Chapter 18: Gastrointestinal and Accessory Organ Problems

Question 1

The lower esophageal sphincter muscle controls entry of food into the

a. esophagus.
b. stomach.
c. small intestine.
d. rectum.

Answer 1

c. small intestine.

Defects in this sphincter may come from changes in the smooth muscle itself or from the nerve-muscle hormone control of peristalsis.

Question 2

The term used to describe difficulty in swallowing is

a. pyrosis.
b. polydipsia.
c. dysphagia.
d. dyspepsia.

Answer 2

c. dysphagia.

Question 3

Many people who have gastroesophageal reflux are

a. underweight.
b. obese.
c. male.
d. children.

Answer 3

b. obese.

Constant regurgitation of acid gastric contents into the lower part of the esophagus creates constant irritation and inflammation to the tissue and can be caused by obesity, pregnancy, pernicious vomiting, or nasogastric tubes.

Question 4

An eroded mucosal area in the central portion of the gastrointestinal tract describes a

a. hiatal hernia.
b. diverticulum.
c. peptic ulcer.
d. Crohn’s lesion.

Answer 4

c. peptic ulcer.

is an eroded mucosal area in the central portion of the gastrointestinal tract. Symptoms usually include increased gastric muscle tone and painful contractions when the stomach is empty. Hemorrhage usually is one of the first signs.

Question 5

A food that should be omitted from the diet of a patient with peptic ulcer disease is

a. black pepper.
b. apple juice.
c. milk.
d. popcorn.

Answer 5

a. black pepper.

Question 6

Most ulcers occur in the

a. esophagus.
b. stomach.
c. duodenum.
d. ileum.

Answer 6

b. stomach.

Symptoms usually include increased gastric muscle tone and painful contractions when the stomach is empty. Hemorrhage usually is one of the first signs.

Question 7

Which of the following describes general nutrition guidelines for a patient with a peptic ulcer?

a. General, well-balanced diet as tolerated
b. High-protein, low-fiber diet with no seasonings
c. High-protein diet and regularly scheduled meals
d. Low-fiber diet with no seasonings and no milk or cream

Answer 7

a. General, well-balanced diet as tolerated

Question 8

Small outpouchings in the gastrointestinal tract are called

a. hernias.
b. lesions.
c. diverticula.
d. epiploic appendages.

Answer 8

c. diverticula.

Question 9

Signs of dysphagia in nursing home residents include

a. vomiting.
b. dry mouth.
c. abdominal pain.
d. recurring pneumonia.

Answer 9

d. recurring pneumonia.

Dysphagia can cause persons to aspirate food particles that may not be evident in coughing or choking episodes. Aspiration of food contents into the lung causes pneumonia and other serious problems.

Question 10

Foods that appear to reduce irritable bowel syndrome include _____ foods.

a. soft
b. low-fiber
c. bland
d. high-fiber

Answer 10

d. high-fiber

may help reduce irritable bowel syndrome. Small-volume bowel dysfunction is a condition that varies from constipation or diarrhea to a combination of both and is characterized by excess gas formation with increased distention and bloating. Fiber can help regulate bowel function.

Question 11

The characteristic symptoms of celiac disease are

a. vomiting and diarrhea.
b. diarrhea and steatorrhea.
c. abdominal pain and constipation.
d. chronic, bloody diarrhea.

Answer 11

b. diarrhea and steatorrhea.

Hypersensitivity to the protein gluten in certain grains causes mucosal surface damage to the intestine. The villi are malformed, which reduces the absorbing surface by as much as 95%.

Question 12

Hepatitis is usually the result of

a. viral infection or alcohol or drug abuse.
b. bacterial or viral infection.
c. excessive fat and protein intake.
d. chronic malnutrition.

Answer 12

a. viral infection or alcohol or drug abuse.

Question 13

Viral hepatitis can be contracted through

a. ingestion of contaminated food or water.
b. airborne viruses from coughing and sneezing.
c. physical contact with an infected person.
d. alcohol abuse.

Answer 13

a. ingestion of contaminated food or water.

Hepatitis is an inflammatory condition caused by viruses, alcohol, drugs, or toxins. Viral hepatitis can be contracted through contaminated food or water.

Question 14

The treatment of hepatitis includes

a. rest and optimal nutrition.
b. antibiotics and optimal nutrition.
c. fluid restriction and rest.
d. diuretics and optimal nutrition.

Answer 14

a. rest and optimal nutrition.

Hepatitis is treated by rest and optimal nutrition. A high-carbohydrate, moderate-fat, high-energy, and high-protein diet is necessary for treatment of hepatitis.

Question 15

Nutrition therapy for hepatitis includes a diet that is _____ in protein, _____ in carbohydrate, and _____ in fat.

a. high, high, high
b. low, high, low
c. low, low, high
d. high, high, moderate

Answer 15

d. high, high, moderate

Optimal nutrition should consist of a diet that is high in protein, high in carbohydrate, and moderate in fat. The amount of carbohydrate depends on individual needs and condition. Approximately 25% to 40% of the diet should come from fat; as the disease progresses, more energy is supplied from this nutrient. Protein is essential for building new cells and tissues of the liver.

Question 16

A major difficulty in treating hepatitis is that

a. the person must stay in isolation for a long time.
b. the person can have only a clear liquid diet.
c. the person usually has a poor appetite.
d. typically only one kind of antibiotic will cure it.

Answer 16

c. the person usually has a poor appetite.

Symptoms of hepatitis include anorexia, jaundice, and underlying malnutrition. The person usually has a poor appetite associated with these symptoms.

Question 17

If the diverticula of the intestine become inflamed, the condition is called

a. diverticulosis.
b. diverticulitis.
c. diarrhea.
d. celiac disease.

Answer 17

b. diverticulitis.

develops when the small pouches or pockets in muscular mucosal lining of the small intestine become infected. The infected area is painful.

Question 18

A cause of diarrhea is

a. drinking too much liquid with a meal.
b. lactose intolerance.
c. excessive intake of protein.
d. swallowing air with food digestion.

Answer 18

b. lactose intolerance.

in people who lack the digestive enzyme lactase is a cause of diarrhea. Lactase deficiency causes malabsorption, which results in diarrhea.

Question 19

Dietary changes that help reduce the incidence of constipation include

a. use of laxatives.
b. decreased fiber intake.
c. increased fluid intake.
d. decreased cheese intake.

Answer 19

c. increased fluid intake.

Question 20

Treatment for diverticulosis includes a diet that is

a. bland.
b. low in fiber.
c. high in fiber.
d. full liquid.

Answer 20

c. high in fiber.

void of foods that may cause gas or intolerance (such as lactose), and low in fat. Large amounts of food in one meal can create discomfort from gastric distention and gas. Air-swallowing habits such as eating rapidly and in large amounts, excessive fluid intake (especially of carbonated beverages), and gum chewing should be decreased.

Question 21

The primary objective of treatment of hepatic encephalopathy is to

a. encourage the patient to eat.
b. feed the patient parenterally to give the liver a rest.
c. remove sources of excess ammonia.
d. encourage the patient to exercise and maintain mental functions.

Answer 21

c. remove sources of excess ammonia.

. One of the main functions of the brain is to remove ammonia and therefore nitrogen from the blood by converting it to urea for urinary excretion. When cirrhosis continues and fibrous scar tissue replaces more and more functional liver tissue, the blood can no longer circulate normally through the liver. Therefore, other vessels develop around the scar tissue, bypass the liver, and proceed to the brain, producing ammonia intoxication.

Question 22

Bile is produced by the

a. gallbladder.
b. pancreas.
c. liver.
d. intestine.

Answer 22

c. liver.

The basic function of the gallbladder is to concentrate and store bile, then release the concentrated bile into the small intestine when fat is present.

Question 23

The most important function of the gallbladder is to

a. produce bile.
b. synthesize cholesterol.
c. release lipase enzymes.
d. concentrate and store bile.

Answer 23

d. concentrate and store bile.

then release the concentrated bile into the small intestine when fat is present.

Question 24

The presence of gallstones in the gallbladder is called

a. cholecystitis.
b. cholelithiasis.
c. cholecystectomy.
d. cholecystokinin.

Answer 24

b. cholelithiasis.

refers to the presence of gallstones in the gallbladder. When continued infection alters the solubility of the bile ingredients, cholesterol separates out and forms gallstones.

Question 25

A clinical symptom of gallbladder inflammation or gallstones is

a. pain and distention after eating.
b. jaundice.
c. anorexia.
d. weakness and apathy.

Answer 25

a. pain and distention after eating.

Question 26

Sodium often is restricted in the patient with cirrhosis to control

a. kidney failure.
b. heart function.
c. neurologic function.
d. fluid retention.

Answer 26

d. fluid retention.

Sodium often is restricted to 500 to 1000 mg/day with cirrhosis to help reduce fluid retention (ascites).

Question 27

Nutritional therapy for the patient with cirrhosis includes a diet that is

a. low in sodium, high in protein, and low in carbohydrates.
b. soft textured and high in energy.
c. high in protein, high in carbohydrates, and high in fat.
d. low in sodium, soft textured, and high in carbohydrates.

Answer 27

d. low in sodium, soft textured, and high in carbohydrates.

Sodium is often restricted to 500 to 1000 mg/day with cirrhosis to help reduce fluid retention (ascites). Soft texture is necessary in the presence of esophageal varices to help prevent the danger of vessel rupture and hemorrhage. Kilocalories, carbohydrates, and vitamins, especially the B-complex vitamins thiamin and folate, are important for healing.

Question 28

The major nutrition problem related to development of ascites is

a. protein deficiency.
b. excessive fat intake.
c. deficiency of digestive enzymes.
d. excessive sodium intake.

Answer 28

a. protein deficiency.

is a nutrition problem related to the development of ascites. Low plasma protein levels eventually lead to ascites, or abdominal fluid accumulation.

Question 29

Pathologic changes in the liver caused by cirrhosis include

a. fatty infiltration.
b. fibrous tissue formation.
c. gallstone formation.
d. edema and swelling

Answer 29

a. fatty infiltration.

Protein in the diet combines with fats (lipoproteins) to remove them, preventing damage from fatty infiltration in the liver.

Question 30

Nutrition therapy for gallbladder disorders includes

a. reducing cholesterol intake.
b. eliminating gas-forming foods.
c. lowering fat intake.
d. increasing caloric intake.

Answer 30

c. lowering fat intake.

A low-fat intake may help avoid pain and discomfort because the presence of fat entering the small intestine stimulates the contraction of the gallbladder.

Question 31

A food that individuals with lactose intolerance might need to limit is

a. yogurt.
b. milkshakes.
c. cheese.
d. soy milk.

Answer 31

b. milkshakes.

Milk and all products containing lactose are carefully avoided. Milk treated with a commercial lactase product or soy milk are safe substitutes. A food that individuals with lactose intolerance might need to limit is milkshakes.

Question 32

The most common food allergens include

a. nuts, shellfish, and milk.
b. milk, citrus fruits, and peanuts.
c. shellfish, strawberry, and egg.
d. milk, peanut, and chocolate.

Answer 32

a. nuts, shellfish, and milk.

Question 33

Patients with cystic fibrosis need to take

a. enzymes and supplements.
b. large doses of vitamins and minerals.
c. antidiarrheal agents.
d. hormones and enzymes.

Answer 33

a. enzymes and supplements.

Cystic fibrosis is a genetic disease of childhood. It is characterized by thick mucus in the lungs, pancreatic insufficiency, malabsorption of undigested food, liver disease, and increased salt concentration in body perspiration. Enzymes and supplements are necessary for treatment. Pancreatic enzymes are used along with vitamin supplements, especially fat-soluble vitamins.

Question 34

An elemental diet formula provides

a. all necessary vitamins and minerals.
b. all nutrients needed in a bland, low-residue form.
c. all nutrients needed in their simplest absorbable form.
d. a diet high in mineral elements.

Answer 34

c. all nutrients needed in their simplest absorbable form.

Elemental formulas of amino acids, glucose, fat, minerals, and vitamins are more easily absorbed and support initial healing in response to antibacterial and antiinflammatory medications.

Question 35

Crohn’s disease is a(n)

a. disorder of protein metabolism.
b. chronic enzyme deficiency.
c. excess in the production of insulin.
d. inflammatory bowel disease.

Answer 35

d. inflammatory bowel disease.

applies to both Crohn’s disease and ulcerative colitis. These conditions can have severe, often devastating nutrition results as more and more of the absorbing surface area becomes involved.

Question 36

Ascites, a localized edema of the peritoneal cavity, is caused by

a. low plasma protein levels.
b. inadequate intake of carbohydrate.
c. too much fat in the diet.
d. excessive fluid intake.

Answer 36

a. low plasma protein levels.

Question 37

Dietary protein is essential for recovery from hepatitis because protein

a. is essential for tissue repair.
b. is needed to produce energy.
c. restores liver glycogen reserves.
d. is the only food that is well tolerated.

Answer 37

a. is essential for tissue repair.

Protein is adjusted according to tolerance. In the absence of impending hepatic coma, the diet should supply 80 to 100 g/day of protein to correct severe malnutrition, heal liver tissue, and restore plasma proteins. If signs of coma begin, the protein must be reduced according to individual tolerance.