Chapter 9: GI Flashcards
- If a patient with multiple sclerosis starts coughing frequently during meals and starts to eat significantly less food than normal, the patient may have
a. pneumonia.
b. gastroesophageal reflux disease.
c. peptic ulcer.
d. dysphagia.
ANS: D
Patients with multiple sclerosis may develop dysphagia; coughing during meals and eating less than usual are common symptoms. Dysphagia may cause pneumonia if food enters the lungs and causes infection. Gastroesophageal reflux disease causes burning and pain but typically not coughing. Peptic ulcer causes intestinal pain but not coughing.
- The most acute risk for patients with dysphagia is
a. constipation.
b. dehydration.
c. dry mouth.
d. panic attacks.
ANS: B
An acute daily concern for patients with dysphagia is dehydration. Patients are not usually allowed to drink fluids without supervision, and so fluid intake must be monitored throughout the day. Constipation and dry mouth may occur with poor fluid and food intake but are less acute. Patients with dysphagia may experience feelings of panic, but this is not the most acute concern.
- The most helpful recommendation for a client who often experiences heartburn at night would be to
a. avoid eating within 4 hours of going to bed.
b. increase the fiber content of the diet.
c. decrease the fiber content of the diet.
d. take antacid medications before going to bed.
ANS: A
Gastroesophageal reflux disease (GERD) usually occurs 1 to 4 hours after eating; therefore, waiting at least 4 hours after eating before going to bed would help prevent heartburn at night. Antacid medications may be helpful but should not be used on a regular basis before other strategies have been tried. Fiber content of the diet does not affect heartburn
- An example of a meal that is likely to relax the lower esophageal sphincter and allow gastroesophageal reflux is
a. pasta with marinara sauce and sourdough bread.
b. ham with rice pilaf.
c. fried chicken and pasta salad.
d. chicken and spinach tortilla wrap and salsa.
ANS: C
High-fat foods and beverages relax the lower esophageal sphincter (allowing stomach contents to back up). Both fried chicken and pasta salad are high in fat and would exacerbate gastroesophageal reflux. The other meals are relatively low in fat and would be much less likely to cause reflux.
- An appropriate meal for someone with dumping syndrome would be
a. a small vanilla milkshake.
b. cream of mushroom soup.
c. half a turkey sandwich.
d. popcorn and sugar-free soda.
ANS: C
Individual tolerances vary, but the turkey half-sandwich would probably be tolerated best. Half a sandwich is probably small enough not to cause symptoms. A milkshake is high in sugar and probably too cold. Cream of mushroom soup is probably too hot, and liquids should be taken between rather than with meals. The carbonation in the soda may increase gastrointestinal distention because of gas.
11. If a patient has
- If a patient has esophagitis and also has worn tooth enamel, he or she may have
a. a hiatal hernia.
b. fluoride deficiency.
c. an eating disorder.
d. gastroesophageal reflux disease.
ANS: C
The eating disorder bulimia nervosa causes esophagitis and eroded tooth enamel because of the effects of stomach acid being vomited back into the esophagus and mouth. A hiatal hernia and GERD may cause esophagitis, but stomach contents would enter only the esophagus, not the mouth, and so the teeth would not be worn. Fluoride deficiency may cause loss of tooth enamel but would not cause esophagitis.
- For patients with inflammatory bowel disease, nutrition therapy is
a. the primary mode of treatment.
b. rarely necessary.
c. an important adjunct to drugs and surgery.
d. highly specialized.
ANS: C
Nutrition therapy is important to help maintain nutritional status of patients with inflammatory bowel disease, but is used in conjunction with drug and surgical treatments; it is not the primary mode of treatment. Nutrition therapy is often needed to maintain weight and micronutrient status
- Because patients with active Crohns disease have intestinal inflammation, they benefit from high intake of
a. fat.
b. dietary fiber.
c. simple sugars.
d. protein.
ANS: D
Patients with inflammatory bowel disease benefit from a diet high in protein to compensate for malabsorption. Fat intake should be moderate to provide adequate kilocalories within a healthful diet; high fat intake may cause steatorrhea. Dietary fiber may irritate the inflamed gut. Simple sugars provide a readily digested and absorbed source of energy but no other nutrients.
- Patients with inflammatory bowel disease may benefit from a high-fiber diet during
a. acute episodes.
b. times of remission.
c. recovery from surgery.
d. preparation for surgery.
ANS: B
A high-fiber diet may help stimulate peristalsis during times of remission in patients with inflammatory bowel disease. During acute episodes, the diet should be low in fiber and should promote bowel rest. In general, the diet should be high calorie, high protein, and nutrient dense to compensate for malabsorption.
- If a patient has had a large portion of their small intestine removed because of cancer and is unable to maintain a stable weight, a feeding regimen that would be most appropriate is
a. enteral feedings into the stomach.
b. enteral feedings into the jejunum.
c. parenteral nutrition only.
d. supplemental parenteral nutrition.
ANS: D
Patients who have undergone removal of large portions of the small intestine and are unable to maintain their weight should receive supplemental parenteral nutrition. Enteral feedings would not be more effective than oral feedings because these patients have a limited amount of gut to absorb the nutrients. Parenteral nutrition should not be used alone because some oral feeding helps stimulate recovery of gut function and maintain gut integrity.
- The best way to prevent formation of diverticula in the colon is to
a. eat plenty of fruits, vegetables, and whole grains.
b. avoid foods with rough hulls, such as nuts and seeds.
c. use stool softeners to promote daily bowel movements.
d. avoid foods that cause gas and increase pressure in the colon.
ANS: A
Diverticula are caused by high pressure in the colon, often in association with straining to have a bowel movement; they can be prevented by intake of high-fiber foods, such as fruits, vegetables, and whole grains. There is no evidence that nuts, seeds, or other foods with hulls increase risk of diverticula. Using stool softeners to promote daily bowel movements may help prevent diverticula, but eating a high-fiber diet is preferable because of other nutritional benefits. Foods that cause gas are not associated with formation of diverticula.
- Where in the brain is the vomiting center located?
a. Hypothalamus c. Pons
b. Medulla oblongata d. Midbrain
ANS: B
The vomiting center of the brain lies in the medulla oblongata. The other locations listed are not related to vomiting.
- Antiemetic agents, such as domperidone and haloperidol, are antagonists for which receptors?
a. 5-Hydroxytryptamine (5-HT) serotonin
b. Histamine-2
c. Acetylcholine
d. Dopamine
ANS: D
Metoclopramide, domperidone, and haloperidol are dopamine antagonists, making them effective antiemetic agents. This selection is the only option that identifies a receptor that is involved in the process of vomiting.
- Which statement is false concerning how abdominal pain is produced?
a. Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain.
b. Edema and vascular congestion produce abdominal pain by stretching.
c. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.
d. Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.
ANS: D
Low concentrations of anaerobes are not typically a cause of abdominal pain.
- What is the cause of functional dysphagia?
a. Intrinsic mechanical obstruction c. Tumor
b. Extrinsic mechanical obstruction d. Neural or muscular disorders
ANS: D
Neural or muscular disorders that interfere with voluntary swallowing or peristalsis cause functional dysphagia. This selection is the only option that accurately identifies a cause of functional dysphagia.
- What are the cardinal symptoms of small intestinal obstruction?
a. Constant, dull pain in the lower abdomen relieved by defecation
b. Acute, intermittent pain 30 minutes to 2 hours after eating
c. Colicky pain caused by distention, followed by vomiting
d. Excruciating pain in the hypogastric area caused by ischemia
ANS: C
Of the options available, only colicky pain caused by distention followed by vomiting are considered the cardinal symptoms of a small intestinal obstruction.
- Which hormones are natural appetite suppressants? (Select all that apply.)
a. Insulin
b. Cortisol
c. Galanin
d. Calcitonin
e. Serotonin
ANS: A, D, E
Insulin, calcitonin, and serotonin are natural appetite suppressants, whereas cortisol and galanin are natural appetite stimulants.
- Food enters the stomach via which sphincter?
a. Cardiac c. Gastric
b. Upper esophageal d. Fundal
ANS: A
Each end of the esophagus is opened and closed by a sphincter. The upper esophageal sphincter (cricopharyngeal muscle) prevents entry of air into the esophagus during respiration. The lower esophageal sphincter (cardiac sphincter) prevents regurgitation from the stomach. The lower esophageal sphincter is located near the esophageal hiatus—the opening in the diaphragm where the esophagus ends at the stomach. The cardiac sphincter is the only option that fulfills the function described in the question
- Which gastric cells secrete hydrochloric acid and intrinsic factor?
a. Parietal c. G
b. Chief d. H
ANS: A
Of the available options, only the parietal cells (oxyntic cells) secrete hydrochloric acid and intrinsic factor.
- Which cells in the stomach secrete histamine?
a. Oxyntic c. D
b. Chief d. Enterochromaffin-like
ANS: D
Of the available options, only enterochromaffin-like cells secrete histamine.
- Exposure to which substance protects the mucosal barrier of the stomach?
a. Prostaglandins c. Helicobacter pylori
b. Aspirin d. Regurgitated bile
ANS: A
Prostaglandins and enterogastrones, such as gastric inhibitory peptide, somatostatin, and secretin, inhibit acid secretion. This selection is the only option that accurately identifies a substance that protects the mucosal barrier of the stomach.
S&S of diverticulitis
fever, nausea, achy pain, occult blood, tender abdominal mass, pericolonic fat stranding (abnormal increase in fat attenuation)
Why does diverticulitis occur?
weak muscularis layer/abnormal connective tissue, high pressure gradient between colon/peritoneal space d/t increased pressure needed to propel stool (low fiber)
layers of the GI tract.
mucosa - innermost, produces mucus, high cell turnover rate
submucosa - connective tissue (blood vessels, nerves, lymph, secretory glands)
muscular - circular, then longitudinal (allows for peristalsis)
serosa - outer layer that connects to other structures
Cranial nerves involved in swallowing
trigeminal (V), glossopharyngeal (IX), vagus (X)
parts of the stomach
top to bottom =
lower esophageal sphincter –> fundus –> body –> pyloris –> pyloric sphincter
S&S of ulcerative colitis
n/v/diarrhea (bloody), tenesmus (defecation urgency), proctitis (inflammation of rectum), cramping, weight loss, diffuse colon inflammation
S&S of cholecystitis
RUQ pain (especially after fatty foods) and tenderness, nausea, fever,
factors that increase likelihood of cholelithiasis or cholecystitis
obesity, high fat diet, high levels of estrogen (cholesterol concentration of bile and decrease gallbladder motility) – premenopausal women
Fat
Female
Forty
Fertile
Risk factors for peptic ulcer disease (PUD)
NSAID ingestion, smoking, psychologic stress, H pylori infection = diminish mucosal protection
cause/patho of a gastric ulcer
excess acid or decreased mucosal defense = stomach lining erosion
- A major complication of persistent gastroesophageal reflux is:
A) strictures.
B) heartburn.
C) chest pain.
D) hoarseness.
A) strictures.
- Acute gastritis refers to a transient inflammation of the gastric mucosa that is most commonly associated with:
A) diarrhea.
B) food allergies.
C) gastric reflux.
D) alcohol intake.
D) alcohol intake.
- The Helicobacter pylori protobacteria cause peptic ulceration by producing:
A) acids
B) toxins
C) ischemia
D) bleeding
B) toxins
- A hallmark of irritable bowel syndrome is abdominal pain:
A) relieved by defecation.
B) most severe at night.
C) with blood in the stool.
D) after and between meals.
A) relieved by defecation.
- Inflammatory bowel diseases are accompanied by systemic manifestations that include:
A) autoimmune anemia.
B) rheumatoid arthritis.
C) thrombocytopenia.
D) lactose intolerance.
A) autoimmune anemia.
- Crohns type of inflammatory bowel disease is characterized by:
A) granulomatous lesions.
B) ulcerative erosions.
C) fibrotic smooth muscle.
D) necrotic crypt abscesses.
A) granulomatous lesions.
- Unlike the Crohn type of inflammatory bowel disease, the ulcerative colitis type is characterized by:
A) skip lesions.
B) steatorrhea.
C) gastric ulcers.
D) pseudopolyps.
D) pseudopolyps.
- Diverticulitis, a complication of diverticulosis, is manifested by acute:
A) rectal bleeding.
B) abdominal distention.
C) large-volume diarrhea.
D) lower left quadrant pain.
D) lower left quadrant pain.
- Major causes of mechanical bowel obstruction include:
A) chemical irritation.
B) ruptured appendix.
C) abdominal distention.
D) postoperative adhesions.
D) postoperative adhesions
10 As a protective measure to keep abdominal inflammation and infection
. localized, the peritoneum:
A) constricts bowel contents.
B) secretes fibrous exudate.
C) increases intestinal motility.
D) abdominal vasoconstriction.
B) secretes fibrous exudate.
11 Which of the following signs and symptoms most clearly suggests the need
. for endoscopy to rule out esophageal cancer?
A) Heartburn after an individual consumes high-fat meals
B) Dysphagia in an individual with no history of neurologic disease
C) A new onset of gastroesophageal reflux in a previously healthy individual
D) Recurrent episodes of gastritis that do not respond to changes in diet
B) Dysphagia in an individual with no history of neurologic disease
12 A 60-year-old male patient has presented to his primary care provider to
. follow up with his ongoing treatment for peptic ulcer disease. What is the most likely goal of this patients pharmacologic treatment?
A) Inhibiting gastric acid production
B) Promoting hypertrophy of the gastric mucosa
C) Increasing the rate of gastric emptying
D) Increasing muscle tone of the cardiac sphincter
A) Inhibiting gastric acid production
13 Which of the following individuals most likely faces the greatest risk of
. developing Clostridium difficile colitis?
A) A 55-year-old man who takes proton pump inhibitors for the treatment of peptic ulcers
B) A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics
C) A premature neonate who has developed hyperbilirubinemia and is receiving phototherapy
D) A 30-year-old patient who has a history of Crohn disease and has been admitted to a hospital to treat a recent flare-up
B) A 79-year-old hospital patient who is being treated with broad-spectrum antibiotics
14 A 66-year-old woman has been diagnosed with diverticular disease based on
. her recent complaints and the results of a computed tomography (CT) scan.
Which of the patients following statements demonstrates an accurate understanding of this diagnosis?
A) From now on, Im going to stick to an organic diet and start taking more supplements.
B) I think this might have happened because Ive used enemas and laxatives too much.
C) Ive always struggled with heartburn and indigestion, and I guess I shouldnt have ignored those warning signs.
D) I suppose I should try to eat more fiber and become a bit more active.
D) I suppose I should try to eat more fiber and become a bit more active.
15 An ultrasound has confirmed appendicitis as the cause of a 20-year-old mans
. sudden abdominal pain. Which of the following etiologic processes is implicated in the development of appendicitis?
A) Obstruction of the intestinal lumen
B) Elimination of normal intestinal flora
C) Sloughing of the intestinal mucosa
D) Increased osmolality of intestinal contents
A) Obstruction of the intestinal lumen
16 Which of the following characteristics differentiates inflammatory diarrhea
. from the noninflammatory type?
A) Larger volume of diarrhea
B) Electrolyte imbalances
C) Absence of blood in the stool
D) Infection of intestinal cells
D) Infection of intestinal cells
17 Which of the following patients should the nurse observe most closely for
. the signs and symptoms of paralytic ileus?
A) A patient who is postoperative day 1 following gall bladder surgery
B) A patient whose acute diarrhea has necessitated the use of antidiarrheal medications
C) An obese patient who refuses to ambulate because he complains of shortness of breath
D) A patient with a longstanding diagnosis of irritable bowel syndrome
A) A patient who is postoperative day 1 following gall bladder surgery
18 Which of the following meals is most likely to exacerbate an individuals
. celiac disease?
A) Spaghetti with meatballs and garlic bread
B) Stir-fried chicken and vegetables with rice
C) Oatmeal with milk, brown sugar, and walnuts
D) Barbecued steak and a baked potato with sour cream
A) Spaghetti with meatballs and garlic bread
19 Which of the following statements is true of colorectal cancer?
.
A) Aspirin and NSAIDs are implicated in the etiology.
B) It is one of the few cancers that is known to sometimes have an infectious etiology.
C) Most cases are quite advanced before symptoms become apparent.
D) Survival rates for colorectal cancer are less than 20%, but are increasing.
C) Most cases are quite advanced before symptoms become apparent.
20 Following the analysis of a recent barium enema and colonoscopy with
. biopsy, a patient has been diagnosed with colorectal cancer. Which of the following treatment modalities will be the mainstay of this patients treatment?
A) Chemotherapy
B) Radiation therapy
C) Pharmacologic therapies
D) Surgery
D) Surgery
A 15 year old male presents to the clinic with complaints of abdominal cramping, watery diarrhea, weight loss, and decreased appetite. He states this has been going on for a few months but has recently worsened. Upon further questioning he tells you that his eyes have been bothering him and he’s noticed his joints have been achy. What is the most likely diagnosis?
Gastritis
Crohn’s
Ulcerative Colitis
IBS
Crohn’s
. The presence of which two conditions help to diagnose NASH from NAFL
Metabolic syndrome and decreased ferritin
Metabolic syndrome and increased ferritin
Pulmonary HTN and increased TIBC
Ascites and decreased TIBC
Metabolic syndrome and increased ferritin
- Which of the following statements about Inflammatory Bowel Disease (IBD) is true?
A. IBD is a non-inflammatory condition that does not cause permanent intestinal damage.
B. IBD includes conditions such as Crohn’s disease and ulcerative colitis, which are characterized by chronic inflammation in the GI tract.
C. IBD primarily affects the stomach and esophagus rather than the intestines.
D. IBD is commonly caused by bacterial infections in the intestines.
B. IBD includes conditions such as Crohn’s disease and ulcerative colitis, which are characterized by chronic inflammation in the GI tract.
- Which of the following GI cancers has the highest 5-year survival rate when detected early?
A. Pancreatic cancer
B. Gastric cancer
C. Colorectal cancer
D. Liver cancer
C. Colorectal cancer
High cell turnover rate due to an acid environment is found in which layer of gastrointestinal tract?
A: Submucosa
B: Mucosa
C: Serosa
D: Muscular
B: Mucosa
In the stomach, Gastrin stimulates gastric acid secretion whereas in the small intestine, ________ inhibits gastric acid secretion.
A: Ghrelin
B: Secretin
C: Somatostatin
D: Motilin
C. Somatostatin
Chronic gastritis is associated with the presence of?
A. Lymphocytes
B. Plasma Cells
C. Macrophages
D. All of the above
D. All of the above
What are the two main causes of peptic ulcers?
a. Spicy foods and eating right before bedtime
b. NSAID use and H. pylori infection
c. Overeating and citrus fruits
d. Gastroenteritis and streptococcal pneumoniae
b. NSAID use and H. pylori infection
The most common cause of pancreatitis is?
a. Alcohol use
b. Fatty diet
c. Obesity
d. Cholelithiasis
d. Cholelithiasis
secretin vs somatostatin
Secretin
Stimulates the pancreas to secrete a fluid rich in bicarbonate, which neutralizes the pH of gastric chyme in the small intestine.
Somatostatin
Inhibits the pancreas from releasing hormones and enzymes, including insulin, glucagon, gastrin, and pancreatic enzymes. In the gastrointestinal tract, somatostatin reduces gastric secretion
s & s of crohns
palpable abdominal mass
skip lesions
