Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor

Multiple Choice Questions

« Return to contents list

Question 1 A 23-year-old male was involved in a major motor vehicle accident 1 year ago and had to undergo extensive bowel resection. He has been left with just 50 cm of small bowel. He remains on TPN for nutritional support. Routine lab testing reveals bilirubin 3.5 mg/dL, AST 120 IU/L, ALT 14 IU/L, alkaline phosphatase 485 IU/L, and INR 1.2. Viral hepatitis serologies are negative. Ultrasound abdomen reveals sludge in the gallbladder, with normal common bile duct.

What is the most appropriate next step?

A. Stop TPN and attempt enteral feeding

B. Decrease the lipid content of the TPN

C. Decrease the calories from dextrose in the TPN

D. Consider choline supplementation

E. All of the above