Ch. 39: Alterations of Digestive Function

Question 1

Which of the following is NOT one of the Rome 2 criteria for constipation?
  Straining
  Hard stool
  Less than one bowel movement per week
  Sensation of incomplete evacuation

Answer 1

Less than one bowel movement per week

The Rome 2 criteria include any two of the following occurring for 12 weeks: (1) straining, (2) lumpy or hard stool, (3) sensation of incomplete evacuation, (4) sensation of anorectal blockage or obstruction, or (5) fewer than three bowel movements per week.

Question 2

A woman experiences diarrhea, and her physician believes this is due to increased mucosal secretion of chloride- or bicarbonate-rich fluid. Which of the following types of diarrhea is this?
  Osmotic
  Secretory
  Motility
  Small-volume

Answer 2

Secretory

Secretory diarrhea is a form of large-volume diarrhea caused by excessive mucosal secretion of chloride- or bicarbonate-rich fluid or inhibition of net sodium absorption. Osmotic diarrhea is due to a nonabsorbable substance in the intestine that draws water into the lumen by osmosis; an example is lactase deficiency. Motility diarrhea is caused by resection of the small intestine. This is often found after bypass surgery (bariatric). Small-volume diarrhea is caused by an inflammatory disorder of the intestine and is a type of secretory diarrhea.

Question 3

A person experiences abdominal pain that is very localized and intense. Which type of pain does this describe?
  Parietal
  Visceral
  Referred
  Phantom

Answer 3

Parietal

Parietal pain arises from the parietal peritoneum. It is more localized and intense than visceral pain. Visceral pain arises from the organs themselves. It is often poorly localized and is dull rather than sharp. Referred pain is visceral pain felt at some distance from a diseased or an affected organ. Referred pain is usually well localized. Phantom pain does not refer to abdominal pain. It is felt after the loss of a limb.

Question 4

A person experiences bright red blood from the rectum. Which of the following is the BEST term to describe this finding?
  Hematemesis
  Hematochezia
  Melena
  Occult bleeding

Answer 4

Hematochezia

Hematochezia is bright red or burgundy blood from the rectum. Hematemesis is blood in the vomitus. Melena is the description for dark or tarry stools. Occult bleeding is usually caused by slow chronic bleeding, and it is not obvious.

Question 5

Which of the following is a cause of functional dysphagia?
  Tumor
  Stricture
  Herniations
  Achalasia

Answer 5

Achalasia

Functional dysphagia is caused by neural or muscular disorders that interfere with voluntary movement or peristalsis. Causes include dermatomyositis, CVA, Parkinson disease, and achalasia. Achalasia results from autoimmune destruction of myenteric ganglion cells and atrophy of smooth muscle cells. Mechanical obstructions are due to either problems with the esophageal wall or obstructions outside the wall pushing in on the lumen.

Question 6

Which of the following is TRUE regarding hiatal hernia?
There are three types.
The most common type is paraesophageal.
Paraesophageal is herniation of the greater curvature of the stomach.
Sliding hernia is caused by standing.

Answer 6

Paraesophageal is herniation of the greater curvature of the stomach.

Paraesophageal hernia is caused by herniation of the greater curvature of the stomach through a second opening in the diaphragm. There are two types of hiatal hernia, sliding and paraesophageal. Sliding is the most common and reverses with standing. It moves into the thoracic cavity with sitting, bending, tight clothing, ascites, and obesity.

Question 7

A person experiences an inflammation of the gastric mucosa. Which of the following bacteria is associated with gastritis?
  Escherichia coli
  Haemophilus influenzae
  Helicobacter pylori
  Streptococcus pneumoniae

Answer 7

Helicobacter pylori

Question 8

Which of the following regarding chronic gastritis is TRUE?
There are four types.
Type A, or fundal gastritis, is the most severe.
Type B, or antral gastritis, is the most rare.
It tends to occur in young individuals.

Answer 8

Type A, or fundal gastritis, is most severe

Fundal is the more rare and severe of the two types of chronic gastritis. Chronic gastritis is classified as type A (fundal) or type B (antral) and occurs most frequently in older adults.

Question 9

An individual develops a peptic ulcer. Which of the following diseases has been linked to the development of a peptic ulcer?
  Rheumatoid arthritis
  Osteoarthritis
  Influenza
  Anemia

Answer 9

Rheumatoid arthritis

Rheumatoid arthritis is associated with the development of a peptic ulcer. This may due to the fact that these individuals also take large quantities of NSAIDs, which have been linked to peptic ulcer formation. Other diseases linked to peptic ulcer formation are emphysema, cirrhosis, and H. pylori infection.

Question 10

A man experiences chronic intermittent pain in the epigastric area. It begins 30 minutes to 2 hours after eating when the stomach is empty. The pain also occurs in the middle of the night. Based on this history, which of the following is the most likely cause?
  Acute gastritis
  Chronic gastritis
  Gastric ulcer
  Duodenal ulcer

Answer 10

Duodenal ulcer

Acute gastritis often has vague abdominal discomfort, epigastric tenderness, and bleeding. Chronic gastritis has symptoms that include anorexia, fullness, nausea, vomiting, and pain. Gastric ulcers have symptoms of epigastric pain and may occur immediately after eating.

Question 11

A person experiences severe head trauma in an accident. There is decreased mucosal blood flow and overstimulation of the vagal nuclei causing hypersecretion of acid. Which of the following stress-related mucosal diseases does this person have?
  Stress ulcer
  Ischemic ulcer
  Cushing ulcer
  Peptic ulcer

Answer 11

Cushing ulcer

Cushing ulcer is a stress ulcer related to severe head trauma or brain surgery. This is caused by overstimulation of the vagus nerve and decreased mucosal blood flow. A stress ulcer is any acute peptic ulcer that tends to accompany severe illness, systemic trauma, or neural injury. Ischemic ulcers develop within hours of an event such as hemorrhage, multisystem trauma, severe burns, or CHF. Peptic ulcer is associated with H. pylori infection or the habitual use of NSAIDs.

Question 12

Which of the following is a fat-soluble vitamin?
  Vitamin C
  Vitamin B12
  Vitamin K 
  Vitamin B6

Answer 12

Vitamin K

Vitamins A, D, E, and K are fat soluble.

Question 13

Which of the following is a TRUE statement regarding ulcerative colitis?
It extends throughout the entire GI tract.
It generally appears in childhood.
Blacks are more commonly affected.
Lesions are limited to the mucosa.

Answer 13

Lesions are limited to the mucosa.

Ulcerative colitis lesions are limited to the mucosa. Ulcerative colitis is a chronic inflammatory condition that is common in those of Jewish or European descent. The lesions usually begin appearing between 20 and 40 years of age and are located from the rectum to the colon proximally.

Question 14

Which of the following extraintestinal manifestations is NOT found in ulcerative colitis?
  Gallstones
  Uveitis
  Polyarthritis
  Urinary tract infections

Answer 14

Urinary tract infections

Due to the fact that immune complexes may be related to this disease, it is not unexpected that problems are noted outside the colon. Ulcerative colitis has been associated with mouth ulcers, episcleritis, anterior uveitis, primary sclerosing cholangitis in the liver, gallstones, alterations in coagulation, and migratory polyarthritis.

Question 15

Which of the following is a TRUE statement regarding Crohn disease?
  It involves the mucosa only.
  Skip lesions are common.
  It affects only the rectum.
  The most common site is the rectum.

Answer 15

Skip lesions are common.

Skip lesions are common in Crohn disease, meaning the disease is not continuous; it skips parts of the colon. Crohn disease affects the entire GI tract and can affect all layers of the mucosa and serosa. The most common area for the disease is the ileocolon.

Question 16

A 20-year-old man presents with periumbilical pain, fever, and loss of appetite. Which of the following is the most likely cause of his abdominal discomfort?
  Diverticulosis
  Diverticulitis
  Appendicitis 
  Mesenteric venous thrombosis

Answer 16

Appendicitis

Appendicitis is an inflammation of the vermiform appendix and commonly occurs between the ages of 20 and 30. There is often periumbilical pain that can be vague. Diverticulosis is asymptomatic diverticular disease, which is herniation or sac-like outpouching of mucosa through the muscle layers of the colon wall. Diverticulitis is inflammation of the diverticula in the colon. Persons are usually older and have a crampy pain, often in the left lower quadrant. Mesenteric venous thrombosis usually occurs in older individuals with malignancies, right-sided heart failure, and deep vein thrombosis.

Question 17

Which of the following is NOT a characteristic of anorexia nervosa?
Fear of becoming obese
Distorted body image
Body weight 25% less than normal
Absence of three consecutive menstrual periods

Answer 17

Body weight 25% less than normal

The characteristics of anorexia nervosa are fear of becoming obese despite progressive weight loss, a distorted body image, body weight 15% less than normal for age and height because of refusal to eat, and absence of three consecutive menstrual periods.

Question 18

A person is diagnosed with portal hypertension due to liver disease. Which of the following is the most common clinical manifestation of portal hypertension?
  Bleeding from esophageal varices
  Abdominal pain from splenomegaly
  Ascites
  Altered mental status

Answer 18

Bleeding from esophageal varices.

The most common clinical manifestation of portal hypertension is vomiting of blood from bleeding esophageal varices. Other problems related to portal hypertension include splenomegaly, ascites, and hepatic encephalopathy.

Question 19

A woman is told that she has hepatitis. She is in a foreign country and was told that the form that she has is self-limiting and is transferred via the fecal-oral route. Which of the following types of hepatitis is most likely?
  Hepatitis A 
  Hepatitis B
  Hepatitis C
  Hepatitis D

Answer 19

Hepatitis A

Hepatitis A can be transmitted by the fecal-oral route or blood transfusion. Hepatitis B and C are transmitted through infected blood or body fluids. Hepatitis D is found in individuals with hepatitis B.

Question 20

Which of the following is NOT true regarding cirrhosis?
Cirrhosis develops rapidly.
The causes are not clearly understood.
Portal hypertension is a complication.
If caused by a toxin, severity is determined by amount of the toxin.

Answer 20

Cirrhosis develops rapidly.

Cirrhosis is a process of cellular injury that develops over years. The causes are not clearly understood, but alcohol and other toxins have been linked to cirrhosis. The severity is determined by the amount of toxin. Portal hypertension is one of the complications of cirrhosis.

Question 21

Which of the following is TRUE regarding cholelithiasis?
It is prevalent in underdeveloped countries.
Incidence is well known and documented.
Cholesterol stones are the most common.
Risk factors include male gender.

Answer 21

Cholesterol stones are the most common.

This disease is prevalent in developed countries. The incidence is not well known because a lot of people are asymptomatic. There are two types of gallstones: cholesterol and pigmented. Cholesterol stones are the most common. Risk factors include obesity, middle age, female gender, American Indian ancestry, and gallbladder disease.

Question 22

Which of the following is NOT a risk factor for esophageal carcinoma?
  Alcohol use
  Tobacco use
  Thin body habitus
  Zinc deficiency

Answer 22

Thin body habitus

The risk factors for esophageal carcinoma include zinc deficiency, obesity, alcohol use, tobacco use, and poor economic conditions.

Question 23

Which of the following is TRUE regarding cancer of the colon?
Colorectal cancer is the most frequent cause of cancer death.
It accounts for 25% of all cancer deaths.
It tends to occur in young individuals less than 40 years of age.
Cancer of the small intestine is rare.

Answer 23

Cancer of the small intestine is rare.

Colon cancer tends to occur in individuals older than 50 years. Colorectal cancer is the second most frequent cause of cancer death in the United States; it accounts for 10% to 15% of all cancer deaths. Small intestine cancer is rare and represents less than 1% of gastrointestinal cancers.

Question 24

A person is diagnosed with colorectal cancer and was told that it is limited to the mucosal lining. Which stage is this person’s cancer?
  Stage 0
  Stage I
  Stage II
  Stage III

Answer 24

Stage 0

Stage 0 is cancer limited to the mucosal lining. Stage I is cancer extending to the middle layers of the colon wall. Stage II is extension beyond the colon wall to nearby tissues. Stage III is spread beyond the colon into lymph nodes and nearby organs. Stage IV is spread to nearby lymph nodes and to other parts of the body.