pancreas. Small peptides, fat-fee chemically defined formula

Question 38

Should immune nutrition be used in pancreatitis?

Answer 38

No evidence to support its use. However, glutamine is indicated if PN used.