Digestive Function Flashcards
A patient with a history of hypertension, obstructive sleep apnea, sliding hiatal hernia, presents to the primary care office with complaints of heartburn at night for the past 6 weeks. The patient states that they’re compliant with the medication regimen prescribed to them by their gastroenterologist and they’ve even raised the head of their bed about 6 inches, but they haven’t noticed an improvement in heartburn symptoms.
Patient Information:
Age - 48
Gender- M
BMI: 24.9
Vital signs:
Temp- 37°C
HR- 87
BP- 124/84
RR- 19
Current Medications:
Cardizem 5mg daily
Omeprazole 40mg daily
Famotidine 20mg daily
The patient states that they’d prefer not to increase their omeprazole dose because they’re worried about increasing their dementia risk. Which of the following interventions would be best for the provider to recommend to this patient?
A. Suggest the patient talk to their cardiologist about switching blood pressure medications.
B. Counsel the patient on dietary changes that include eating less at night and consolidate most of their food intake into the first two meals of the day.
C Increase the famotidine dose to 40mg daily. Perform a mini cognitive assessment.
D. Explore weight loss strategies and refer the patient to a general surgeon to repair the hiatal hernia
Drugs that relax the lower esophageal sphincter, such as calcium channel blockers, are contraindicated in patients with sliding hiatal hernias (Rogers, p. 1325, 2022). This patient has hypertension which seems to be somewhat under control, but it is possible/ likely that the patient could be managed on a drug from a different class.
Which of the following clinical presentations would be most consistent with Hirschsprung Disease?
Patient #1
Information:
Age – 3 days
Gender- F
PMH (infant):
*Single liveborn infant delivered by Cesarean
*Abnormal findings on neonatal screening for cystic fibrosis
Presentation:
* Abdominal distention, palpable “dough-like” dilated intestinal loops
* Bile colored emesis
* Radiologic exam confirms meconium present in small intestine
Patient #2
Information:
Age- 3 days
Gender- M
PMH (infant):
* Single liveborn infant delivered vaginally
- Preterm newborn
PMH (mother): - Unspecified Preeclampsia
- Gestational Diabetes
- Preterm labor with preterm delivery
Presentation:
Patient is icteric. Serum bilirubin concentration 23 mg/dL.
Patient #3
Information:
Age – 26y/o
Gender- M
PMH:
* current everyday smoker
* vitamin d deficiency
Presentation:
Complains of diarrhea and bright red hematochezia. Abdomen is tender to palpation. Serum albumin level 3.0 g/dL.
Patient #4
Information:
Age- 59
Gender- F
PMH:
*Alcohol dependency
- alcoholic hepatitis
- Cirrhosis
Presentation:
Patient is icteric. Patient complains of anorexia, fatigue, and melena. RBC 3.2 million cells/mcL,
patient #1 hirschspring disease
patient #2 pathologic jaundice
patient #3 chrons disease
patient #4 bleeding esophageal varices
Which statement is false regarding the pathophysiologic processes associated with hepatic encephalopathy?
A. excessive amounts of the inhibitory neurotransmitter serotonin produced in the gut may contribute to decreased levels of consciousness
B. it is thought the accumulation of products (that would otherwise be detoxified by the liver) leads to transient inhibition of postural muscles known as asterixis
C. the body develops collateral vessels to shunt the blood around the diseased liver
D. neurotransmission within the brain is altered when osmotic changes occur in the presence of glutamine
excessive amounts of the inhibitory neurotransmitter serotonin produced in the gut may contribute to decreased levels of consciousness –The neurotransmitter thought to be involved in this process is GABA
A patient presents to your office with a chief complaint of greasy, pale, foul-smelling stools. Which of the following would not be on your differential:
A Small intestinal bacterial overgrowth
B Pancreatic insufficiency
C Bile duct malfunction
D H. pylori infection
H pylori infection generally causes gastritis and erosions of the gastric/duodenal lining, but typically does not result in steatorrhea
the rest create steatorrhea (greasy foul smelling stool)
To reduce the risk of hepatic encephalopathy in patients with liver failure, the NP should advise the patient on all of the following, except:
A Eat a low protein diet
B Avoid opioid analgesics
C Use lactulose to avoid constipation
D Avoid alcoholic beverages entirely
eat low protein
healthy intake of protein is necessary to avoid malnutrition, so a diet with healthy proteins including lean meats, legumes, and low-fat dairy is recommended.
You are a nurse practitioner working in the emergency department. A patient presents with gross voluminous hematemesis. Past medical history of alcoholism and gastritis leads you to believe the patient has an underlying condition of:
A. Nonalcoholic fatty liver disease
B. Portal hypertension
C. Gastric ulcers
D. Chronic mesenteric ischemia
Portal hypertension – causes the development of varices due to the prolonged pressure in the portal vein, “particularly in the lower esophagus and stomach” (Rogers, 2023, p. 1342). “Esophageal varices is the most common clinical manifestation of portal hypertension, [with] acute rupture of esophageal varices [causing] hemorrhage and voluminous vomiting of dark colored blood”
Risk factors which increase the chance of development for stomach and esophageal adenocarcinomas include all of the following except:
A Gastroesophageal reflux disease
B Smoking
C Diets high in nitrates and salts
D Use of proton pump inhibitors
proton pump inhibitors are the treatment of choice to reduce GERD symptoms and are often prescribed for chemo-prevention of Barretts esophagitis
A mother is concerned about her infant noting increased fussiness and changes in stool, which would be most concerning?
A A one week old with mustard seed stool
B A 6 month old with current jelly stools
C A 12 month old with pale, greasy, foul smelling stool with oil droplets and intermittently constipated
D A 2 year old with hard small stool
a 6 month old with currant jelly stools is concerning for intussusception. Based on age and chief complaint. The telescoping of the intestines needs to be reversed to prevent serious complications
A 36-year-old male presents to his primary physician with a history of GERD, he states he constantly is having heartburn, regurgitation, and dysphagia, he just had, and upper endoscopy completed, that shows a protrusion of an abdominal structure into the thoracic cavity, you would suspect what type of diagnosis for this patient?
A. Gastric ulcer
B. Hiatal hernia
C. Small bowel obstruction
D. Gastritis
Hiatal hernia (correct) – this is characterized as a protrusion of the abdominal structure into the thoracic cavity, clinical manifestations include, GERD, heart burn, regurgitation, dysphagia, and epigastric pain, diagnosis is confirmed by upper endoscopy
What is the most common cause of duodenal ulcers?
A. Malabsorption
B. Alcohol use
C. H. pylori
D. Oral intake of vitamins
duodenal ulcers occur with greater frequency than other types of peptic ulcers and are generally caused by H. pylori infection and NSAID use
A patient is admitted to the labor and delivery unit, she is 39 weeks and 2 days pregnant, she is showing signs of active labor, she is 9 cm dilated, her waters broke on its own and you notice the waters is a dark greenish color. What is the baby at risk for?
A. GERD
B. Meconium ileus
C. Meconium aspiration syndrome
D. Meconium plug syndrome
Meconium aspiration syndrome (correct) – this occurs following contamination of amniotic fluid associated with fetal hypoxia, gasping respirations cause aspiration of the contaminated amniotic fluid deep into the fetal lung, meconium the substance that fills the entire intestine before birth, it is dark greenish
The diarrhea caused by viral infections like rotavirus and C. difficile, resulting in large volume of stool high in chloride or bicarbonate-rich fluids is an example of what type of diarrhea?
A Motility diarrhea
B Secretory diarrhea
C Osmotic diarrhea
D Steatorrhea
secretory diarrhea. The is caused by excessive mucosal secretions of chloride or bicarbonate-rich fluid or overall inhibition of net sodium absorption. Causes are viral, bacterial endotoxin, bacterial overgrowth, neoplasm, ulcerative colitis, crohn’s disease and fecal impaction. This is hormone mediated.
A 7 year old child presents to the clinic for symptoms of anorexia, diarrhea, bone pain, Fatigue and irritability. Labs show anemia, hypomagnesemia and hypocalcemia. The clinician suspects the child has celiacs disease, after testing this suspicion is confirmed. The clinician knows the treatment for this disease consists of the following except?
A Life long gluten free diet
B Increase in malt in the diet
C Addition of fat soluble vitamins
D Iron supplements
increase in malt in the diet. Celiac disease is an autoimmune disease causing damage to the small intestinal villous epithelium when gluten is introduced. It has a strong genetic predisposition. This causes atrophy to the small intestinal mucosa because of shedding of the epithelial cells and results in hypertrophy of the mucosa. The severity of the disease depends on the length of time the mucosa is exposed to gluten. This causes malabsorption, anemia, vitamin deficiencies and systemic inflammation. Malt, barley, rye and wheat all need to be excluded from the diet to reduce damage to the mucosa.
A 55 year old presents 3 weeks of jaundice, dark urine and clay colored stool. He states that he has been fatigued and experiencing abdominal pain. Assessment shows hepatomegaly with pain on palpation. After testing the patient is diagnosed with viral hepatitis. What phase of the disease is the patient in?
A. Prodromal
B Icteric
C Recovery
D Chronic active hepatitis
icteric phase. This is the second phase of viral hepatitis. The patient presents with 2-6 weeks of the above symptoms 1-2 weeks after prodromal phase and lasts 2-6 weeks. During this time the liver function is negatively affected.
Which of the following organs is primarily responsible for nutrient absorption in the digestive system?
A. Stomach
B. Liver
C. Small Intestine
D. Pancreas
Small Intestine - This is the correct answer as the small intestine is the primary site for nutrient absorption in the digestive system. It features villi and microvilli that increase the surface area to maximize nutrient uptake.
