M9 Gastrointestinal

Question 1

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

Answer 1

A)catabolize plasma protein

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

Question 2

Which vein in the liver is nutrient dense?

Answer 2

Portal vein (comes from lower organs)

Question 3

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

Answer 3

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)

Question 4

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

Answer 4

B) LFT decreased

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

Question 5

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

Answer 5

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.

Question 6

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

Answer 6

Osmotic diarrhea

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

Question 7

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

Answer 7

Answer: D)IBS

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

Question 8

What causes secretory diarrhea?

Answer 8

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

Question 9

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

Answer 9

Answer: D) secretory diarrhea

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

Question 10

What is the most common etiology for motility diarrhea?

A)constipation

B)dumping syndrome

C)short bowel syndrome

D)rotavirus

Answer 10

Answer: C) short bowel syndrome

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

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

Question 11

Which is not a complication of motility diarrhea?

A)dehydration

B)eletrolyte imbalances

C)metabolic alkalosis

D)weight loss

E)lower GI bleed

Answer 11

Answer: C) metabolic alkalosis

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

Question 12

Where could an upper GI bleed occur?

A)esophagus

B)duodenum

C)stomach

D)jejunum

Answer 12

Answer: choices A,B,C

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

Answer: D) hematochezia

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

Question 15

What is hematemesis?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

1000 mL regardless of origin of bleed.

Question 18

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

Answer 18

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).

Question 19

Where would a lower GI bleed occur?

Answer 19

Answer: jejunum, ileum, colon, rectum

Question 20

Which is not a cause of lower GI bleeds?

A)IBS

B)cancer

C)diverticula

D)hemorrhoid

E)One or more of the above

Answer 20

A) IBS does not cause lower GI bleeds

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

Question 21

What type of ulcer is made worse with eating?

Answer 21

Gastric ulcers

Question 22

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

Answer 22

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

Question 23

Which is not a risk of gastric ulcer development?

A)COPD

B)female gender

C)NSAIDS

D)H. pylori

E)ETOH

Answer 23

B) female gender

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

Question 24

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.

Answer 24

Gastric ulcer or duodenal ulcer

Question 25

How to NSAIDS increase the occurrence of GI ulcers?

Answer 25

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

Question 26

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

Answer 26

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.

Question 27

Crohn's disease occurs in ______ (men/women) ages \_\_\_\_\_\_, with what risk factors \_\_\_\_\_\_, \_\_\_\_\_\_\_, \_\_\_\_\_\_.

Answer 27

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

Question 28

Where can Crohn's disease occur in the GI?

Answer 28

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

Question 29

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

Answer 29

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.

Question 30

Crohn's disease is ______ and ulcerative colitis is \_\_\_\_\_\_\_. A)transmural, transmural B)superficial, transmural C) superficial, superficial D) None of the above

Answer 30

D) None of the above Crohn's disease is **transmural** (full thickness) and ulcerative colitis is **superficial**.

Question 31

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

Answer 31

Answer A) fungus. All the other choices have been linked to the incidence of Crohn's disease.

Question 32

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

Answer 32

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.

Question 33

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

Answer 33

Answer: A) acute pancreatitis

Question 34

What is a complication of small bowel obstruction? A)hypokalemia B)hypercalcemia C)volume overload D)hypertension

Answer 34

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.

Question 35

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

Answer 35

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.

Question 36

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

Answer 36

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.

Question 37

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

Answer 37

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.

Question 38

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?

Answer 38

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.

Question 39

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

Answer 39

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.

Question 40

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

Answer 40

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.

Question 41

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

Answer 41

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_**.

Question 42

Which areas are affected by ulcerative colitis?

Answer 42

Answer: Rectum and sigmoid colon

Question 43

Which inflammatory bowel disease affects the large intestine? A)Crohn's B)Ulcerative colitis C)IBS D)Diverticulitis

Answer 43

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.

Question 44

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

Answer 44

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.

Question 45

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

Answer 45

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

Question 46

What is asymptomatic diverticula termed?

Answer 46

Answer: diverticulosis

Question 47

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

Answer 47

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** Diverticul**_osis_** is an asymptomatic diverticula

Question 48

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.

Answer 48

Answer: appendicitis

Question 49

A _____ bowel adhesion mechanically blocks the lumen but _____ (does/does not) impair perfusion. A)paralytic B)strangled C)simple D)surgical

Answer 49

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

Question 50

What type of bowel obstruction would you expect to monitor for post-operatively? A)simple B)surgical C)strangled D)paralytic

Answer 50

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.

Question 51

Which of the following is not a S&S of a small bowel obstruction? A)dehydration B)fever C)hypertension D)tachycardia

Answer 51

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

Question 52

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

Answer 52

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.

Question 53

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

Answer 53

Answer: D) small bowel obstruction.

Question 54

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

Answer 54

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.