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ANS: B: Fatty liver is the earliest form of alcoholic liver disease. Alcohol abuse does not cause diarrhea or cholecystitis. Viral hepatitis is caused by viral infection.

ANS: D: Fatty infiltration of the liver can be reversed by removing the underlying cause. This may be alcohol abuse, excessive kcal intake, obesity, complications of drug therapy (e.g., corticosteroids, tetracyclines), total parenteral nutrition, pregnancy, diabetes mellitus, inadequate intake of protein (e.g., kwashiorkor), infection, or malignancy. Losing weight and reducing fat intake will only help if the underlying cause for that individual is related to weight and fat intake. Increasing protein intake will only help if the cause is kwashiorkor.

ANS: A: hepatitis A is transmitted via the fecal-oral route. Hepatitis B and D are transmitted parenterally or sexually. Hepatitis C is transmitted via blood or serum (sharing of contaminated needles, razors, toothbrushes, nail files, barber's scissors, tattooing equipment, body piercing, or acupuncture needles).

ANS: A: All types of hepatitis cause jaundice. Hepatitis E causes flu-like aches and pains, including headache. Dehydration may occur if patients have nausea and vomiting.

ANS: C: Total abstinence from alcohol is imperative for patients with hepatitis. The diet should be high in protein and kcals; supplemental electrolytes are not generally needed.

ANS: B: Hepatitis E is transmitted via the fecal-oral route; food prepared by infected food handlers may transmit the disease. Raw fruits and vegetables (e.g., fruit salad) are common sources of infection. Foods that are cooked, such as curried shrimp and Tandoori chicken, and foods prepared by street vendors, are not common sources.

ANS: C: Patients with hepatitis often have very little appetite, which makes it hard for them to achieve adequate oral intake of nutrients. Patients with hepatitis do not usually have problems with malabsorption, fat intolerance, or increased metabolic rate.

ANS: D: In cirrhosis of the liver, liver cells are replaced by accumulations of fibrous connective tissue and fat. The cells die, so they do decrease in number, but do not increase in size. Liver tumors are caused by cancer, not cirrhosis. Cirrhosis does not cause breakdown of connective tissue.

ANS: C: A low-fiber, soft diet is recommended for patients with esophageal varices because fibrous or abrasive foods could cause potentially life-threatening bleeding. Patients with hepatitis A should follow a high-protein, high-kcal diet; patients with cholelithiasis should follow a low-fat diet; patients with hepatic encephalopathy should restrict their protein intake.

ANS: B: Patients with ascites should restrict their intake of sodium to limit fluid retention. Protein intake should not be restricted unless the patient has encephalopathy. Dietary fiber intake should only be limited if the patient has esophageal varices. Intake of saturated fat does not need to be limited.

ANS: D: If a patient with cirrhosis of the liver becomes confused and apathetic, he or she may be developing hepatic encephalopathy, as the brain is influenced by compounds that have been absorbed from the intestine and have not been metabolized by the liver. Fatty liver develops first, before progression to cirrhosis. Any form of hepatitis can lead to cirrhosis, but cirrhosis does not cause hepatitis. Depression may cause apathy, but does not usually cause confusion.

ANS: C: Neomycin is an antibiotic used to sterilize the bowel to decrease the amount of urea that can be converted to ammonia. Lactulose is used to lower stool pH which traps ammonia in the colon. Antidepressants are ineffective because the mental problems associated with encephalopathy are related to metabolism rather than depression. Diuretics are used to treat ascites associated with cirrhosis, but are not used for encephalopathy. Steroids are not effective. Lactulose is used to lower stool pH, not for its laxative and stool softening effects.

ANS: C: Someone who drinks 1-2 drinks per day is considered a moderate drinker. A heavy drinker consumes 3 or more drinks daily. A light drinker is not defined. Alcoholism is a disabling addictive dependence on alcohol, usually characterized by intake of significantly more than 1-2 drinks daily.

ANS: D: Moderate alcohol intake may help reduce risk of heart disease. Risk of many types of cancer increases with increasing alcohol intake. Risk of hypertension increases with alcohol intake. Risk of stroke is not linked to alcohol intake.

ANS: D: Patients who are vulnerable to development of hepatic encephalopathy may be given a formula that contains branched-chain amino acids and restricted aromatic amino acids to ensure adequate protein intake with minimal ammonia production. Essential fatty acids and essential amino acids do not help prevent hepatic encephalopathy.

ANS: A: adequate intake of kcals helps prevent breakdown of muscle to provide energy in patients with cirrhosis of the liver. Adequate kcal intake does not prevent ascites, essential fatty acid deficiency, and loss of appetite and taste acuity.

ANS: C: Patients with end-stage liver disease often accumulate fluid due to ascites and edema. This increases body weight, which may mask fat and muscle losses. Patients with end-stage liver disease are not usually dehydrated and do not usually have electrolyte imbalances. Fat infiltrates the liver but is not otherwise redistributed in the body.

ANS: D: Long-term nutrition management after a liver transplant needs to be tailored to help prevent excessive weight gain, hypertension, and hyperlipidemia. Weight loss, anorexia, and nausea do not usually occur. Ascites, edema, and electrolyte imbalances may occur immediately after the transplant, but do not usually persist long term. Cirrhosis, hepatic encephalopathy, and hepatic coma do not occur after a successful transplant.

ANS: D: Rapid weight loss increases risk for gallstones, so a mother who has lost 25 pounds in the past 3 months could easily develop gallstones. Underweight, regular exercise, smoking, and eating eggs do not increase risk for gallstones. Overweight increases risk for gallstones, but less than rapid weight loss.

ANS: A: Cholecystitis occurs when gallstones block the cystic duct or as the result of stasis, bacterial infection, or ischemia of the gallbladder. Concentration of bile in the gallbladder causes cholelithiasis, or formation of gallstones. Failure of the gallbladder to contract and release bile may lead to gallstone formation; this may be caused by very low fat intake or dieting. Intake of excessive amounts of cholesterol and fat and bacterial infection are not associated with gallbladder disease.

ANS: A: A low-fat diet is used to treat painful symptoms associated with cholelithiasis and cholecystitis. Gradual weight loss may be beneficial in the long term, but will not decrease painful symptoms. Increased fluid intake and a low-cholesterol diet do not alleviate symptoms.

ANS: C: After cholecystectomy, long-term dietary restrictions are not needed. Some patients need to restrict fat intake for a few weeks during recovery, but not long term. High protein and fluid intakes and small, frequent meals are not needed.

ANS: B: Pancreatitis causes decreased production of digestive enzymes and bicarbonate, causing malabsorption of fats and proteins. Duodenal ulcers do not occur. Pancreatitis affects mainly the exocrine pancreas, so blood glucose levels are unaffected.

ANS: D: During acute episodes of pancreatitis, patients often need enteral nutrition infused into the jejunum, further down the gut than would cause pancreatic stimulation. An oral feeding can cause pancreatic stimulation and acute pain.

ANS: A: Enteral feedings for patients with pancreatitis should be low-fat elemental formulas infused into the jejunum to decrease pancreatic stimulation. High-kcal, high-protein formulas and infusion into the duodenum would both increase pancreatic stimulation.