Test your basic knowledge |

Nutrition Diagnosis

Subjects : health-sciences, nursing, health-fitness-nutrition

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Imbalance of nutrients
High BUN - High BGL - High liver enzymes - Weight gain - Edema
Weight Loss - dx: AIDS - TB - AN
Low serum vitamin levels - Physical signs of deficiency - Diet hx of low intake
Diet hx of high intake - Diarrhea - Constipation - GI distress

2. What is Dysphagia Nutritional Therapy?
Renal disease or liver disease - Limit protein - Limit potassium - phosphorus - Sodium and Fluid restrictions - Emphasizes high biologic value - Minimum level of CHOs needed to spare protein
Individualized diets based on swallowing ability and food preference - Evaluate ability to swallow solids and liquids: often done by speech therapist who can also aid in teaching the patient swallowing techniques - Features of food to consider and mo
Technical complications - Pneumothorax - Septic complications - Local or systemic - Metabolic complications - Most common complication - Most common is hyperglycemia
Anthropometric data -Clinical data -Dietary intake assessment

3. Excessive fiber intake
Indirect calorimetry measurement - Vitamin/mineral abnormalities in lab values - Inadequate weight gain - or unintentional weight loss Clinical evidence of vitamin/mineral deficiency
Diet hx of xs fiber intake - GI distress
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH
Socioeconomic status -comorbid disease states -Age adults: =< 75 children<5 PHYSICAL -stress and trauma- metabolic demands -mechanical ventilation-unable to eat -therapeutic bowel rest

4. What is Carb-controlled Diet?
CHO 55-60% - protein 10-20% - lipid <30% - fiber 20-35 grams - Evaluate glucose levels - serum lipids - kcalories - diet - insulin/medication
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance
Low serum osmolality - Weight gain - Edema - Excess salt intake
Elevated BUN:creatinine ratio - Hyperglycemia - Hypercapnia - Elevated liver enzymes - Weight gain - Edema - Meds that reduce energy requirements or impair metabolism

5. What is Mechanically Altered Diet?

6. What are the feeding modalities?
Abnormal liver enzymes - Fatty liver - Weight gain/loss - Edema
TJC requires screenings within 48hrs
Low cholesterol - Weight loss - Poor dentition - Self-feeding problems - Inadequate nutrition support
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days

7. What are the Carb and Protein Parenteral Nutrition Solutions?
High serum vit. A -D -K - B6 - niacin - Physical signs of excess - Diet hx
Low serum vitamin levels - Physical signs of deficiency - Diet hx of low intake
Carbohydrate - Dextrose solutions - Available in initial concentrations of 5% to 70% - Mixed with amino acids and other nutrients to form the final solution - Protein - Mixture of essential and nonessential crystalline amino acids - Available wi
Prealbumin- (visceral protein status) Normal Value: 16-40 g/dl Compromised Protein status: 10-15 g/dl Possible protein malnutrition: <10 g/dl

8. What is the classifications of BMI and numbers?
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Indirect calorimetry measurement - Vitamin/mineral abnormalities in lab values - Inadequate weight gain - or unintentional weight loss Clinical evidence of vitamin/mineral deficiency
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30
Low cholesterol - Low Ca - High PTT - Low Cu/Zn/Fe - Weight loss - Dehydration

9. Inadequate oral food/ beverage intake
Weight loss (5% in 1 month; 10% in 6 months) - Increased activity - dx: Parkinsons - cerebral palsy - dementia
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
Potential to become malnourished

10. What else do you check with biochemical tests?
Weight loss (5% in 1 month; 10% in 6 months) - Increased activity - dx: Parkinsons - cerebral palsy - dementia
Potential to become malnourished
CHO 55-60% - protein 10-20% - lipid <30% - fiber 20-35 grams - Evaluate glucose levels - serum lipids - kcalories - diet - insulin/medication
Anthropometric data -Clinical data -Dietary intake assessment

11. What are the complications of Parenteral Nutrition?
Technical complications - Pneumothorax - Septic complications - Local or systemic - Metabolic complications - Most common complication - Most common is hyperglycemia
High/low BGL - Meds (steroids) - Diet hx
Diet hx of low fiber intake - Constipation/low stool volume
Underweight-bmi<18.5 normal- 18.5-24.9 overweight-25.0-29.9 obese- bmi>30

12. What is Protein-Controlled Diet?
Renal disease or liver disease - Limit protein - Limit potassium - phosphorus - Sodium and Fluid restrictions - Emphasizes high biologic value - Minimum level of CHOs needed to spare protein
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO

13. Less than optimal parenteral infusion
Diet hx of xs fiber intake - GI distress
Management of malabsorption - chronic pancreatitis - gallbladder disease - Medium chain triglycerides (MCTs) utilized with high intake of CHO and protein - Easy to digest - Restricts - High fat - additional fat in cooking - Enzyme replacement may be
Diet hx of low fiber intake - Constipation/low stool volume
Abnormal liver function tests - Abnormal levels of nutrient - Weight gain or weight loss - Edema - Nausea - Intolerance

14. Inadequate protein-energy intake
Encourage patient to think/talk about food before meals - Can help stimulate flow of saliva - Aids in formation of bolus - Chewing and swallowing process - Tart or sour foods - Stimulate saliva production - Have patient lick jelly from the lips - puc
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Before Putting anything in - Radiography - pH of aspirated fluids - Air injection and ausculation - Visual assessment of aspiration
Diet hx of xs fiber intake - GI distress

15. How long should Nutritional screenings be done to residents being admitted?
Diet hx of low fiber intake - Constipation/low stool volume
14 days of admission
Kcal count -24 hr recall -Food records
Diet hx of low intake

16. What is the long-term nutritional biochemical analysis? What are the values?
Diet hx of low plant food intake
Potential to become malnourished
Serum Albumin- (visceral protein status) Normal Value: 3.5-5 g/dl 2.8-3.5- compromised protein status <2.4- possible protein malnutrition
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term

17. Why are dietary adjustments sometimes necessary?
Allows body to heal -To prepare diagnostic test -To prepare Surgical Procedure
Management of malabsorption - chronic pancreatitis - gallbladder disease - Medium chain triglycerides (MCTs) utilized with high intake of CHO and protein - Easy to digest - Restricts - High fat - additional fat in cooking - Enzyme replacement may be
Carbohydrate - Dextrose solutions - Available in initial concentrations of 5% to 70% - Mixed with amino acids and other nutrients to form the final solution - Protein - Mixture of essential and nonessential crystalline amino acids - Available wi
High liver enzymes - Constipation - Diarrhea - CV changes - High intake of supplements/plant foods

18. How do you manage TPN?

19. Excessive vitamin intake
Based on - Patient's digestive and absorptive capabilities - Metabolic requirements - Need for fluid restriction - Done in conjunction with dietician who will calculate patients individual nutritional need and develop plan to initiate feedings
Reports or observations of energy intake less than needs - Projected change in ability to procure or consume adequate energy - Knowledge deficit - Projected increase in physical activity
Diet hx of aberrant CHO intake - Steroids - DM - Inborn errors
High serum vit. A -D -K - B6 - niacin - Physical signs of excess - Diet hx

20. What are the assessments for Enteral Feedings?
Caused by disease
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
Socioeconomic status -comorbid disease states -Age adults: =< 75 children<5 PHYSICAL -stress and trauma- metabolic demands -mechanical ventilation-unable to eat -therapeutic bowel rest

21. What is Soft Diet?
Common for this diet to be ordered postoperatively - Permits patient's preferences and situations to be taken into consideration - Also allows for postoperative diet progression at the patient's tolerance
High serum vit. A -D -K - B6 - niacin - Physical signs of excess - Diet hx
Foods that are easy to chew - digest - and absorb - Used during transition from liquid diets to regular or general diets - Foods low in fiber - Only lightly seasoned - Not appropriate for patients requiring mechanical soft diets
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings

22. Predicted Suboptimal Nutrient Intake
Low serum osmolality - Weight gain - Edema - Excess salt intake
CHO 55-60% - protein 10-20% - lipid <30% - fiber 20-35 grams - Evaluate glucose levels - serum lipids - kcalories - diet - insulin/medication
Management of malabsorption - chronic pancreatitis - gallbladder disease - Medium chain triglycerides (MCTs) utilized with high intake of CHO and protein - Easy to digest - Restricts - High fat - additional fat in cooking - Enzyme replacement may be
Biochemical parameters indicating suboptimal nutrient intake - Estimated intake less than needs - Cultural or religious practices - Knowledge deficit - Meds affecting appetite

23. How do you monitor response for enteral treatment?
Low serum osmolality - Weight gain - Edema - Excess salt intake
Weight status and trends - BUN - creatinine - serum chemistries - proteins - Fluid status - intake and output
Diet hx of high intake - Diarrhea - Constipation - GI distress
Pudding Thick - Consistency of applesauce or smooth mashed potatoes - Most restrictive - Used with severe levels of dysphagia in which oral intake is still allowed - May require IV hydration - Necessary to closely monitor fluid intake to prevent dehy

24. How long does TJC require resident screenings to be done during admission?
IV lipid emulsions - Used as a concentrated energy source and to prevent the development of essential fatty acid deficiency - Kcal density of lipid solutions is useful when volume restriction is necessary
Low chol - alb - prealb - elytes/minerals - vitamins - Weight loss - Low BMI - Diet hx of low intake - fever - dx: Crohn's - AIDS - burns
Diet hx of aberrant CHO intake - Steroids - DM - Inborn errors
TJC requires screenings within 48hrs

25. What are the Dietary Evaluations?
GI problems - Diarrhea - Nausea and vomiting - Cramping - Distention - Constipation - Mechanical complications - Tube displacement - Tube obstruction - Pulmonary aspiration - Mucosal damage
High liver enzymes - Constipation - Diarrhea - CV changes - High intake of supplements/plant foods
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term
Kcal count -24 hr recall -Food records

26. How do you feed patients with Dysphagia?
Pudding Thick - Consistency of applesauce or smooth mashed potatoes - Most restrictive - Used with severe levels of dysphagia in which oral intake is still allowed - May require IV hydration - Necessary to closely monitor fluid intake to prevent dehy
High BUN - High BGL - High liver enzymes - Weight gain - Edema
High BUN - High serum osmolality - High Na - Weight loss - Thirst
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry

27. Malnutrition - Symptoms
Pureed - Mechanically altered - Advanced
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days
Pudding Thick - Consistency of applesauce or smooth mashed potatoes - Most restrictive - Used with severe levels of dysphagia in which oral intake is still allowed - May require IV hydration - Necessary to closely monitor fluid intake to prevent dehy
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO

28. Excessive carbohydrate intake
Low HDL - High TSH - High Mg - High PO4 - Diet hx of xs intake - Liver damage - GI distress
Weight Loss - dx: AIDS - TB - AN
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings
Diet hx of aberrant CHO intake - Steroids - DM - Inborn errors

29. Predicted Excessive Nutrient Intake
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term
Low serum mineral levels - Physical signs of deficiency - Diet hx of low intake - Celiac disease - SBS - IBD
High BUN - Low GFR - Poor growth - Deranged AA ratios - diet hx high PRO or AA supplement

30. What is Fat-Controlled Diet?
Management of malabsorption - chronic pancreatitis - gallbladder disease - Medium chain triglycerides (MCTs) utilized with high intake of CHO and protein - Easy to digest - Restricts - High fat - additional fat in cooking - Enzyme replacement may be
Diet hx of aberrant CHO intake - Steroids - DM - Inborn errors
Weight gain - Diet hx of energy dense food intake
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term

31. Excessive or inappropriate protein intake
Biochemical parameters indicating suboptimal nutrient intake - Estimated intake less than needs - Cultural or religious practices - Knowledge deficit - Meds affecting appetite
14 days of admission
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
High BUN - Low GFR - Poor growth - Deranged AA ratios - diet hx high PRO or AA supplement

32. Excessive parenteral nutrition infusion
Diet hx of high intake - Diarrhea - Constipation - GI distress
Weight loss (5% in 1 month; 10% in 6 months) - Increased activity - dx: Parkinsons - cerebral palsy - dementia
Elevated BUN:creatinine ratio - Hyperglycemia - Hypercapnia - Elevated liver enzymes - Weight gain - Edema - Meds that reduce energy requirements or impair metabolism
Individualized diets based on swallowing ability and food preference - Evaluate ability to swallow solids and liquids: often done by speech therapist who can also aid in teaching the patient swallowing techniques - Features of food to consider and mo

33. What are the 3 levels of Dysphagia?
Prevents aspiration - Thickener added to liquids to created required thickness - Nectar/Syrup thick - Consistency of heavy syrup in canned fruit - Least restrictive - Cream based soups and most nutritional supplements - Honey thick - Consistency of h
Pureed - Mechanically altered - Advanced
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry
Anthropometric data -Clinical data -Dietary intake assessment

34. Inadequate fat intake
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days
Weight Loss - dx: AIDS - TB - AN
Pudding Thick - Consistency of applesauce or smooth mashed potatoes - Most restrictive - Used with severe levels of dysphagia in which oral intake is still allowed - May require IV hydration - Necessary to closely monitor fluid intake to prevent dehy
Assessment - Residuals - Weight - Lung sounds - Edema - I & O - Blood glucose monitoring - Blood chemistry

35. What is Regular/General Diet?
Low serum osmolality - Weight gain - Edema - Excess salt intake
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days
Designed to attain or maintain optimal nutritional status in those who do not require modified or therapeutic diets - Used to promote health and reduce risks for developing chronic diet-related diseases
Pudding Thick - Consistency of applesauce or smooth mashed potatoes - Most restrictive - Used with severe levels of dysphagia in which oral intake is still allowed - May require IV hydration - Necessary to closely monitor fluid intake to prevent dehy

36. Predicted suboptimal energy intake
Regular diet with attention to texture - Consistency of food can be varied according to the patient's ability to chew and swallow - Foods chopped - ground - mashed - or pureed - Patient's needs should be evaluated - Modifying consistency according to
Carbohydrate - Dextrose solutions - Available in initial concentrations of 5% to 70% - Mixed with amino acids and other nutrients to form the final solution - Protein - Mixture of essential and nonessential crystalline amino acids - Available wi
Reports or observations of energy intake less than needs - Projected change in ability to procure or consume adequate energy - Knowledge deficit - Projected increase in physical activity
Serum and urine creatinine and BUN (somatic muscle protein) -ELEVATED if muscle is broken down Normal Values: -Serum Creatinine: 0.5-1.2mg/100ml -BUN: 10-20 mg/ml

37. Excessive energy intake
Weight gain - Diet hx of energy dense food intake
14 days of admission
Food items that minimize elimination patterns by reducing fecal volume - Restricted - High fiber foods - Milk and milk products - Fried foods - Pepper - Alcohol - Heavy seasonings
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term

38. What is Primary Nutrition Risk?
Ketone breath - Diet hx low CHO - Dx: liver - pancreas - celiac's disease
Patients who have difficulty chewing or swallowing food - Goal is to provide a diet that meets nutritional needs and prevents aspiration - Causes of dysphagia - Acute: CVA - seizure - trauma - surgery - anoxia - Progressive: dementia - Parkinson's -
Inadequate Intake
High BGL - Weight gain - High Hgb A1C - diet hx of energy dense food intake - Excess eating away from home

39. Increased nutrient needs

40. What is the clinical assessments?
Management of malabsorption - chronic pancreatitis - gallbladder disease - Medium chain triglycerides (MCTs) utilized with high intake of CHO and protein - Easy to digest - Restricts - High fat - additional fat in cooking - Enzyme replacement may be
Socioeconomic status -comorbid disease states -Age adults: =< 75 children<5 PHYSICAL -stress and trauma- metabolic demands -mechanical ventilation-unable to eat -therapeutic bowel rest
Biochemical parameters indicating suboptimal nutrient intake - Estimated intake less than needs - Cultural or religious practices - Knowledge deficit - Meds affecting appetite
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care

41. Inadequate vitamin intake
High/low BGL - Meds - Insulin use -
TJC requires screenings within 48hrs
Low serum vitamin levels - Physical signs of deficiency - Diet hx of low intake
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term

42. What are the IV lipid emulsions for Parenteral Nutriton Solution?
Food allergy diet - Common: nuts - eggs - cow's milk - shellfish - wheat - Gluten-restricted diet - Celiac disease (malabsorption syndrome) - Omits wheat - rye - barley - oats - buckwheat - malt - Allows rice and corn - Lactose-restricted - Primary i
High BUN - High BGL - High liver enzymes - Weight gain - Edema
IV lipid emulsions - Used as a concentrated energy source and to prevent the development of essential fatty acid deficiency - Kcal density of lipid solutions is useful when volume restriction is necessary
Height/length -Weight -BMI -Body Measures (skin fold thickness)

43. What is Pureed Diet?
CHO 55-60% - protein 10-20% - lipid <30% - fiber 20-35 grams - Evaluate glucose levels - serum lipids - kcalories - diet - insulin/medication
Elevated BUN:creatinine ratio - Hyperglycemia - Hypercapnia - Elevated liver enzymes - Weight gain - Edema - Meds that reduce energy requirements or impair metabolism
Provides essential nutrients in blenderized form - Clients who are unable to chew or swallow - Can be used long-term
Dry skin - Weight loss - diet hx of low intake - dx: AIDS - TB - AN - sepsis - infection - xs ETOH

44. Excessive fluid intake
TJC requires screenings within 48hrs
Low serum osmolality - Weight gain - Edema - Excess salt intake
High chol - PO4 - GFR <90 - High BUN - Edema - Dx: kidney/liver
Reports or observations of energy intake more than needs - Lower physical activity - Planned change in mobility/physical activity - Meds increasing appetite - Knowledge deficit

45. Less than optimal enteral nutrition
Pudding Thick - Consistency of applesauce or smooth mashed potatoes - Most restrictive - Used with severe levels of dysphagia in which oral intake is still allowed - May require IV hydration - Necessary to closely monitor fluid intake to prevent dehy
Abnormal liver enzymes - Fatty liver - Weight gain/loss - Edema
Low alb - Low BMI - Weight loss - Poor growth rate - Diet hx low PRO
Low serum osmolality - Weight gain - Edema - Excess salt intake

46. Inconsistent carbohydrate intake
High BUN - High serum osmolality - High Na - Weight loss - Thirst
High/low BGL - Meds - Insulin use -
Diet hx of low plant food intake
Low serum osmolality - Weight gain - Edema - Excess salt intake

47. What is Enteral Nutrition? Why preferred over Parenteral Nutrition?
Used when patient has functioning GI tract - Used when patients unable to orally consume adequate nutrients and kcal - Preferred over parenteral nutrition - Physiologically beneficial in maintaining the integrity and function of the gut - Short-term
High AST/GGT - Blood ETOH - diet hx of > 2 drinks/day - liver dx
Biochemical parameters indicating excessive nutrient intake - Knowledge deficit - Meds affecting appetite - Nutrition in Patient Care
Low serum mineral levels - Physical signs of deficiency - Diet hx of low intake - Celiac disease - SBS - IBD

48. What are Dysphagia 'warning signs'?
Individualized diets based on swallowing ability and food preference - Evaluate ability to swallow solids and liquids: often done by speech therapist who can also aid in teaching the patient swallowing techniques - Features of food to consider and mo
Collecting food in the mouth - Spitting out food - Inability to control tongue - Coughing before or after swallowing - Choking - Excessive drooling - Regurgitation of food or liquid through nose - mouth or trach tube - Increased time required to eat
Encourage patient to think/talk about food before meals - Can help stimulate flow of saliva - Aids in formation of bolus - Chewing and swallowing process - Tart or sour foods - Stimulate saliva production - Have patient lick jelly from the lips - puc
>Moderate nutritional risk: transition from restrictive therapeutic to regular dietary intake >High Nutritional Risk: -Parenteral feeding -Tube Feeding -NPO -Clear liquids for more than 3 days

49. Inadequate parenteral nutrition infusion
Caused by disease
Foods clear and liquid at room/body temperature - :Used to help prevent dehydration and keep colon contents to a minimum - -Good source of fluids and water - Inadequate in: - Protein - Fat - Energy - Fiber - Recommended for short-term use (3-5 days
Potential to become malnourished
Indirect calorimetry measurement - Vitamin/mineral abnormalities in lab values - Inadequate weight gain - or unintentional weight loss Clinical evidence of vitamin/mineral deficiency

50. Inadequate fluid intake
High BUN - High serum osmolality - High Na - Weight loss - Thirst
Serum and urine creatinine and BUN (somatic muscle protein) -ELEVATED if muscle is broken down Normal Values: -Serum Creatinine: 0.5-1.2mg/100ml -BUN: 10-20 mg/ml
High serum vit. A -D -K - B6 - niacin - Physical signs of excess - Diet hx
High chol - PO4 - GFR <90 - High BUN - Edema - Dx: kidney/liver