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.
Which of the following is a common clinical manifestation of a duodenal ulcer?
A. Severe chest pain during physical activity
B. Gnawing or burning pain in the epigastric region that occurs 2-3 hours after meals
C. and tenderness in the lower abdomen
D. Persistent diarrhea with blood
Gnawing or burning pain in the epigastric region that occurs 2-3 hours after meals
Which of the following are common clinical manifestations of gastroesophageal reflux disease (GERD) in children?
A. Frequent vomiting or regurgitation
B. Persistent cough or wheezing
C. Difficulty swallowing
D. All of the above
All of the above
Patient with a 10-year history of GERD reports smoking 1 pack of cigarettes a day for the past 30 years and reports a new onset of nocturnal reflux, and difficulty swallowing. The patient also states that the medication for reflux is “not working anymore.” The NP understands that the patient is at increased risk for the following conditions EXCEPT:
A. Esophageal Cancer
B. Esophageal Varices
C. Barrett’s Esophagus (BE)
D. Esophageal Strictures
Esophageal Varices
Rationale Esophageal varices are caused by portal hypertension, where the increase in pressure from the portal vein makes a new vascular pathway to bypass the obstruction in the liver. The new path causes the esophagus to swell and bleed
The patient presents to the clinic with slurred speech, tremors, and jaundice. She says it started 2 days ago and denies any medical history. The chart review shows a new placement of the Paragard intrauterine device (IUD) 2 weeks ago. On the exam, the patient’s cornea is notable for green-yellow rings and yellow sclera. Bloodwork is remarkable for low serum ceruloplasmin and elevated AST/ALT. CBC and v/s are normal. The NP suspects:
A Gall Stones, and need for gall stone removal
B. Galactosemia and need to start a galactose-free diet
C. Fructosemia and the need for Vitamin C supplementation
D Wilson Disease, remove Paragard and anticipate chelation therapy.
Wilson’s Disease, remove Paragard, and anticipate chelation therapy.
Rationale: Wilson’s Disease is a genetic disorder where the liver cannot excrete copper. Elevated levels of copper can cause indistinct speech, dystonia, green-yellow rings in the cornea, anorexia, intention tremors, and jaundice. Paragard is made with copper and is contraindicated in Wilson disease. It should be considered for removal
Patient reports losing their job and breaking up with their partner. The patient also states that they ingested many Tylenol pills and was sent to the ER for medical clearance. The NP will assess for:
A. Urinary Tract infection
B. Acute Liver Failure
C. Esophageal Atresia
D. Celiac Disease
Acute Liver Failure
Rationale: The patient is at risk for acute liver failure. The patient ingested large amounts of Tylenol and needs to be treated with N-acetyl cysteine (Mucomyst) within 16 hours of consumption. Acetaminophen overdose is the leading cause of acute liver failure in the US
A patient presents with dyspepsia and upper abdominal discomfort that radiates to the epigastric area. The patient reported that the pain improves after meals but worsens 2 to 5 hours after a meal. The patient reports that he has been taking NSAIDs for back pain. The patient also reports bloating and weight gain. This presentation suggests the presence of which of the following?
A Gastric Ulcer
B Gastroesophageal reflux disease
C Duodenal ulcer
D Pancreatitis
Duodenal ulcers –occur with greater frequency than other types of peptic ulcers and are generally caused by H. pylori infection and NSAID use. The patient is presenting with symptoms consistent with a duodenal ulcer. The characteristic manifestation of a duodenal ulcer is chronic, intermittent pain in the epigastric area. The pain begins 2 or 3 hours after eating, when the stomach is empty. Pain is relieved rapidly by ingestion of food or antacids, creating a typical pain-food-relief pattern
A patient presents with right lower quadrant abdominal pain, anorexia, nausea, and vomiting. During the physical assessment, you noticed pain with abdominal palpation and rebound tenderness to the right lower quadrant. White blood cell count is 12,000 cells/mm³ with elevated C-reactive protein. This suggests which of the following acute processes?
A. Appendicitis
B. Pancreatic cancer
C. Pancreatitis.
D. Diverticulitis
Appendicitis –is an inflammation of the vermiform appendix. Epigastric or periumbilical pain is the typical symptoms of an inflamed appendix. The pain may be vague at first but will increase in intensity over 3 to 4 hours. It may subside and then migrate to the right lower quadrant, indicating extension of the inflammation to the surrounding tissues. Nausea, vomiting, and anorexia follow the onset of pain, and a low-grade fever is common. Diarrhea occurs in some individuals, particularly children, others have constipation. Perforation, peritonitis, and abscess formation are the most serious complications of appendicitis.
A patient diagnosed with cirrhosis, with a history of hepatitis C and alcohol use disorder, presents with ascites and shortness of breath. Paracentesis was performed, removing 1.3 L of fluid. Before the patient’s discharge, you want to educate the patient. Which of the following is inappropriate?
A. “Cirrhosis involves the replacement of normal healthy liver tissue with scar tissue, causing significant scarring in the liver that can obstruct biliary channels and blood flow.”
B. “Alcohol increases the rate of cell death and severity of inflammation in the liver. If you stop drinking alcohol, it will slow the progression of liver damage and improve the process of regeneration.”
C. “Cirrhosis can cause immune suppression and increase the risk of infection. I highly recommend receiving the flu vaccine for this season.”
D. “If you rest, take vitamin supplements, and follow a nutritious diet, liver damage can be reversible.”
it would be inappropriate to say “If you rest, take vitamin supplements, and follow a nutritious diet, liver damage can be reversible.”
Which of the following is not a concern for individuals who experience gastroesophageal reflux disease?
A Barrett esophagus
B. Esophagitis
C. Asthma attacks
D. Weight gain
weight gain
GERD symptoms may contribute to weight loss
