Chapter 41

Question 1

Persons who have GERD have (increased, decreased) resting tone of the (upper, lower) esophageal sphincter; the symptoms include heartburn & chronic (constipation, cough).

Answer 1

decreased, lower, cough

Question 2

The most common type of hiatal hernia is (paraesophageal, sliding); this type (is, is not) associated with GERD.

Answer 2

sliding, is

Question 3

Acute obstruction high in the small intestine causes (vomiting, constipation) first, acute obstruction low in small intestine causes (vomiting, constipation) first.

Answer 3

vomiting, constipation

Question 4

With acute mesenteric ischemia, the damaged intestinal mucosa cannot produce enough mucus to protect itself from (acid, digestive enzymes); bacteria invade the (healthy, necrotic) intestinal wall, eventually causing (peritonitis, malabsorption).

Answer 4

digestive enzymes, necrotic, peritonitis

Question 5

Neurons in the (subthalamic, arcuate) nucleus play a major role in regulating appetite, food intake, & energy metabolism; hormones that circulate in the blood serve as (central, peripheral) signals to this area when their concentrations increase or decrease in relation to (body fat mass, liver function).

Answer 5

arcuate, peripheral, body fat mass

Question 6

(Peripheral, Visceral) obesity is associated with a greater risk for metabolic syndrome, T2DM, & CV complications; resistance to (adiponectin, leptin) & decreased production of (adiponectin, leptin) contribute to the insulin resistance in obesity.

Answer 6

Visceral, leptin, adiponectin

Question 7

Cirrhosis & hepatitis can cause (posthepatic, intrahepatic) portal hypertension; severe right-sided heart failure can cause (post-hepatic, intrahepatic) portal HTN.

Answer 7

Cirrohosis & hepatitis = intrahepatic HTN

LHF = post-hepatic HTN

Question 8

The most accepted theory of ascites formation involves the combination of portal (vasodilation, hypertension) & splanchic (vasodilation, hypertension).

Answer 8

portal HTN and splanchic vasodilation

Question 9

Ascites can be complicated by (bacterial, viral) peritonitis?

Answer 9

Bacterial

Question 10

The (blue, yellow) color of jaundice usually appears first in the (skin, sclera of the eye).

Answer 10

yellow, sclera of the eye

Question 11

Major cause of these clinical manifestation of cirrhosis: PORTAL HTN or HEPATOCYTE DYSFUNCTION?
esophageal varices
jaundice
hepatic encephalopathy
hemorrhoids
splenomegaly
caput medusae
hypoalbuminemia

Answer 11

PORTAL HYPERTENSION results in:
esophageal varices, hemorrhoids, splenomegaly, & caput medusae

HEPATOCYTE DYSFUNCTION results in:
jaundice, hepatic encephalopathy, & hypoalbuminemia (more cellular level dysfunction)

Question 12

TYPES OF HEPATITIS & CHARACTERISTICS

Route of Transmission:
Fecal-oral (F-O)
parenteral (P)
Sexual (S)

Answer 12

Hep A Hep B Hep C Hep D Hep E

Trans- F-O, P, P & S P F-O, P, F-O
mission & S &S

Acute or Acute Both Both Chronic Acute
Chronic?

Carrier No Yes Yes Yes No
state?

Question 13

What is the difference between GERD & NERD?

Answer 13

GERD involves reflux of acid & pepsin from stomach to esophagus & causes esophagitis.

NERD (non-erosive RD) involves similar symptoms but no visible signs of erosion.

Question 14

What is difference between type A & type B chronic gastritis?

Answer 14

Type A: Caused by autoimmune damage primarily of gastric funds (leads to pernicious anemia)

Type B: Chronic gastritis caused by non-immune mechanisms (H. pylori, chronic ETOH, NSAIDs) & primarily affects gastric antrum

Question 15

What is the difference between maldigestion & malabsorption?

Answer 15

Maldigestion is faulty chemical breakdown of nutrients, takes place in intestinal lumen or at brush border of intestinal mucosa of small intestine.

Malabsorption is failure of intestinal mucosa to transport digested nutrients from intestine to blood or lymph.

Question 16

What is the difference between metabolic pathways in short-term & long-term starvation?

Answer 16

Short-term starvation (3-4 days): body responds with glycogenolysis & gluconeogenesis with only a small amount of protein catabolism (LIKE WHEN FASTING FOR RITUALS, RELIGIOUS OBSERVATIONS, ETC.)

Long-term starvation (+4 days): body responds with lipolysis & eventually proteolysis, which can cause death (LIKE IN ANOREXIA NERVOSA)

Question 17

What is the difference between alcoholic cirrhosis & biliary cirrhosis?

Answer 17

ALCOHOLIC: damage begins with hepatocytes

BILIARY: damage begins in bile canaliculi & bile ducts

Question 18

Disorder caused by absence of an enzyme causes bloating, crampy pain, diarrhea, & flatulence after ingesting milk.

Answer 18

Lactase deficiency

Question 19

This is a functional gastrointestinal disorder characterized by abdl pain & altered bowel habits.

Answer 19

Irritable bowel syndrome

Question 20

A disorder characterized by rapid gastric emptying of hypertonic chyme after bariatric surgery causing tachycardia, hypotension, pallor, diaphoresis, cramping, nausea, & diarrhea.

Answer 20

Dumping syndrome

Question 21

This GI disorder manifests with asymptomatic presence of saclike outpouchings that are continuous with the GI tract lumen.

Answer 21

Diverticulosis - most common in age 60+, those with decreased dietary fiber, increased intracolonic pressure like with constipation, abnormal neuromuscular function, & alterations in intestinal motility.

OFTEN A BOARDS QUESTION (reads something like bright red bleeding with defecation, crampy pain, in a 75 year old female, two options are diverticulitis or hemorrhoids..so can be confusing if you don’t pay attention to patient’s age…just FYI)

Question 22

This gastrin-secreting tumor causes gastric & duodenal ulcers, GERD with abdl pain & diarrhea

Answer 22

Zollinger-Ellison syndrome

Question 23

Provision of nutrients after starvation should be done slowly and cautiously because this syndrome can occur when rapid provision of nutrients causes severe hypophosphatemia & other electrolyte imbalances that can be fatal.

Answer 23

Refeeding syndrome

Question 24

This disease is progression from an asymptomatic form to a symptomatic form when saclike outpouchings of the continous GI tract lumen become inflamed

Answer 24

Diverticulitis

Question 25

This disorder is characterized by increased serum bilirubin levels, primarily conjugated, due to obstruction of common bile duct.

Answer 25

Cholestatic jaundice

Question 26

This type of jaundice is when serum bilirubin levels, both conjugated & unconjugated, are a result of failure of liver cells to conjugate bilirubin & failure of bilirubin to pass from liver to intestine.

Answer 26

hepatocellular jaundice

Question 27

Necrosis of liver cells without preexisting liver disease or cirrhosis is known as ______ ________ _______, often due to acetaminophen overdose.

Answer 27

Acute liver failure

Question 28

Functional dysphagia caused by loss of esophageal innervation is called?

Answer 28

achalasia

Question 29

Protrusion of the upper part of the stomach through the diaphragm & into the thorax is called?

Answer 29

hiatal hernia (sliding hiatal hernia is the most common type)

Question 30

Persons who have acute obstruction high in the small intestine are at risk for metabolic ___________, but those with acute obstruction low in the small intestine are at risk for metabolic _________.

Answer 30

alkalosis, acidosis

Question 31

Acute gastritis often heals within a few ______, especially when injurious agents such as NSAIDs and alcohol are stopped.

Answer 31

days

Question 32

Gastric & duodenal ulcers are both called ______ ulcers; risk factors include H. ________ and use of NSAIDs.

Answer 32

peptic, pylori

Question 33

Although pancreatic insufficiency causes poor digestion of all nutrients, maldigestion of ______ due to lack of _______ is the chief problem.

Answer 33

fat, lipase

Question 34

Divertula involve herniation of the_______ through the muscle layers; the most common location where diverticula develop is the ________.

Answer 34

mucosa; colon

Question 35

Pain from appendicitis typically moves from the epigastric or ________ region to the ______ ______ _______.

Answer 35

periumbilical, RLQ

Question 36

Obesity is defined as a BMI that exceeds _____kg/m2 & generally develops when caloric intake _______ caloric expenditure in genetically susceptible individuals.

Answer 36

30; exceeds

Question 37

Cytokines & hormones secreted by adipose tissue are known as ______; in obesity, _______ that infiltrate adipose tissue secrete proinflammatory cytokines.

Answer 37

adipokenes, macrophages

Question 38

Hepatitis ______ virus depends on hepatitis B virus in order to replicate.

Answer 38

D

Question 39

Jaundice in viral hepatitis occurs during the _______ phase; when jaundice resolves, the ______ phase begins.

Answer 39

icteric; recovery

Question 40

Cholecystitis occurs when a gallstone lodges in the _______ duct, the most common type of gallstone is made of _________.

Answer 40

cystic, cholesterol

Question 41

The primary diagnostic marker for acute pancreatitis is elevated serum _______; chronic pancreatitis may be autoimmune or associated with chronic _______ abuse.

Answer 41

lipase, alcohol

Question 42

Fatty liver is associated with chronic use of _______, or with ______ (including in children); although fatty liver is asymptomatic, persons who have it may develop steatohepatitis & may progress to ________, liver failure, or liver cancer.

Answer 42

alcohol, obesity; cirrhosis

Question 43

Comparing Crohn’s Disease and Ulcerative Colitis

Answer 43

Crohn’s Disease Ulcerative Colitis

Fam Hx more common less common

Lesions entire GI tract, mostly Mostly rectum &
small & large intestine, colon, continuous
Skip-lesions lesions

Nature of involve entire wall Mucosal layer only
Lesions thickness

Fistulas/ Common Rare
Abscesses

Narrowed Common Rare
Lumen, poss
Obstruction

Recurrent Common Common
diarrhea

Blood in Less Common More Common
Stools

Clinical Remissions & Exac Remissions & Exac
Course

Question 44

Type of cancer with its risk factors

Pancreatic, colon, primary liver, gastric, & esophageal

Answer 44

Heavy cigarette smoking - PANCREATIC
Familial adenomatous polyposis coli - COLON
H. pylori, high salt intake, nitrates & nitrites - GASTRIC
Cirrhosis, chronic hep B or C - PRIMARY LIVER CANCER
Alcohol & tobacco use, reflux - ESOPHAGEAL

Question 45

Physical changes in the esophageal mucosa as a result prolonged exposure to acids & reflux (GERD) causing chronic inflammation, metaplasia, & dysplasia and is a risk factor for esophageal cancer

Answer 45

Barrett esophagus