CHRONIC LIVER DISEASE-MAJ Frisbie

Chronic Liver Disease-MAJ Susan Frisbie
1. Which of the following statements is true about Hepatitis B?
a) It has a high maternal mortality rate in pregnancy
b) Women usually do well during pregnancy if on prophylactic medication
c) All medication for active Hepatitis B is postponed during pregnancy
d) Pregnancy risks include gestational diabetes and preterm labor

- a) HBV status usually has no affect on pregnancy (Palmer, 2004)
- b) no prophylaxis med indicated(Gambarin-Gelwan, 2007)
- c)Telbivudine, FDA approved, Category B classification(Gambarin-Gelwan, 2007)
- d) CORRECT

2. Pregnancy risk/s for chronic Hepatitis B include:
a) gestational diabetes and preterm labor
b) low birth weight
c) fetal liver failure
d) preterm delivery

- a) CORRECT
- b) has not been found statistically significant (Gambarin-Gelwan, 2007)
- c) viral hepatitis does not acutely affect the fetus (Gambarin-Gelwan, 2007)
- d) has not been found statistically significant (Gambarin-Gelwan, 2007)

3. Ms. Hepavirus is requesting combined oral contraceptives (COC). She tested positive for Hepatitis C 6 months ago on a routine employment physical, has had no complications, normal liver function tests and is asymptomatic. As the Advanced Practice Nurse you explain to her:
a) A copper IUD is a safe method
b) COC’s are an absolute contraindication
c) COC’s with a synthetic estrogen is more easily metabolized
d) Twenty percent of Hepatitis C positive patients experience acute liver failure after 5 years of COC’s

- a) CORRECT
- b) Women with mild disease can safely use hormonal contraception (WHO, 2009)
- c) Synthetic estrogen, Ethinylestradiol, is more potent and remains in the blood longer and has a greater effect on the liver (WHO, 2009)
- d) Limited data from studies suggest that COC use does not affect the rate of progression (Kapp, Tilley, & Curtis, 2009)


4. Chronic liver disease affects female and male fertility by:
a) Interfering with estrogen and androgen metabolism
b) Producing auto antibodies against gametes
c) Decreasing SHBG in cirrhosis
d) Causing hepatocytes to produce excess androgens

- a) CORRECT
- b) auto antibodies are produced in liver failure associated with an autoimmune component and the anti bodies destroy the liver, not the gametes
- c) SHBG is increased in severe liver disease (Sussman, Chudnovsky, & Niederberger, 2008)
- d) hepatocytes do not produce androgens, the adrenal glands and gonads produce androgens

5. Women during pregnancy with Wilson’s disease are at risk for recurrent miscarriages r/t:
a) Increased copper deposition in the uterus
b) Inhibition of SHBG production r/t auto antibodies
c) Thickening of the placenta r/t increased zinc deposition
d) Ectopic tumor production of oxytocin

- a) CORRECT
- b) People with Wilson’s disease cannot release copper from the liver at a normal rate r/t mutation it the gene ATP7B and the excess copper is released in the bloodstream and travels to other organs ( Theodoridis, 2009)
- c) Wilson’s disease is not related to zinc and Wilson’s disease affects the uterus not the placenta. People with Wilson’s disease cannot release copper from the liver at a normal rate r/t mutation it the gene ATP7B and the excess copper is released in the bloodstream and travels to other organs ( Theodoridis, 2009)
- d) Wilson’s disease is not an ectopic tumor. People with Wilson’s disease cannot release copper from the liver at a normal rate r/t mutation it the gene ATP7B and the excess copper is released in the bloodstream and travels to other organs ( Theodoridis, 2009)












1) d 2) a 3) a 4) a 5) a