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NURS 5315 > M9 Gastrointestinal > Flashcards

M9 Gastrointestinal Flashcards

1
Q

Which is not a function of the liver?

A)catabolize plasma protein

B)detox blood

C)lipid regulation

D)sugar storage/release

E)bile

F)All of the above are functions

A

A)catabolize plasma protein

The other choices are correct, and A is incorrect because the liver works to synthesize plasma proteins.

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2
Q

Which vein in the liver is nutrient dense?

A

Portal vein (comes from lower organs)

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3
Q

Which is not true of aging and the GI tract?

A)decreased intrinsic factor

B)Blood flow decreased to GI

C)Liver blood flow decreased

D)LFT decreased

E)Pancreas is fibrotic/atrophies

A

D)LFT decreased

Aging and GI related changes include:

Decreased: esophageal motility (GERD), gastric motility/secretions/blood flow (injury to mucosa and nutrient absorption issues) intrinsic factor (anemia), liver regeneration and liver blood flow (decreased drug clearance)

LFTS are normal

The pancreas will have mild fibrosis/atrophy (decreased beta cell fx)

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4
Q

Which is false regarding age related changes to GI:

A) liver blood flow decreased

B)LFT decreased

C)Decreased intrinsic factor

D)Decreased GI secretions

E)None of the above

A

B) LFT decreased

Age related changes to GI do not impact LFTS (they remain normal)

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5
Q

Acute diarrhea is ___ loose stools within 24 hours for no more than ___ days. Persistent diarrhea is ____-____ days and chronic diarrhea is ____ days.

A

Answer: acute is 3 loose stools for no more than 24 hours for no more than 14 days; persistent is 14-30 days; chronic is 30+ days.

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6
Q

What type of diarrhea is the caused by nonabsorbable substances and osmosis pulling water into the intestine which results in large volume diarrhea?

A

Osmotic diarrhea

Causes: laxatives, tube feeding, dumping syndrome, malabsorption, pancreas enzyme deficiency, bile salt deficiency, celiac disease

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7
Q

Which of the following is not a cause of osmotic diarrhea?

A)Celiac disease

B)bile salt deficiency

C)pancreas enzyme deficiency

D)IBS

E)dumping syndrome

A

Answer: D)IBS

IBS can cause motility diarrhea. The other answer choices could cause osmotic diarrhea.

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8
Q

What causes secretory diarrhea?

A

Answer: infectious causes such as rotavirus, bacterial enterotoxin, C-diff

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9
Q

Which diagnosis does this describe: enteroendocrine cells are triggered which alters NaCl transportation and causes decreased water absorption?

A)Ascites

B)Portosystemic bypass

C)Small bowel obstruction

D)Secretory diarrhea

E)None of the above

A

Answer: D) secretory diarrhea

The trigger is an infectious rotavirus, bacterial enterotoxin, C-diff

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10
Q

What is the most common etiology for motility diarrhea?

A)constipation

B)dumping syndrome

C)short bowel syndrome

D)rotavirus

A

Answer: C) short bowel syndrome

Can include: resection, bypass, IBS, laxative abuse, diabetic neuropathy

Complications are: dehydration, electrolyte issues, metabolic acidosis, weight loss

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11
Q

Which is not a complication of motility diarrhea?

A)dehydration

B)eletrolyte imbalances

C)metabolic alkalosis

D)weight loss

E)lower GI bleed

A

Answer: C) metabolic alkalosis

Motility diarrhea could cause metabolic acidosis, weight loss, dehydration, and electrolytee issues

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12
Q

Where could an upper GI bleed occur?

A)esophagus

B)duodenum

C)stomach

D)jejunum

A

Answer: choices A,B,C

The upper GI consists of the mouth, esophagus, stomach, duodenum

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13
Q

Which is not a cause of an upper GI bleed?

A)diverticula

B)esophageal varices

C)Mallory-Weiss tear

D)cancer

E)anticoagulants/antiplatelet drugs

A

Answer: A) diverticula

Diverticula occur in the large intestine which is part of the lower GI

Upper GI bleeds occur in the esophagus, stomach, duodenum

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14
Q

Which is not a sign of an upper GI bleed?

A)hematemesis

B)melena

C)”coffee ground” emesis

D)hematochezia

E)One or more of the above

A

Answer: D) hematochezia

Hematochezia is bright red blood in the stool and it is seen in lower GI bleeds

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15
Q

What is hematemesis?

A

Frank, bright red emesis ususually seen in upper GI bleeds.

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16
Q

In upper GI bleeds, ______ emesis is an emergency, while _____ emesis is not.

A

Answer: bright red bloody emesis is an emergency, while “coffee ground” emesis is not.

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17
Q

What blood volume loss in mL will can cause hypovolemic shock?

A

1000 mL regardless of origin of bleed.

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18
Q

Which is not a complication of an upper GI bleed?

A)hypotension

B)bradycardia

C)increased urine output

D)anoxia

E)One or more of the above

A

E)One or more of the above

Upper GI bleeds can cause: hypotension (SBP <100), tachycardia, vasoconstriction, hypovolemic shock, decreased urine output, renal failure, anoxia and death (if cerebral perfusion impaired).

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19
Q

Where would a lower GI bleed occur?

A

Answer: jejunum, ileum, colon, rectum

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20
Q

Which is not a cause of lower GI bleeds?

A)IBS

B)cancer

C)diverticula

D)hemorrhoid

E)One or more of the above

A

A) IBS does not cause lower GI bleeds

Lower GI bleeds can be caused by: inflammatory bowel disease, cancer, diverticuula, and hemorrhoids.

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21
Q

What type of ulcer is made worse with eating?

A

Gastric ulcers

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22
Q

What type of ulcer (pain) is relieved with eating?

A

Duodenal ulcers. The pain occurs when the stomach is empty.

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23
Q

Which is not a risk of gastric ulcer development?

A)COPD

B)female gender

C)NSAIDS

D)H. pylori

E)ETOH

A

B) female gender

The risks of gastric ulcer include: age 55-65, NSAIDS, smoking, ETOH, COPD, chronic disease, low socioeconomic status, and H.Pylori

24
Q

What diagnosis would you give the following patient: there is a break in the nitegrity of the mucosa which exposes underlying tissue to gastric acid. This erosion can continue to the point where it extends completely through the mucosa to the underlying vessels/vasculature.

A

Gastric ulcer or duodenal ulcer

25
Q

How to NSAIDS increase the occurrence of GI ulcers?

A

Prostaglandins have protective properties for the GI tract, and NSAIDS block the production of these prostaglandins.

26
Q

Which is not a S&S of a gastric ulcer?

A)hematemesis

B)melena

C)hematochezia

D)peritonitis

E)One or more of the above

A

Answer C) hematochezia

Gastric ulcers cause: hematemesis, coffee ground emesis, & melena (black tarry stool).

Complications include bleeding, performation, & peritonitis.

Hematochezia is seen in lower GI bleeds and is bright red blood in stool.

27
Q

Crohn’s disease occurs in ______ (men/women) ages ______, with what risk factors ______, _______, ______.

A

Answer:

Crohn’s disease occurs in women (more often) aged 40 and younger with risks including: altered gut, smoking, family history.

Other risk factors include: Jewish descent, and a genetic mutation in CARD15/NOD2

28
Q

Where can Crohn’s disease occur in the GI?

A

Answer: anywhere (mouth to anus) but it is usually seen in the ileum and proximal colon.

29
Q

Which is true regarding CARD15/NOD2?

A)It is decreased in diverticulitis

B)It increases phagocytosis of bacteria

C)It decreases GI motility which leads to increased enzymatic activity linked to the incidence of skip lesions in Crohn’s

D)It encodes a protein

E)None of the above

A

Answer: D) it encodes a protein

The CARD15/NOD2 is mutated in Crohn’s disease individuals, but normally it encodes for a protein that helps the gut to identify bacteria and mount an immune response to the bacteria.

30
Q

Crohn’s disease is ______ and ulcerative colitis is _______.

A)transmural, transmural

B)superficial, transmural

C) superficial, superficial

D) None of the above

A

D) None of the above

Crohn’s disease is transmural (full thickness) and ulcerative colitis is superficial.

31
Q

Which is not a cause of Crohn’s disease/triggering factor?

A)fungus

B)bacteria/virus

C)T-cell issues

D)autoimmune response

E)None of the above

A

Answer A) fungus.

All the other choices have been linked to the incidence of Crohn’s disease.

32
Q

A patient presents with a complaint of hematochezia for two days. Which of the following is the most likely source?

A) peptic ulcer

B)duodenal ulcer

C)diverticular bleed

D)ruptured appendix

A

Answer: C) diverticular bleed

Hematochezia is the presence of bright red blood from the rectum. This is an indicator that the source of the bleed is in the lower GI tract. A peptic ulcer or duodenal ulcer are located in the upper GI tract and would result in black, tarry, stools. Diverticula are usually located in the large intestine (the lower GI tract) and when they rupture they cause hematochezia. A ruptured appendix would not cause clinical manifestations consistent with a GI bleed.

33
Q

A 50-year-old female complains of epigastric pain which radiates to the back and is relieved by sitting up. She has been nauseated and vomiting. Which is the most likely diagnosis?

A)acute pancreatitis

B)appendicitis

C)peptic ulcer disease

D)esophageal cancer

A

Answer: A) acute pancreatitis

34
Q

What is a complication of small bowel obstruction?

A)hypokalemia

B)hypercalcemia

C)volume overload

D)hypertension

A

Answer: A) hypokalemia

Hypokalemia is the only complication listed above which results from an SBO. It occurs secondary to vomiting or poor absorption and makes the intestinal atony worse.

35
Q

Which change in the GI system may be attributed to the aging process?

A)pancreatic fibrotic changes

B)Elevated AST and ALT

C)Increased nutrient absorption

D)Normal beta cell function

A

Answer: A) pancreatic fibrotic changes

An expected age related change in the GI system includes fibrotic changes in the pancreas. Beta cell function decreases, nutrient absorption slows and decreases with age. Elevated LFTs are always indicative of a liver injury and are not a normal age related event.

36
Q

A 16-day-old infant begins to experience vomiting immediately after eating and has not had a bowel movement in 1 day. Which statement bests describes the most likely pathology responsible for this infant’s symptoms?

A)a narrow gastric outlet

B)immature GI neuron development

C)failure of the intermaxillary process to fuse

D)impaired hepatic excretion of unconjugated bilirubin

A

Answer: A) narrow gastric outlet

A failure of the intermaxillary and nasomedial processes to fuse is consistent with a cleft lip.

An impaired hepatic excretion of unconjugated bilirubin is consistent with non-obstructive jaundice.

37
Q

Which instruction is most important to include in the education of a male patient with a positive Hepatitis A IgM antibody?

A)avoid kissing to prevent spreading the infection

B)Hepatitis A vaccine is indicated to prevent the progression of the infection

C)Wash your hands each time after using the restroom

D)Prevent sexual transmission of the infection by using a condom

A

Answer: C) wash your hands each time after using the restroom

The presence of the hepatitis A IgM antibody indicates that the patient has an acute hepatitis A infection. During an acute infection the patient is infectious. Hepatitis A is spread through the fecal/oral route. Therefore, it is most important that the patient be instructed to thoroughly wash his hands after he uses the restroom. An acute hepatitis B infection can be spread through kissing and is sexually transmitted. Hepatitis C may also be sexually transmitted. The hepatitis A vaccine is only indicated when a patient tests negative for Hepatitis A IgM or IgG, and it does not prevent disease progression. It only prevents an individual from contracting the infection.

38
Q

Which question best assists the nurse practitioner with identifying the most likely location of a gastrointestinal bleed?

A)what color are your stools?

B)have you been vomiting?

C)how long have you been bleeding?

D)have you had a prior GI bleed?

A

Answer: A) what color are your stools?

The color of stool will give the nurse practitioner the best indication of the location of the gastrointestinal bleed. Black, tarry, stools are a sign of an upper GI bleed and bright, red blood is an indicator that the bleed originates in the lower GI tract. Option B does not help the NP determine the location of the bleed. If option B asked for the color of the emesis then it would help to identify the location but it did not ask for the color. Option C will give the nurse practitioner an idea of the severity of the GI bleed but not the location. A history of a prior GI bleed will increase the risk of recurrent GI bleeds; however, it will not give any indication of the location of the bleed.

39
Q

Which patient is at the most risk for malnutrition?

A)a 25-year-old patient with active Crohn’s disease

B)a 60-year-old patient stable on a tube feeding

C)a 20-year-old patient with active ulcerative colitis

D)a 50-year-old patient NPO for surgery today

A

Answer: A)a 25-year-old patient with active Crohn’s disease

Crohn’s disease can affect the entire GI tract. The Crohn’s lesions are transmural, skip lesions throughout the GI tract which result in malabsorption. The patient in option B is stable and receiving nutrition. Ulcerative colitis mainly affects the large intestine and nutrient absorption primarily occurs in the small intestine. These individuals do not tend to experience difficulties with malnutrition. A person who is NPO for surgery is not at the highest risk for malnutrition.

40
Q

A three week old infant is brought in for evaluation of intermittent projectile vomiting after meals. These episodes started one week ago and have been progressive. Which pathological process is the best explanation for the infant s clinical manifestations?

A)thick, viscous, mucous plug obstructing the terminal ileum

B)pyloric cell hypertrophy and hyperplasia

C)pancreatic enzyme deficiency which causes mal-digestion

D)defective endodermal cell growth in the esophagus

A

answer: B) pyloric cell hypertrophy and hyperplasia

The clinical manifestations this infant is experiencing are classic for pyloric stenosis. The only pathological process consistent with pyloric stenosis is option B. Option A describes a meconium ileus. Option C describes cystic fibrosis and option D describes esophageal atresia.

41
Q

Which of the following is not true regarding Crohn’s disease?

A)symptoms can include bloody stools, fistulas, abscesses

B)it occurs in the sigmoid colon

C)those at risk are ages 20+

D)is it less common in smokers

E)One or more of the above

A

E)One or more of the above

Crohn’s disease can present with abdominal pain, diarrhea, dehydration, bloody stool, weight loss, abscess, obstruction, fistulas, strictures.

Those at are ages 40 and under.

It is more common in smokers.

42
Q

Which areas are affected by ulcerative colitis?

A

Answer: Rectum and sigmoid colon

43
Q

Which inflammatory bowel disease affects the large intestine?

A)Crohn’s

B)Ulcerative colitis

C)IBS

D)Diverticulitis

A

Answer B) ulcerative colitis

Crohn’s typically occurs in the ilieum and proximal colon.

Ulcerative colitis occurs in the LARGE intestine (rectum and sigmoid colon)

The other two options are not examples of inflammatory bowel diseases.

44
Q

Which is true regarding ulcerative colitis?

A)It is transmural

B)malabsorption occurs

C)it can affect the rectum

D)it is more common in smokers

A

Answer C)it can affect the rectum

Ulcerative colitis is not transmural, but rather it is superficial. Malabsorption does not occur because the ileum is not involved. It is LESS COMMON in smokers.

45
Q

Which is not a S&S/complication of ulcerative colitis?

A)bloody stool

B)polyarthritis

C)toxic megacolon

D)perirectal abscess

E)none of the above

F)one or more of the above

A

Answer E) none of the above [all answer choices are correct]

Ulcerative colitis S&S: chronic/recurrent diarrhea, bloody stools, fever.

May also have: polyarthritis, uveitis, sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum

Complications include fissures, hemorrhoids, perirectal abscess, toxic megacolon, perforation, colon cancer, VTE and microthrombi

46
Q

What is asymptomatic diverticula termed?

A

Answer: diverticulosis

47
Q

What is true of diverticulitis?

A)it is an inflammation of the diverticula

B)NSAIDS can increase the risk

C)RLQ pain is a symptom

D)it is usually asymptomatic

E)One or more of the above

A

Answer E) one or more of the above

Diverticulitis is an inflammation of the diverticula with an outpouching of the large intestine mucosa from the muscular layer of intestine which pushes into the lumen.

Risks include: NSAID use, age, genes, obesity, smoking, etc

Pain is usually seen in the LLQ

Diverticulosis is an asymptomatic diverticula

48
Q

What diagnosis would you assign to the following patient: a 16 year old male with a c/o periumbilical pain which has now settled into the RLQ with N/V/D.

A

Answer: appendicitis

49
Q

A _____ bowel adhesion mechanically blocks the lumen but _____ (does/does not) impair perfusion.

A)paralytic

B)strangled

C)simple

D)surgical

A

Answer: A simple bowel adhesion mechanically blocks the lumen but does not impair perfusion.

50
Q

What type of bowel obstruction would you expect to monitor for post-operatively?

A)simple

B)surgical

C)strangled

D)paralytic

A

Answer: D) paralytic

Paralytic obstructions are seen after surgery, with acute pancreatitis, hypokalemia, all of which cause a failure in motility. Opioids, anesthesia, inflammation, and SNS can contribute.

51
Q

Which of the following is not a S&S of a small bowel obstruction?

A)dehydration

B)fever

C)hypertension

D)tachycardia

A

Answer: C)hypertension

In SBO symptoms include: abominal pain, N/V, dehydration, distention, low BP, tachycardia, fever, leukocytosis, and rebound tenderness

52
Q

In a partial SBO a common symptom is ______ whereas in a complete SBO a common symptom is _______.

A)clear emesis, decreased bowel sounds

B)decreased bowel sounds, increased bowel sounds

C)constipation, increased bowel sounds

D)diarrhea, increased bowel sounds

A

Answer: D)

In a partial SBO a common symptom is diarrhea** whereas in a complete SBO a common symptom is **increased bowel sounds.

A pylorus will have lots of clear emesis.

53
Q

What pathological process does this describe: intestinal distention occurs which decreases the ability to reabsorb water and elctrolytes by compression of surrounding vasculature. This will increase the secretion of these into the GI lumen.

A)Crohn’s disease

B)Secretory diarrhea

C)IBS

D)Small bowel obstruction

A

Answer: D) small bowel obstruction.

54
Q

Which of the following are accurate statements regarding SBO complications.

A)The patient is at risk for hypokalemia due to a failure of the vasculature to reabsorb electrolytes.

B)Metabolic alkalosis can occur

C)Metabolic acidosis can occur

D)Fluid balance must be monitored and managed

E)One or more of the above

A

Answer E) one or more of the above.

In SBO:

*Lots of electrolytes (particularly K+) are lost and the patient is at risk for hypokalemia

*Metabolic alkalosis can occur if the patient loses H+ in emesis (K+ is also lost through this process). This occurs when the SBO is high.

*Metabolic acidosis can occur due to HCO3- not being reabsorbed (K+ will also be low due to vasodilation). This occurs when SBO is low or with prolonged obstruction.

Fluid output and electrolyte replacement are critical.

55
Q
A

NURS 5315 (4 decks)

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