Week 11: GI Flashcards

Question 1

Q

DIGESTIVE SYSTEM

_________ ingested food and fluids
- Breaks them down into their units
- Controlled by enzymes

_______ necessary components
- Membrane transport mechanisms
- Mostly in ______________

Answer

A

Processes ingested food and fluids
- Breaks them down into their units
- Controlled by enzymes

Absorbs necessary components
- Membrane transport mechanisms
- Mostly in small intestine

Question 2

Q

Oral cavity

-Initial phase of ___________ breakdown of food
—Mastication by teeth

-Initial chemical digestion
—_________________________ —starts chemical breakdown of carbohydrates
-Formation of bolus

Answer

A

-Initial phase of mechanical breakdown of food
—Mastication by teeth

-Initial chemical digestion
—Salivary amylase—starts chemical breakdown of carbohydrates
-Formation of bolus

Question 3

Q

Pharynx
- _____________ (deglutition)

Answer

A

Swallowing

Question 4

Q

Esophagus
- Closed except during ____________, skeletal muscle at superior end—
followed by smooth muscle

Answer

A

swallowing,

Question 5

Q

STOMACH

Expansible muscular sac—acts as ____________ for food and fluid
_________ smooth muscle layers
Constant mixing and churning of food

Answer

A

Expansible muscular sac—acts as reservoir for food and fluid
Three smooth muscle layers
Constant mixing and churning of food

Question 6

Q

STOMACH

Initial digestion of proteins
- By _________
- Formed by combination of pepsinogen and HCl

Production of _________ factor
- Essential for absorption of vitamin B12 in the ileum

Formation of chyme
Absorption of small and lipid-soluble molecules

Answer

A

Initial digestion of proteins
- By pepsin
- Formed by combination of pepsinogen and HCl

Production of intrinsic factor
- Essential for absorption of vitamin B12 in the ileum

Formation of chyme
Absorption of small and lipid-soluble molecules

Question 7

Q

LIVER

“_________ factory” of the body
Receives blood from hepatic portal vein
- Transport of nutrients from intestine to liver

Hepatocytes store _________
- Play role in carbohydrate, protein, fat metabolism

Production of plasma proteins and clotting factors
Breakdown of old and damaged _________
_______ production

Answer

A

“Metabolic factory” of the body
Receives blood from hepatic portal vein
- Transport of nutrients from intestine to liver

Hepatocytes store nutrients
- Play role in carbohydrate, protein, fat metabolism

Production of plasma proteins and clotting factors
Breakdown of old and damaged erythrocytes
Bile production

Question 8

Q

PANCREAS

Exocrine pancreas arranged in _________
Secretes digestive _________, electrolytes
- Trypsin, Chymotrypsin, Carboxypeptidase, Ribonuclease, Pancreatic amylase, Bicarbonate ions
Pancreatic duct joins bile duct to enter duodenum

Answer

A

Exocrine pancreas arranged in lobules
Secretes digestive enzymes, electrolytes
- Trypsin, Chymotrypsin, Carboxypeptidase, Ribonuclease, Pancreatic amylase, Bicarbonate ions
Pancreatic duct joins bile duct to enter duodenum

Question 9

Q

Small intestine

Duodenum, jejunum, ileum
Villi (folds of the mucosa) and microvilli (folds of cell membranes)
– Increase surface area for ___________
Major site for _____________ of nutrients
Lacteal—lymphatic vessel
Site of production of:
–_______
– Enterokinase, peptidases, nucleosidases, lipase, sucrase, maltase,
lactase, cholecystokinin (hormone)

Answer

A

Duodenum, jejunum, ileum
Villi (folds of the mucosa) and microvilli (folds of cell membranes)
– Increase surface area for absorption
Major site for absorption of nutrients
Lacteal—lymphatic vessel
Site of production of:
–Mucus
– Enterokinase, peptidases, nucleosidases, lipase, sucrase, maltase,
lactase, cholecystokinin (hormone)

Question 10

Q

Large intestine

______ patches (lymphatic tissue)
Resident normal flora
Breakdown of certain food materials
-Vitamin ___ synthesis by bacteria
Fluid and electrolyte ______________
Formation of solid feces
Mass movements

Answer

A

Peyer patches (lymphatic tissue)
Resident normal flora
Breakdown of certain food materials
-Vitamin K synthesis by bacteria
Fluid and electrolyte reabsorption
Formation of solid feces
Mass movements

Question 11

Q

NEURAL AND HORMONAL CONTROLS

Parasympathetic nervous system (PNS)

Primarily through vagus nerve (cranial nerve [CN] X)
Increased ______________ and ______________

Answer

A

Primarily through vagus nerve (cranial nerve [CN] X)
Increased motility & secretions

Question 12

Q

NEURAL AND HORMONAL CONTROLS

Sympathetic nervous system (SNS)

-Stimulated by factors such as _______________
- _________ gastrointestinal activity
- Causes vasoconstriction
- _____________ secretions and regeneration of epithelial cells

Answer

A

-Stimulated by factors such as fear, anger
- Inhibits gastrointestinal activity
- Causes vasoconstriction
- Reduced secretions and regeneration of epithelial cells

Question 13

Q

Facial (CN VII) and glossopharyngeal (CN IX) nerves
- Maintain continuous flow of _______________

Answer

A

saliva in mouth

Question 14

Q

Stomach empties within _______ hours after meal.

Question 15

Q

Gastrin
- Secreted by mucosal cells (stomach) in response to ___________ of stomach or partially digested substances
- Increases gastric motility, relaxes pyloric and ileocecal sphincters— promotes _________________________

Answer

A

Secreted by mucosal cells (stomach) in response to distention of stomach or partially digested substances
Increases gastric motility, relaxes pyloric and ileocecal sphincters— promotes stomach emptying

Question 16

Q

Histamine
- Increased secretion of ____________________

Answer

A

hydrochloric acid

Question 17

Q

Secretin
- Decreases ____________ secretions

Question 18

Q

Cholecystokinin
-Inhibits gastric emptying; stimulates contraction of ______________

Answer

A

gallbladder

Question 19

Q

Carbohydrates
- Digestion starts in ______
- Followed by digestion in the ______ intestine

Answer

A

Digestion starts in mouth
Followed by digestion in the small intestine

Question 20

Q

Proteins
- Digestion starts in _________, continues in small intestine

Question 21

Q

Lipids
- Emulsified by ______ prior to chemical breakdown
-Action of __________ form monoglycerides and free fatty acids
- Formation of chylomicrons

Answer

A

Emulsified by bile prior to chemical breakdown
-Action of enzymes form monoglycerides and free fatty acids
Formation of chylomicrons

Question 22

Q

Fat-soluble vitamins
- Vitamins _______________
- Absorbed with fats

Answer

A

A, D, E, K

Question 23

Q

Water-soluble vitamins
- Vitamins B and C—diffuse into:

Question 24

Q

Electrolytes
- Absorbed by active transport or ____________

Answer

A

diffusion

Question 25

Q

Drugs are primarily absorbed in the _____________
- Various transport mechanisms
- Some (e.g., aspirin) absorbed in the stomach

Answer

A

intestine.

Question 26

Q

Water

Absorbed primarily by __________
-About 700 mL of water is secreted into the digestive tract each day.
About 2300 mL is ingested in food and fluids
Only 50 to 200 mL leaves the body in feces.
-Severe vomiting or diarrhea will interrupt this ___________ mechanism.
- - Affects fluid and electrolyte balance of body

Answer

A

Absorbed primarily by osmosis
-About 700 mL of water is secreted into the digestive tract each day.
About 2300 mL is ingested in food and fluids
Only 50 to 200 mL leaves the body in feces.
-Severe vomiting or diarrhea will interrupt this recycling mechanism.
Affects fluid and electrolyte balance of body

Question 27

Q

ANOREXIA, NAUSEA, VOMITING, AND BULIMIA

May be signs of digestive disorder or other condition elsewhere in the body

Systemic infection, Uremia, Emotional responses, Motion sickness, Pressure in the brain, Overindulgence of food, drugs, Pain

-Can cause serious complications: _________________________________

Answer

A

Dehydration, acidosis, malnutrition

Question 28

Q

Nausea

-____________, _____________ feeling
- Simulated by distention, irritation, inflammation of digestive tract
-Also stimulated by smells, visual images, pain, and chemical toxins and/or drugs

Answer

A

-Unpleasant subjective feeling
- Simulated by distention, irritation, inflammation of digestive tract
-Also stimulated by smells, visual images, pain, and chemical toxins and/or drugs

Question 29

Q

Vomiting (emesis)

Vomiting center located in the ___________
~Coordinates activities involved in vomiting
~Protects airway during vomiting
Forceful expulsion of __________ from stomach
~Sometimes includes ________ from intestine

Answer

A

Vomiting center located in the medulla
-Coordinates activities involved in vomiting
-Protects airway during vomiting
Forceful expulsion of chyme from stomach
-Sometimes includes bile from intestine

Question 30

Q

Bulimia—eating disorder

Damage to structures of the GI tract caused by recurrent vomiting
______________,
____________,
________________

Answer

A

Oral mucosa
Teeth
Esophagus

Question 31

Q

Vomit

Presence of blood—_________________
- Coffee ground vomitus—brown granular material indicates action of HCl on hemoglobin
- Hemorrhage—red blood may be in vomitus

Yellow- or green-stained vomitus
- ______ from the duodenum

Deeper brown color
-May indicate content from _______ intestine

Recurrent vomiting of undigested food
- Problem with gastric ____________ or infection

Answer

A

Presence of blood—hematemesis
- Coffee ground vomitus—brown granular material indicates action of HCl on hemoglobin
- Hemorrhage—red blood may be in vomitus

Yellow- or green-stained vomitus
- Bile from the duodenum

Deeper brown color
-May indicate content from lower intestine

Recurrent vomiting of undigested food
- Problem with gastric emptying or infection

Question 32

Q

DIARRHEA
Excessive ____________ of stools
- Usually of loose or watery consistency
-May be acute or chronic
-Frequently with nausea and vomiting when infection or inflammation develops
-Prolonged diarrhea may lead to dehydration, ____________ imbalance, __________ , malnutrition

Answer

A

Excessive frequency of stools
- Usually of loose or watery consistency
-May be acute or chronic
-Frequently with nausea and vomiting when infection or inflammation develops
-Prolonged diarrhea may lead to dehydration, electrolyte imbalance, acidosis, malnutrition

Question 33

Q

COMMON TYPES OF DIARRHEA

Large-volume diarrhea (secretory or osmotic)
- Watery stool resulting from increased secretions into intestine from the plasma
- Often related to __________
- Limited reabsorption because of reversal of normal carriers for sodium and/or glucose

Small-volume diarrhea
- Often caused by ______________________
-Stool may contain blood, mucus, pus
- May be accompanied by abdominal cramps and tenesmus

Answer

A

Large-volume diarrhea (secretory or osmotic)
- Watery stool resulting from increased secretions into intestine from the plasma
- Often related to infection
- Limited reabsorption because of reversal of normal carriers for sodium and/or glucose

Small-volume diarrhea
- Often caused by inflammatory bowel disease
-Stool may contain blood, mucus, pus
- May be accompanied by abdominal cramps and tenesmus

Question 34

Q

Steatorrhea—“fatty diarrhea”

Frequent bulky, _________________ stools
Foul odor
Characteristic of _________________ syndromes- Celiac disease, cystic fibrosis
Fat usually the first dietary component affected
Presence interferes with digestion of other nutrients.
Abdomen often distended

Answer

A

Frequent bulky, greasy, loose stools
Foul odor
Characteristic of malabsorption syndromes
Celiac disease, cystic fibrosis
Fat usually the first dietary component affected
Presence interferes with digestion of other nutrients.
Abdomen often distended

Question 35

Q

BLOOD IN STOOL may occur in normal stools with diarrhea, constipation, tumors, or an inflammatory condition.

Frank blood
- _____ blood—usually from lesions in rectum or anal canal

___________ blood
-Small hidden amounts, detectable with stool test
- May be caused by small bleeding ulcers

___________
- Dark-colored, tarry stool
- May result from significant bleeding in upper digestive tract

Answer

A

Frank blood
- Red blood—usually from lesions in rectum or anal canal

Occult blood
-Small hidden amounts, detectable with stool test
- May be caused by small bleeding ulcers

Melena
- Dark-colored, tarry stool
- May result from significant bleeding in upper digestive tract

Question 36

Q

GAS from swallowed air, such as drinking from ___________
-_____________ action on food
-Foods or alterations in motility

Excessive gas causes:
- Eructation
-Borborygmus
-Abdominal distention and pain
- Flatus

Answer

A

GAS from swallowed air, such as drinking from a straw
-Bacterial action on food
-Foods or alterations in motility

Excessive gas causes:
- Eructation
-Borborygmus
-Abdominal distention and pain
- Flatus

Question 37

Q

CAUSES OF CONSTIPATION

Weakness of ____________ muscle because of age or illness
Inadequate dietary _________
Inadequate _________ intake
Failure to respond to defecation reflex
Immobility
Neurological disorders
Drugs (i.e., opiates)
Some antacids, iron medications
Obstructions caused by tumors or strictures

Answer

A

Weakness of smooth muscle because of age or illness
Inadequate dietary fiber
Inadequate fluid intake
Failure to respond to defecation reflex
Immobility
Neurological disorders
Drugs (i.e., opiates)
Some antacids, iron medications
Obstructions caused by tumors or strictures

Question 38

Q

Burning sensation
- Inflammation and __________________ in upper digestive tract

Dull, aching pain
- Typical result of ____________ of liver capsule

_______________ or diffuse pain
- Inflammation, distention, stretching of intestines

Colicky, often severe pain
-Recurrent __________ muscle spasms or contraction
-Response to severe inflammation or obstruction

Answer

A

Burning sensation
- Inflammation and ulceration in upper digestive tract

Dull, aching pain
- Typical result of stretching of liver capsule

Cramping or diffuse pain
- Inflammation, distention, stretching of intestines

Colicky, often severe pain
-Recurrent smooth muscle spasms or contraction
-Response to severe inflammation or obstruction

Question 39

Q

MALNUTRITION May be limited to a specific nutrient or general

Causes of limited malnutrition—specific problem
- Vitamin _____ deficiency
- _____ deficiency

Causes of generalized malnutrition
- Chronic anorexia, vomiting, diarrhea
- Other systemic causes
- Chronic ______________________
- Cancer treatments
- Wasting syndrome
- Lack of available nutrients

Answer

A

Causes of limited malnutrition—specific problem
- Vitamin B12 deficiency
- Iron deficiency

Causes of generalized malnutrition
- Chronic anorexia, vomiting, diarrhea
- Other systemic causes
- Chronic inflammatory bowel disorders
- Cancer treatments
- Wasting syndrome
- Lack of available nutrients

Question 40

Q

Antacids
- To relieve ___________

Antiemetics
- To relieve ____________

Laxatives or enemas
- Treatment of acute _______________

Antidiarrheals
- Reduction of peristalsis
- Relieve __________

Answer

A

Antacids
- To relieve pyrosis

Antiemetics
- To relieve vomiting

Laxatives or enemas
- Treatment of acute constipation

Antidiarrheals
- Reduction of peristalsis
- Relieve cramps

Question 41

Q

Sulfasalazine
- Anti-inflammatory and antibacterial
- Used for acute episodes of ________________________

Answer

A

inflammatory bowel disease

Question 42

Q

Clarithromycin or azithromycin
-Effective against __________________ infection
- Usually combined with a proton pump inhibitor

Answer

A

Helicobacter pylori

Question 43

Q

Sucralfate
-________________
-Enhance gastric mucosal barrier against irritants such as nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer

A

Coating agent

Question 44

Q

Anticholinergic drugs
- Reduce PNS activity
- Reduce ____________________

Answer

A

secretions and motility

Question 45

Q

Histamine 2 antagonists
- Useful for gastric ________

Question 46

Q

Proton pump inhibitors
- Reduce gastric ___________

Answer

A

secretion

Question 47

Q

Candidiasis
- Candida albicans—causative agent
-Often part of the resident flora
- _____________________

Oral candidiasis (thrush)
-People receiving broad-spectrum antibiotics
During and after cancer therapy
-Immunocompromised individuals or those with diabetes
May appear as red, swollen areas
May be irregular patches of a white curdlike material

Answer

A

Opportunistic organism

Question 48

Q

Herpes simplex type 1 infection

Transmitted by _________________
Virus remains __________ in sensory ganglion
Activated by stress, trauma, other infection
Formation of blister, ulcers, clear fluid release—contains virus; can be autoinoculated to other areas
Lesions heal spontaneously in __________ days.
Acute stage may be alleviated by antiviral medication.
May spread to eyes- Conjunctivitis and keratitis

Answer

A

Transmitted by kissing or close contact
Virus remains dormant in sensory ganglion
Activated by stress, trauma, other infection
Formation of blister, ulcers, clear fluid release—contains virus; can be autoinoculated to other areas
Lesions heal spontaneously in 7 to 10 days.
Acute stage may be alleviated by antiviral medication.
May spread to eyes- Conjunctivitis and keratitis

Question 49

Q

Syphilis
- Caused by Treponema pallidum
-May cause _____ lesions
- Highly contagious during first and second stages

Primary stage
- Chancre, a painless _____ on tongue, lip, palate
-Heals spontaneously (1 or 2 weeks)

Secondary stage
- Red macules or papules on palate—highly infectious
- Heals spontaneously
- Both stages treated with long-acting ___________

Answer

A

Caused by Treponema pallidum
-May cause oral lesions
Highly contagious during first and second stages

Primary stage
- Chancre, a painless ulcer on tongue, lip, palate
-Heals spontaneously (1 or 2 weeks)

Secondary stage
- Red macules or papules on palate—highly infectious
- Heals spontaneously
- Both stages treated with long-acting penicillin

Question 50

Q

Caries

-Streptococcus mutans—initiating microbe
- Lactobacillus follows in large numbers.
-Bacteria break down sugars and produce large quantities of lactic acid.
-Lactic acid dissolves mineral in tooth enamel
- Tooth erosion and caries formation
-Caries is promoted by frequent intake of __________________
-__________—anticaries treatment

Answer

A

-Streptococcus mutans—initiating microbe
- Lactobacillus follows in large numbers.
-Bacteria break down sugars and produce large quantities of lactic acid.
-Lactic acid dissolves mineral in tooth enamel
- Tooth erosion and caries formation
-Caries is promoted by frequent intake of sugars and acids.
-Fluoride—anticaries treatment

Question 51

Q

Gingivitis

Inflammation of the gingiva
–Tissue becomes ____, soft, swollen, bleeds easily
– May be a result of accumulated _____
Inadequate oral hygiene
Toothbrush trauma
–Results from improper or excessive ____________
– Creates extensive grooving on tooth surface
– Increase plaque retention and damage to gingivae

Answer

A

Inflammation of the gingiva
–Tissue becomes red, soft, swollen, bleeds easily
– May be a result of accumulated plaque
Inadequate oral hygiene
Toothbrush trauma
–Results from improper or excessive brushing
– Creates extensive grooving on tooth surface
– Increase plaque retention and damage to gingivae

Question 52

Q

Periodontal disease

-Infection and damage to the periodontal ligament and bone
-Predisposing condition is __________
-Caused by ____________ as a result of poor dental hygiene
- Subsequent loss of ________ possible
- Several categories, depending on degree of disease
- May be aggravated by systemic disease and medications that reduce salivary ___________

Answer

A

-Infection and damage to the periodontal ligament and bone
-Predisposing condition is gingivitis
-Caused by microorganisms as a result of poor dental hygiene
- Subsequent loss of teeth possible
- Several categories, depending on degree of disease
- May be aggravated by systemic disease and medications that reduce salivary secretions

Question 53

Q

-Periodontitis occurs when organisms enter the gingival ________________ and travel to the -connective tissues and bone of the dental arch.
-Resorption of bone and loss of ligament fibers result in weakened _____________ of teeth.
-May result in total loss of tooth from socket
-Treated by anti____________, local surgery of gingiva, and improved dental hygiene

Answer

A

-Periodontitis occurs when organisms enter the gingival blood vessels and travel to the -connective tissues and bone of the dental arch.
-Resorption of bone and loss of ligament fibers result in weakened attachment of teeth.
-May result in total loss of tooth from socket
-Treated by antimicrobials, local surgery of gingiva, and improved dental hygiene

Question 54

Q

Hyperkeratosis
-Leukoplakia (example)
- Whitish __________ or epidermal thickening of mucosa
- Occurs on buccal mucosa, palate, lower lip
- May be related to ___________ or chronic irritation
- Lesions require monitoring.
-Epithelial dysplasia beneath plaque may develop into __________________

Answer

A

-Leukoplakia (example)
- Whitish plaque or epidermal thickening of mucosa
- Occurs on buccal mucosa, palate, lower lip
- May be related to smoking or chronic irritation
- Lesions require monitoring.
-Epithelial dysplasia beneath plaque may develop into squamous cell carcinoma.

Question 55

Q

CANCER OF THE ORAL CAVITY

__________________ carcinoma—common type
Often develops in persons older than 40 years
- Smokers, preexisting leukoplakia, alcohol abuse
-Floor of the mouth, lateral borders of the tongue
- Multiple lesions possible

___________ sarcoma in patients with AIDS
Lip cancer has a better prognosis.
- Common in smokers, particularly pipe smokers

Answer

A

Squamous cell carcinoma—common type
Often develops in persons older than 40 years
- Smokers, preexisting leukoplakia, alcohol abuse
-Floor of the mouth, lateral borders of the tongue
- Multiple lesions possible

Kaposi sarcoma in patients with AIDS
Lip cancer has a better prognosis.
- Common in smokers, particularly pipe smokers

Question 56

Q

____________
- Inflammation of the salivary glands
- May be infectious or noninfectious
- Most commonly affected—parotid gland

Answer

A

Sialadenitis

Question 57

Q

Mumps—infectious parotitis
- ________ infection
- Vaccine ___________

Answer

A

Viral infection
Vaccine available

Question 58

Q

Noninfectious parotitis
- Often seen in older adults who lack adequate _________________ and mouth care

Answer

A

fluid intake

Question 59

Q

Most malignant tumor of salivary glands is __________________ carcinoma

Answer

A

mucoepidermoid

Question 60

Q

DYSPHAGIA - Difficulty swallowing

Causes
- ___________ deficit [Infection, Stroke, Brain damage, Achalasia]
- ______________ disorder [dystrophy]
- Mechanical obstruction [dystrophy]

Results and presentation
- ______ with swallowing
- Inability to swallow larger pieces of solid material
- Difficulty swallowing liquids

Answer

A

Causes
- Neurological deficit [Infection, Stroke, Brain damage, Achalasia]
- Muscular disorder [dystrophy]
- Mechanical obstruction [dystrophy]

Results and presentation
- Pain with swallowing
- Inability to swallow larger pieces of solid material
- Difficulty swallowing liquids

Question 61

Q

ESOPHAGEAL CANCER

Primarily _________________ carcinoma
Usually in __________ esophagus
Significant dysphagia in later stages
Poor _____________ because of late manifestations
Associated with chronic irritation because of:
- Chronic esophagitis
- Achalasia
- Hiatal hernia
-Alcohol abuse, smoking

Answer

A

Primarily squamous cell carcinoma
Usually in distal esophagus
Significant dysphagia in later stages
Poor prognosis because of late manifestations
Associated with chronic irritation because of:
- Chronic esophagitis
- Achalasia
- Hiatal hernia
-Alcohol abuse, smoking

Question 62

Q

HIATAL HERNIA - Part of the stomach protrudes into the thoracic cavity.

Sliding hernia
- More common type
- Portions of the stomach and gastroesophageal junction slide up above the ____________.

Rolling or paraesophageal hernia
- Part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm and may become _________.

Answer

A

Sliding hernia
- More common type
- Portions of the stomach and gastroesophageal junction slide up above the diaphragm.

Rolling or paraesophageal hernia
- Part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm and may become trapped.

Question 63

Q

HIATAL HERNIA (CONT.)

Food may _________ in pouch of the hernia
- Causes inflammation of the mucosa
- Reflux of food up the esophagus
- May cause chronic esophagitis

Signs
- ___________ or pyrosis
- Frequent __________
- Increased discomfort when laying down
- Substernal pain that may radiate to shoulder and jaw

Answer

A

Food may lodge in pouch of the hernia
- Causes inflammation of the mucosa
- Reflux of food up the esophagus
- May cause chronic esophagitis

Signs
- Heartburn or pyrosis
- Frequent belching
- Increased discomfort when laying down
- Substernal pain that may radiate to shoulder and jaw

Question 64

Q

GASTROESOPHAGEAL REFLUX DISEASE AKA GERD

-Periodic reflux of gastric contents into distal esophagus causes _________ and inflammation.
-Often seen in conjunction with ________ hernia
-Severity depends on competence of the lower esophageal sphincter.
-Delayed gastric ___________ may be a factor.

Avoidance of:
-Caffeine, fatty and spicy foods, alcohol, smoking, certain drugs
-Use of medication may reduce reflux and inflammation

Answer

A

-Periodic reflux of gastric contents into distal esophagus causes erosion and inflammation.
-Often seen in conjunction with hiatal hernia
-Severity depends on competence of the lower esophageal sphincter.
-Delayed gastric emptying may be a factor.

Avoidance of:
-Caffeine, fatty and spicy foods, alcohol, smoking, certain drugs
-Use of medication may reduce reflux and inflammation

Answer 60

A

May result from
- Infection by microorganisms
- Allergies to foods
-Spicy or irritating foods
-Excessive alcohol intake
- Ingestion of aspirin or other NSAIDs
- Ingestion of corrosive or toxic substances
- Radiation or chemotherapy

Basic signs of gastrointestinal irritation
- Anorexia, nausea, vomiting may develop
- Hematemesis caused by bleeding
- Epigastric pain, cramps or general discomfort
- With infection, diarrhea may develop.

Acute gastritis is usually self-limiting.
-Complete regeneration of gastric mucosa
- Supportive treatment with prolonged vomiting
- May require treatment with antimicrobial drugs

Answer 61

A

Characterized by atrophy of stomach mucosa
- Loss of secretory glands
- Reduced production of intrinsic factor
-Helicobacter pylori infection is often present.

Signs may be vague.
- Mild epigastric discomfort, anorexia, intolerance for certain foods
-Increased risk of peptic ulcers and gastric carcinoma
-Certain autoimmune disorders are associated with one type of chronic gastric atrophy.

Answer 62

A

inflammation of stomach and intestine
-Usually caused by infection
-May also be caused by allergic reactions to food or drugs
-Microbes can be transmitted by fecally
-contaminated food, soil, and/or water
- Most infections are self-limiting.
- Serious illness may result in compromised host or virulent organisms.
- May cause epidemic outbreaks in refugee or disaster settings
- Safe sanitation essential for prevention

Answer 63

A

infective strains

Answer 64

A

-Most caused by H. pylori infection
-Usually occur in the proximal duodenum (duodenal ulcers)
-Also found in the antrum of the stomach (gastric ulcers)
-Development begins with breakdown of mucosal barrier
-Decreased mucosal defense
- More common in gastric ulcer development
- Increased acid secretion predominant factor in duodenal ulcers

Answer 65

A

Damage to mucosal barrier predisposes to development of ulcers and is associated with:
-Inadequate blood supply
–Caused by vasoconstriction (e.g., by stress, smoking, shock, circulatory impairment in older adults, scar tissue, anemia)
–Interferes with rapid regeneration of epithelium
–Excessive glucocorticoid secretion or medication
-Ulcerogenic substances break down mucous layer.
–Aspirin, NSAIDs, alcohol
-Atrophy of gastric mucosa
–Chronic gastritis

Answer 66

A

Increased gastrin secretion
Increased vagal stimulation
Increased sensitivity to vagal stimuli
Increased number of acid pepsin secretory cells in the stomach (genetic anomaly)
Increased stimulation of acid pepsin secretion
Alcohol, caffeine, certain foods
Interference with normal feedback mechanisms
Rapid gastric emptying

Answer 67

A

Hemorrhage
Caused by erosion of blood vessels
Common complication
May be the first sign of a peptic ulcer
Perforation
Ulcer erodes completely through the wall.
Chyme can enter the peritoneal cavity.
Results in chemical peritonitis
Obstruction may result later because of the formation of scar tissue

Answer 68

A

Signs and symptoms
- Epigastric burning or localized pain, usually following stomach emptying

Diagnostic tests
-Fiberoptic endoscopy
- Barium x-ray
- Endoscopic biopsy

Treatment
- Combination of antimicrobial and proton pump inhibitor to eliminate H. pylori
- Reduction of exacerbating factors

Answer 69

A

Associated with severe trauma or systemic problems
- Burns, head injury
- Hemorrhage or sepsis

Rapid onset
- Multiple ulcers (usually gastric) may form within hours of precipitating mevent
- First indicator—hemorrhage and severe pain

Answer 70

A

Arises primarily in mucous glands
Mostly in the antrum or pyloric area

Early carcinoma
- Confined to mucosa and submucosa Later stages
- Involves muscularis
- Eventually invades serosa and spreads to lymph nodes

Asymptomatic in the early stages
- Often, prognosis is poor on diagnosis

Answer 71

A

-Diet seems to be a key factor, particularly smoked foods, nitrites, and nitrates.
-Genetic influences also play a role.
-Symptoms vague until cancer is advanced.
- Reason for late diagnosis
- Surgery together with chemotherapy and radiation may relieve symptoms.
- Survival rate less than 20%

Answer 72

A

Control of gastric emptying is lost, and gastric contents are “dumped” into the duodenum without complete digestion; May follow gastric resection
Hyperosmolar chyme draws fluid from vascular compartment into intestine
- Intestinal distention
- Increased intestinal motility
- Decreased blood pressure → anxiety and syncope

Answer 73

A

-Abdominal cramps, nausea, diarrhea
-Hypoglycemia 2 to 3 hours after meal
-High blood glucose levels in chyme stimulate increased insulin secretion → drop in blood glucose levels
-May be resolved by dietary changes
-Frequent small meals—high in protein, low in simple carbohydrates
-Often resolves over time

Answer 74

A

Narrowing and obstruction of pyloric sphincter
May be developmental anomaly
Signs appear within several weeks after birth.
- Projectile vomiting immediately after feeding
- Firm mass can be palpated at pylorus.
- Infant fails to gain weight, dehydration, persistent hunger
Surgery required to remove obstruction.
May be acquired later in life
- Persistent feeling of fullness
- Increased incidence of vomiting

Answer 75

A

-Formation of gallstones
- Solid material (calculi) that form in bile

Answer 76

A

gallbladder

Answer 77

A

bile ducts

Answer 78

A

gallstones

Answer 79

A

May consist of:
- Cholesterol or bile pigment
- Mixed content with calcium salts

Small stones
- May be silent and excreted in bile

Larger stones
- Obstruct flow of bile in cystic or common bile ducts; cause severe pain, which is often referred to subscapular area

Answer 80

A

Women twice as likely to develop stones
-High cholesterol in bile
High cholesterol intake
Obesity
Multiparity
-Use of oral contraceptives or estrogen supplements
Hemolytic anemia
Alcoholic cirrhosis
-Biliary tract infection

Answer 81

A

Sudden severe waves of pain
Radiating pain
Nausea and vomiting usually present
Pain continues, and jaundice develops.
Bile backs up into the liver and blood.
Risk of ruptured gallbladder if obstruction persists
Pain decreases if stone moves into duodenum
-Surgical intervention may be necessary.
May be removed using laparoscopic surgery
Low-fat diet necessary following surgery

Answer 82

A

Prehepatic jaundice
- Result of excessive destruction of red blood cells
- Characteristic of hemolytic anemias or transfusion reactions

Intrahepatic jaundice
- Occurs with disease or damage to hepatocytes
- Hepatitis or cirrhosis

Posthepatic jaundice
- Caused by obstruction of bile flow into gallbladder or duodenum
- Tumor, cholelithiasis

Answer 83

A

Direct or conjugated bilirubin can be measured in the blood.

Total bilirubin is measured in blood.

Total bilirubin minus direct bilirubin = indirect or unconjugated bilirubin.

Answer 84

A

Prehepatic jaundice
- Unconjugated bilirubin level elevated

Intrahepatic jaundice
- Both unconjugated and conjugated bilirubin levels may be elevated.

Posthepatic jaundice
- Increased conjugated bilirubin level
- Light-colored stool caused by absence of bile

Answer 85

A

Alcoholic
- Fatty liver

Idiopathic
- Fatty liver

Viral hepatitis
- Local infection

Infection elsewhere in body
- Examples—infectious mononucleosis or amebiasis Chemical or drug toxicity

Answer 86

A

Cell injury results in inflammation and necrosis in the liver.
- Degrees of inflammation and damage vary.
Liver is edematous and tender.

Answer 87

A

Small RNA virus
Infectious hepatitis
Transmitted by fecal-oral route in areas of inadequate sanitation or hygiene
-Often from contaminated water or shellfish
Sexual transmission has occurred during anal intercourse.
Acute but self-limiting infection
No carrier or chronic state
Fecal shedding of virus before onset of signs
Vaccine available for travelers, food care workers, and health care workers

Answer 88

A

Partially double-stranded DNA virus
Over 50% of HIV-positive patients are positive for HBV.
50% of patients are asymptomatic but contagious because of carrier state.
Chronic inflammation can occur.
Transmission primarily by infected blood
Sexual transmission has been noted.
-Tattooing and body piercing may transmit the virus.
Vaccine available, routinely given to children

Answer 89

A

Single-stranded RNA virus
-Most common type transmitted by blood transfusion
May exist in a carrier state
About 50% of patients enter the chronic state.
-Increases risk of hepatocellular carcinoma
Treated with interferon injections

Answer 90

A

Also called delta virus
Incomplete RNA virus
Requires HBV to replicate and produce active infection
HDV infection increases severity of HBV infection
Transmitted by blood

Answer 91

A

-single stranded RNA virus
- Transmitted by oral-fecal route
- No chronic or carrier state

Answer 92

A

Preicteric stage
- Fatigue and malaise
- Anorexia and nausea
- General muscle aching

Icteric stage
- Onset of jaundice
- Stools light in color, urine becomes darker
-Liver tender and enlarged, mild aching pain

Posticteric stage—recovery stage
- Reductions in signs
- Weakness persists for weeks

Answer 93

A

Only body defense is formation of antibodies via vaccination

Supportive measures
- Rest, diet high in protein, carbohydrate, and vitamins
Chronic hepatitis can be treated with interferon.
- Decreases viral replication
- Effective in only 30% to 40% of individuals
- Drug combination (slow-acting interferon plus antiviral drug) more effective

Answer 94

A

Variety of hepatotoxins can cause inflammation and necrosis of the liver.

Drugs include:
- Acetaminophen, halothane, phenothiazines, tetracycline
- Chemicals include: Carbon tetrachloride (not used currently), toluene, ethanol

Direct effect of toxins
May result from sudden exposure to large amounts or from lower dose and long-term exposure

Answer 95

A

Alcoholic liver disease
Biliary cirrhosis
Associated with immune disorders
Postnecrotic cirrhosis
Linked with chronic hepatitis or long-term exposure to toxic materials
Metabolic
Usually caused by genetic metabolic storage disorders

Answer 96

A

Extensive diffuse fibrosis
- Interferes with blood supply
- Bile may back up.
Loss of lobular organization
Degenerative changes may be asymptomatic until disease is well advanced.
Liver biopsy and serologic test to determine cause and extent of damage

Answer 97

A

Initial stage—fatty liver
- Enlargement of the liver
- Asymptomatic and reversible with reduced alcohol intake

Second stage—alcoholic hepatitis
-Inflammation and cell necrosis
- Fibrous tissue formation—irreversible change

Third stage—end-stage cirrhosis
-Fibrotic tissue replaces normal tissue.
- Little normal function remains.

Answer 98

A

Decreased removal and conjugation of bilirubin
Decreased production of bile
Impaired digestion and absorption of nutrients
Decreased production of blood-clotting factors
Impaired glucose and glycogen metabolism
Impaired conversion of ammonia to urea

Answer 99

A

Decreased inactivation of hormones and drugs
- Drug dosages must be carefully monitored to avoid toxicity.
Decreased removal of toxic substances
Reduction of bile entering the intestine
- Impairs digestion and absorption
Backup of bile in the liver
- Leads to obstructive jaundice
Blockage of blood flow through the liver
- Leads to portal hypertension
Congestion in the spleen
- Increases hemolysis
Inadequate storage of iron and vitamin B12
Congestion in intestinal walls and stomach
- Impairing digestion and absorption
Development of esophageal varices
- Hemorrhage
Development of ascites, an accumulation of fluid in the peritoneal cavity
- Causes abdominal distention and pressure

Answer 100

A

Initial manifestations often mild and vague
- Fatigue, anorexia, weight loss, anemia, diarrhea
- Dull aching pain may be present in upper right abdominal quadrant.

Advanced cirrhosis
- Ascites and peripheral edema
- Increased bruising
- Esophageal varices
- May rupture, leading to hemorrhage, circulatory shock
- Jaundice, encephalopathy

Answer 101

A

Avoidance of alcohol or specific cause
Supportive or symptomatic treatment
Dietary restrictions
Balancing serum electrolytes
Paracentesis
Antibiotics to reduce intestinal flora
Emergency treatment if esophageal varices rupture
Liver transplantation

Answer 102

A

Hepatocellular carcinoma
- Most common primary tumor of liver
- More common in cirrhotic livers
Secondary or metastatic cancer
- Arises from areas served by the hepatic vein or spread along the peritoneal membranes
Initial signs are mild and general.
Diagnosis usually occurs with advanced stages
Chemotherapy, possible lobectomy or radiofrequency ablation
(RFA) procedure

Answer 103

A

Inflammation of the pancreas
- Results in autodigestion of the tissue
May be acute or chronic
- Acute form considered a medical emergency
Pancreas lacks a fibrous capsule
- Destruction may progress into tissue surrounding the pancreas
- Substances released by necrotic tissue lead to widespread inflammation
- Hypovolemia and circulatory collapse may follow.

Answer 104

A

Chemical peritonitis results in bacterial peritonitis.
-Septicemia may result.
- Adult respiratory distress syndrome and acute renal failure are possible complications.

Causes
- Gallstones
-Alcohol abuse
-Sudden onset may follow intake of large meal or large amount of alcohol

Answer 105

A

Severe epigastric or abdominal pain radiating to the back—
primary symptoms
Signs of shock
- Caused by hypovolemia

Low-grade fever until infection develops
-Body temperature may then rise significantly.

Abdominal distention and decreased bowel sounds
-Decreased peristalsis and paralytic ileus

Answer 106

A

Diagnostic tests
- Serum amylase levels—first rise, then fall after 48 hours
-Serum lipid levels are elevated.
- Hypocalcemia
- Leukocytosis

Treatment
-Oral intake is stopped.
- Treatment of shock and electrolyte imbalances
- Analgesics for pain relief

Answer 107

A

Risk factors
-Smoking
- Pancreatitis and dietary factors

Adenocarcinoma—most common form
- Arises from the epithelial cells in the ducts
-Weight loss and jaundice early manifestations
-Frequently asymptomatic until well advanced
-Metastases occur early.
-Mortality is close to 95%.

Answer 108

A

Malabsorption syndrome
Primarily a childhood disorder
- May occur in adults in middle age
Appears to have genetic link
Defect in intestinal enzyme
- Prevents further digestion of gliadin (breakdown product of gluten)
- Toxic effect on intestinal villi—atrophy of villi
- Malabsorption and malnutrition result.

Answer 109

A

First signs appear when cereals are added.- At about 4 to 6 months of age

Manifestation
- Steatorrhea, muscle wasting, failure to gain weight
- Irritability and malaise common
Diagnosed by a series of blood tests
Gluten-free diet for treatment
- Intestinal mucosa returns to normal after a few weeks without gluten intake.

Answer 110

A

-Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases (IBDs).
-Causes unknown
-Genetic factor appears to be involved.
-Crohn’s disease—often during adolescence
-Ulcerative colitis—second or third decade

Many similarities between Crohn’s disease and ulcerative colitis

Answer 111

A

May affect any area of the digestive tract
- Usually small intestine affected
Inflammation occurs in characteristic distribution
- “Skip lesions”—affected areas separated by areas of normal tissue
Progressive inflammation and fibrosis may cause obstructed areas.
- Damaged walls impair processing and absorption of food.
- Inflammation stimulates intestinal motility.

Answer 112

A

Interference with digestion and absorption
- Hypoproteinemia, avitaminosis, malnutrition, possibly steatorrhea

Other complications
- Adhesions between loops may form and fistulas may develop.

Children
- Delayed growth and sexual maturation

Glucocorticoid used in treatment

Answer 113

A

Inflammation starts in the rectum
Progresses through the colon
Mucosa and submucosa are inflamed.
- Tissue destruction interferes with absorption of fluid and electrolytes in colon.
Severe acute episodes—toxic megacolon may develop.
-Marked diarrhea, with up to 12 stools per day
- Contains blood and mucus; cramping pain

Answer 114

A

Anti-inflammatory medications
- Sulfasalazine
- Glucocorticoids

-Antimotility agents
-Nutritional supplements
-Antimicrobials
-Immunotherapeutic agents
-Surgical resection - Usually ileostomy or colostomy

Answer 115

A

Abnormal gastrointestinal mobility and secretion
Visceral hypersensitivity
Postinfectious IBS
Overgrowth of flora
Food allergy or intolerance
Psychosocial factors

Answer 116

A

Lower abdominal pain
Diarrhea
-Constipation, alternating with diarrhea
Bloating, nausea

Diagnosis
- Based on signs and symptoms
- Testing for food allergies
- Testing for bacterial or parasitic infections
- No single cure for IBS

Answer 117

A

Obstruction of the appendiceal lumen
- By a fecalith, gallstone, or foreign material
Fluid builds up inside the appendix.
- Microorganisms proliferate
Appendiceal wall becomes inflamed.
- Purulent exudate forms
- Appendix is swollen.
- Results in increased permeability

Answer 118

A

Bacteria and toxins escape into surroundings.
-Leads to abscess formation or localized bacterial peritonitis
Abscess may develop when inflamed area is walled off.
- Inflammation and pain may temporarily subside.
Localized infection or peritonitis develops around the appendix.
- May spread along the peritoneal membranes

Answer 119

A

Increased necrosis and gangrene in the wall
-Caused by increasing pressure in the appendix

Appendix ruptures or perforates
-Release of contents into peritoneal cavity
-Generalized peritonitis
- May be life-threatening

Treatment
- Surgical removal of appendix and antimicrobial drugs

Answer 120

A

General periumbilical pain
- Related to the inflammation
Nausea and vomiting common
Pain becomes severe and localized in lower right quadrant (LRQ).
- Involvement of parietal peritoneum over appendix

After rupture
- Pain subsides temporarily.
Pain recurs—severe, generalized abdominal pain and guarding
Low-grade fever and leukocytosis
- Development of inflammation
Boardlike abdomen, tachycardia, hypotension
- As peritonitis develops, abdominal wall muscles spasm.
- Toxins lead to reduced blood pressure.

Answer 121

A

Diverticulum
- Outpouching (herniation) of the mucosa through the muscular layer of the colon

Diverticulosis
- Asymptomatic diverticular disease

Diverticulitis
- Inflammation of the diverticula

Answer 122

A

Form at gaps between muscle layers
Congenital weakness of wall may be a factor
Weaker areas bulge when pressure increases.
Many cases are asymptomatic.
Diverticulitis stasis of material in diverticula leads to inflammation and infection.
- Cramping, tenderness, nausea, vomiting
- Slight fever and elevated white blood cell count

Treatment of diverticulitis
- Antimicrobial drugs
- Dietary modifications to prevent stasis

Answer 123

A

Most malignancies develop from adenomatous polyps.
Early diagnosis is essential.
Cancer occurs primarily in persons older than 50 years.

Risk factors
- Familial multiple polyposis
- Long-term ulcerative colitis
- Genetic factors
- Environmental factors
- Diet low in fiber

Answer 124

A

General signs
- Change in bowel habits
- Alternating diarrhea and constipation
-Bleeding
- Fatigue, weight loss, anemia

Treatment
- Surgical removal with radiation and/or chemotherapy

Answer 125

A

Lack of movement of intestinal contents through the intestine
- More common in small intestine

Mechanical obstructions
- Result from tumors, adhesions, hernias, other tangible obstructions

Functional or adynamic obstructions
- Result from impairment of peristalsis
- Spinal cord injury
- Paralytic ileus caused by toxins or electrolyte imbalance

Answer 126

A

Gases and fluids accumulate proximal to the blockage, distending the intestine.
Increasingly strong contractions of proximal intestine
- Effort to move contents along
Pressure increases in lumen.
- More secretions enter the intestine.
- Compression of veins in wall
- Intestinal wall becomes edematous
- Prevention of absorption

Answer 127

A

Intestinal distention leads to persistent vomiting.
-Additional loss of fluid and electrolytes
- Hypovolemia can result.
Intestinal wall becomes ischemic and necrotic.
- If obstruction is not removed, gangrene ensues.
Ischemia and necrosis → decreased innervation and cessation of
peristalsis
Paralytic ileus occurs if it is not a cause to begin with.

Answer 128

A

Obstruction promotes rapid reproduction of intestinal bacteria.
- Some produce endotoxins.
-Affected wall becomes necrotic and more permeable
- Bacteria and toxins leak into peritoneal cavity (peritonitis) or into blood (bacteremia and septicemia).
Perforation of the necrotic segment may occur.
- Generalized peritonitis and septic shock

Answer 129

A

Mechanical obstruction of small intestine
- Severe colicky abdominal pain
-Intermittent bowel sounds can be heard.

Paralytic ileus
- Pain is steady.
- Bowel sounds decrease or are absent.

Vomiting and abdominal distention
- Occurs quickly with obstruction of small intestine
- Vomiting is recurrent, eventually with bile-stained content
Obstruction of the small intestine is a medical emergency!

Answer 130

A

Obstruction of large intestine
- Develops slowly, with mild signs
- Constipation
- Mild abdominal pain, followed by abdominal distention
- Anorexia, vomiting, more severe pain

Treatment
-Treatment of underlying cause
- Fluid and electrolyte replacement
-Surgery and antimicrobial therapy

Answer 131

A

Enzymes released with pancreatitis
Urine leaking form a ruptured bladder
Chyme spilled from a perforated ulcer
Bile escaping from the ruptured gallbladder
Blood
-Any other foreign material in the cavity

Answer 132

A

Bacterial peritonitis caused by:
- Direct trauma affecting the intestine
- Ruptured appendix
- Intestinal obstruction and gangrene

Any abdominal surgery
- If foreign material is left or infection develops

Pelvic inflammatory disease in women
- When infection reaches the cavity through fallopian tubes

Answer 133

A

Signs and symptoms
- Sudden, severe, generalized abdominal pain
-Localized tenderness at site of underlying problem
- Vomiting common, abdominal distention
- Dehydration, hypovolemia, low blood pressure
- Decreased blood pressure, tachycardia, fever, leukocytosis

Treatment
-Depends on primary cause
- Surgery might be required.
-Massive antimicrobial drugs—specific to causative organism

Brainscape's Knowledge GenomeTM

Week 11: GI Flashcards

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