PATHO Exam 4 CH 41 Alt GI Fnx – Flashcards
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1. Where in the brain is the vomiting center located? a. Hypothalamus c. Pons b. Medulla oblongata d. Midbrain
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ANS: B The vomiting center of the brain lies in the medulla oblongata.
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Antiemetic agents, such as domperidone and haloperidol, are antagonists for which receptors? a. 5-Hydroxytryptamine (5-HT) serotonin b. Histamine-2 c. Acetylcholine d. Dopamine
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D Metoclopramide, domperidone, and haloperidol are dopamine antagonists, making them effective antiemetic agents. This selection is the only option that identifies a receptor that is involved in the process of vomiting.
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What type of vomiting is caused by the direct stimulation of the vomiting center by neurologic lesions involving the brainstem? a. Retch c. Duodenal b. Periodic d. Projectile
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D Of the available options, only projectile vomiting is caused by the direct stimulation of the vomiting center by neurologic lesions, such as increased intracranial pressure, tumors, or aneurysms involving the brainstem.
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Considering the normal frequency of bowel evacuation, how infrequently can evacuation occur and still be considered within normal range? a. Once a day c. Once a week b. Once every 2 days d. Once every 2 weeks
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C Normal bowel habits range from two or three evacuations per day to one per week.
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How many stools per day are considered the upper limits of normal? a. Two c. Five b. Three d. Seven
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B More than three stools per day is considered abnormal.
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The adult intestine processes approximately how many liters of luminal content per day? a. 3 c. 9 b. 6 d. 12
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C The adult intestine processes approximately 9 L of luminal content per day. Of this amount, 2 L is ingested and the remaining 7 L consists of intestinal secretions.
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A person who has cholera would be expected to have which type of diarrhea? a. Osmotic c. Small volume b. Secretory d. Motility
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B Primary causes of secretory diarrhea are bacterial enterotoxins, particularly those released by cholera or strains of Escherichia coli, and neoplasms, such as gastrinoma or thyroid carcinoma. None of the other options are associated with secretory diarrhea.
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What type of diarrhea is a result of lactase deficiency? a. Motility c. Secretory b. Osmotic d. Small-volume
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B Malabsorption related to lactase deficiency, pancreatic enzyme or bile salt deficiency, small intestine bacterial overgrowth, and celiac disease cause osmotic diarrhea. None of the other options are associated with lactase deficiencies.
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Which statement is false concerning how abdominal pain is produced? a. Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain. b. Edema and vascular congestion produce abdominal pain by stretching. c. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain. d. Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, a. Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain. b. Edema and vascular congestion produce abdominal pain by stretching. c. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain. d. Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.
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D Low concentrations of anaerobes are not typically a cause of abdominal pain.
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How can abdominal pain that is visceral in nature best be described? a. Abdominal pain that is visceral in nature is diffused, vague, poorly localized, and dull. b. It travels from a specific organ to the spinal cord. c. The pain lateralizes from only one side of the nervous system. d. Abdominal pain is associated with the peristalsis of the gastrointestinal tract.
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A Pain is usually felt near the midline in the epigastrium (upper midabdomen), midabdomen, or lower abdomen. The pain is poorly localized, is dull rather than sharp, and is difficult to describe.
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What is the cause of gastroesophageal reflux disease? a. Excessive production of hydrochloric acid b. Zone of low pressure of the lower esophageal sphincter c. Presence of Helicobacter pylori in the esophagus d. Reverse muscular peristalsis of the esophagus
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B Normally, the resting tone of the lower esophageal sphincter maintains a zone of high pressure that prevents gastroesophageal reflux. In individuals who develop reflux esophagitis, this pressure tends to be lower than normal from either transient relaxation or a weakness of the sphincter.
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What term is used to identify frank bleeding of the rectum? a. Melena c. Occult bleeding b. Hematochezia d. Hematemesis
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B Hematochezia is the only available option that is associated with frank bright red or burgundy blood from the rectum.
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What is the cause of functional dysphagia? a. Intrinsic mechanical obstruction c. Tumor b. Extrinsic mechanical obstruction d. Neural or muscular disorders
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D Neural or muscular disorders that interfere with voluntary swallowing or peristalsis cause functional dysphagia.
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What is the cause of reflux esophagitis? a. Immune response to gastroesophageal reflux b. Delayed gastric emptying c. Congenital anomaly d. Secretory response to gastroesophageal reflux
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B Delayed gastric emptying contributes to reflux esophagitis by (1) lengthening the period during which reflux is possible and (2) increasing the acid content of chyme.
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By what mechanism does intussusception cause an intestinal obstruction? a. Telescoping of part of the intestine into another section of intestine, usually causing strangulation of the blood supply b. Twisting the intestine on its mesenteric pedicle, causing occlusion of the blood supply c. Loss of peristaltic motor activity in the intestine, causing an adynamic ileus d. Forming fibrin and scar tissue that attach to the intestinal omentum, causing obstruction
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A Intussusception is the telescoping of part of the intestine into another section of intestine, usually causing strangulation of the blood supply.
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What is the most immediate result of a small intestinal obstruction? a. Vomiting c. Electrolyte imbalances b. Dehydration d. Distention
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D Distention begins almost immediately, as gases and fluids accumulate proximal to the obstruction. Within 24 hours, up to 8 L of fluid and electrolytes enters the lumen in the form of saliva, gastric juice, bile, pancreatic juice, and intestinal secretions. Copious vomiting or sequestration of fluids in the intestinal lumen prevents their reabsorption and produces severe fluid and electrolyte disturbances.
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An intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing which outcome? a. Gain of bicarbonate from pancreatic secretions that cannot be absorbed b. Excessive loss of hydrogen ions normally absorbed from gastric juices c. Excessive loss of potassium, promoting atony of the intestinal wall d. Loss of bile acid secretions that cannot be absorbed
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B If the obstruction is at the pylorus or high in the small intestine, then metabolic alkalosis initially develops as a result of excessive loss of hydrogen ions that normally would be reabsorbed from the gastric juices.
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What are the cardinal symptoms of small intestinal obstruction? a. Constant, dull pain in the lower abdomen relieved by defecation b. Acute, intermittent pain 30 minutes to hours after eating c. Colicky pain caused by distention, followed by vomiting d. Excruciating pain in the hypogastric area caused by ischemia
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C Of the options available, only colicky pain caused by distention followed by vomiting are considered the cardinal symptoms of a small intestinal obstruction.
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What is a cause of chronic antral gastritis? a. Helicobacter pylori bacteria b. Development of autoantibodies to gastric H+/K+ ATPase c. Pernicious anemia d. Reflux of bile and alkaline pancreatic secretions
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A Chronic antral gastritis generally involves only the antrum and is more common than fundal gastritis. It is caused by H. pylori bacteria or the chronic use of alcohol, tobacco, and nonsteroidal antiinflammatory drugs.
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What is the primary cause of peptic ulcers? a. Hypersecretion of gastric acid c. Helicobacter pylori b. Hyposecretion of pepsin d. Escherichia coli
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C Infection with H. pylori is a primary cause of peptic ulcers.
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A peptic ulcer may occur in all of the following areas except the: a. Stomach c. Jejunum b. Duodenum d. Esophagus
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C A peptic ulcer is a break, or ulceration, in the protective mucosal lining of the lower esophagus, stomach, or duodenum.
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Which statement is false regarding the contributing factors of duodenal ulcers? a. Bleeding from duodenal ulcers causes hematemesis or melena. b. Gastric emptying is slowed, causing greater exposure of the mucosa to acid. c. The characteristic pain begins 30 minutes to 2 hours after eating when the stomach is empty. d. Duodenal ulcers occur with greater frequency than other types of peptic ulcers.
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ANS: B Duodenal ulcers can be associated with altered mucosal defenses, rapid gastric emptying, elevated serum gastrin levels, or acid production stimulated by smoking.
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After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are the results of which mechanism? a. Anaphylactic reaction in which chemical mediators, such as histamine, prostaglandins, and leukotrienes, relax vascular smooth muscles, causing shock b. Postoperative hemorrhage during which a large volume of blood is lost, causing hypotension with compensatory tachycardia c. Concentrated bolus that moves from the stomach into the small intestine, causing hyperglycemia and resulting in polyuria and eventually hypovolemic shock d. Rapid gastric emptying and the creation of a high osmotic gradient in the small intestine, causing a sudden shift of fluid from the blood vessels to the intestinal lumen
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D Dumping syndrome occurs with varying severity in 5% to 10% of individuals who have undergone partial gastrectomy or pyloroplasty. Rapid gastric emptying and the creation of a high osmotic gradient in the small intestine cause a sudden shift of fluid from the vascular compartment to the intestinal lumen. Plasma volume decreases, causing vasomotor responses, such as increased pulse rate, hypotension, weakness, pallor, sweating, and dizziness. Rapid distention of the intestine produces a feeling of epigastric fullness, cramping, nausea, vomiting, and diarrhea.
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Which statement is consistent with dumping syndrome? a. Dumping syndrome usually responds well to dietary management. b. It occurs 1 to 2 hours after eating. c. Constipation is often a result of the dumping syndrome. d. It can result in alkaline reflux gastritis.
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A Most individuals with the dumping syndrome respond well to dietary management. None of the other options is associated with the dumping syndrome.
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What stimulates the desire to eat? a. Agouti-related protein (AgRP) b. Alpha-melanocyte-stimulating hormone (α-MSH) c. Cocaine- and amphetamine-regulated transcript (CART) d. Peptide YY (PYY)
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A Specific neurons produce neuropeptide Y (NPY) and AgRP, which stimulates eating and decreases metabolism (anabolic).
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Which structure regulates eating behavior and energy metabolism? a. Anterior pituitary c. Posterior pituitary b. Hypothalamus d. Parietal lobe
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B The arcuate nucleus (ARC) in the hypothalamus has two sets of neurons with opposing effects that interact to regulate and balance food intake and energy metabolism. This selection is the only option that regulates eating behavior and energy metabolism.
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Which symptom is characteristic of bulimia nervosa? a. Recurrent episodes of binge eating with fears of not being able to stop eating. b. Fear of becoming obese, despite progressive weight loss. c. Perception that the body is fat when it is actually underweight. d. Absence of three consecutive menstrual periods.
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A Diagnosis of bulimia is based on, among other findings, recurrent episodes of binge eating during which the individual fears not being able to stop. The remaining options are characteristic of anorexia nervosa.
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The most common clinical manifestation of portal hypertension is what type of bleeding? a. Rectal c. Esophageal b. Duodenal d. Intestinal
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C The vomiting of blood from bleeding esophageal varices is the most common clinical manifestation of portal hypertension
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What is the most common manifestation of portal hypertension-induced splenomegaly? a. Leukopenia c. Erythrocytopenia b. Thrombocytopenia d. Pancytopenia
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B Thrombocytopenia (decreased platelet count) is the most common manifestation of congestive splenomegaly and can contribute to a tendency of increased bleeding.
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Which statement is false concerning the accumulation of fluid in the the peritoneal cavity? a. Impaired excretion of sodium by the kidneys promotes water retention. b. Decreased oncotic pressure and increased hepatic sinusoidal hydrostatic pressure cause the movement of fluid into the peritoneal cavity. c. Decreased blood flow to the kidneys activates aldosterone, which retains sodium. d. Circulating nitric oxide causes vasoconstriction, which forces fluid from the capillaries into the peritoneal cavity.
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D The arterial vasodilation theory proposes that circulating nitric oxide or the release of endotoxin from translocation of intestinal bacteria triggers arterial vasodilation of the splanchnic organs early in the course of cirrhosis and stimulates renal sodium retention through the renin-angiotensin-aldosterone system, increased sympathetic tone, and changes in the intrarenal blood flow.
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Which statement is false regarding the sources of increased ammonia that contribute to hepatic encephalopathy? a. End products of intestinal protein digestion are sources of increased ammonia. b. Digested blood leaking from ruptured varices is a source of increased ammonia. c. Accumulation of short-chain fatty acids that is attached to ammonia is a source of increased ammonia. d. Ammonia-forming bacteria in the colon are sources of increased ammonia.
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C The accumulation of short-chain fatty acids, serotonin, tryptophan, and false neurotransmitters probably contributes to neural derangement and is not associated with ammonia levels. The other options provide accurate information regarding how the sources of ammonia contribute to hepatic encephalopathy.
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Hepatic fat accumulation is observed in which form of cirrhosis? a. Biliary c. Postnecrotic b. Metabolic d. Alcoholic
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D Alcoholic cirrhosis is a complex process that begins with fatty infiltration (hepatic steatosis). Fat deposition (deposition of triglycerides) within the liver hepatocytes is primarily caused by increased lipogenesis and decreased fatty acid oxidation by hepatocytes.
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Which statement is false concerning the pathophysiologic process of alcoholic cirrhosis? a. Inflammation and damage leading to cirrhosis begin in the bile canaliculi. b. Alcohol is transformed to acetaldehyde, which promotes liver fibrosis. c. Mitochondrial function is impaired, decreasing oxidation of fatty acids. d. Acetaldehyde inhibits export of proteins from the liver.
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A Biliary cirrhosis differs from alcoholic cirrhosis in that the damage and inflammation leading to cirrhosis begin in bile canaliculi and bile ducts, rather than in the hepatocytes.
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Which statement is false regarding the pathophysiologic process of acute pancreatitis? a. Bile duct or pancreatic duct obstruction blocks the outflow of pancreatic digestive enzymes. b. Acute pancreatitis can also result from direct cellular injury from drugs or viral infection. c. Acute pancreatitis is an autoimmune disease in which immunoglobulin G (IgG) coats the pancreatic acinar cells; consequently, the pancreatic enzymes destroy the cells. d. Acute pancreatitis is usually mild and spontaneously resolves.
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C The backup of pancreatic secretions and the activation and release of enzymes (activated trypsin activates chymotrypsin, lipase, and elastase) within the pancreatic acinar cells cause acute pancreatitis, an obstructive disease. The activated enzymes cause autodigestion (e.g., proteolysis, lipolysis) of the pancreatic cells and tissues, resulting in inflammation. Acute pancreatitis is usually a mild disease and spontaneously resolves; however, approximately 20% of those with the disease develop a severe acute pancreatitis that requires hospitalization. Pancreatitis develops because of a blockage to the outflow of pancreatic digestive enzymes caused by bile duct or pancreatic duct obstruction (e.g.,gallstones). Acute pancreatitis can also result from direct cellular injury from drugs or viral infection.
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The mutation of which gene is an early event associated with the pathogenetic origin of esophageal cancer? a. K-ras mutation c. myc b. TP53 d. HER2
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B Mutation of the TP53 gene is an early event associated with esophageal cancer.
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Obesity is defined as a body mass index (BMI) greater than what measurement? a. 22 c. 28 b. 25 d. 30
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D Obesity is an energy imbalance, with caloric intake exceeding energy expenditure, and is defined as a BMI greater than 30.
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Which statements are true regarding parietal pain? (Select all that apply.) a. Parietal pain arises from the parietal peritoneum. b. It is generally more localized than visceral pain. c. Parietal pain is usually less intense than visceral pain. d. Nerve fibers that travel to the spinal cord are involved in parietal pain. e. Parietal pain corresponds to dermatomes T6 and L1.
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A, B, D, E Parietal pain arises from the parietal peritoneum and is more localized and intense than visceral pain. Nerve fibers from the parietal peritoneum travel with peripheral nerves to the spinal cord, and the sensation of pain corresponds to skin dermatomes T6 and L1.
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Which statements are true regarding chronic gastritis? (Select all that apply.) a. Chronic gastritis tends to occur in older adults. b. It causes thinning and degeneration of the stomach wall. c. Chronic gastritis results in chronic inflammation and mucosal atrophy. d. Mucosal atrophy is a common outcome of chronic gastritis. e. Epithelial metaplasia is often observed with chronic gastritis.
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A, C, D, E Chronic gastritis tends to occur in older adults and causes chronic inflammation, mucosal atrophy, and epithelial metaplasia. Neither thinning nor degeneration of the stomach wall is associated with chronic gastritis.
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Which hormones are natural appetite suppressants? (Select all that apply.) a. Insulin b. Cortisol c. Galanin d. Calcitonin e. Serotonin
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A, D, E Insulin, calcitonin, and serotonin are natural appetite suppressants, whereas cortisol and galanin are natural appetite stimulants.
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Which are the early (prodromal) clinical manifestations of hepatitis? (Select all that apply.) a. Fatigue b. Vomiting c. Itching d. Splenomegaly e. Hyperalgia
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A, B, E The prodromal (preicteric) phase of hepatitis begins approximately 2 weeks after exposure and ends with the appearance of jaundice. Fatigue, anorexia, malaise, nausea, vomiting, headache, hyperalgia, cough, and low-grade fever are prodromal symptoms that precede the onset of jaundice. Itching and splenomegaly are not associated with the prodromal phase of hepatitis.
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Which clinical manifestations are consistent with cancer of the cecum and ascending colon? (Select all that apply.) a. Mahogany-colored blood mixed with stool b. Anemia c. Pain d. Constipation e. Palpable mass in the lower right quadrant
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A, B, C, E Clinical manifestations consistent with cancer of the cecum and ascending colon include pain, a palpable mass in the lower right quadrant, anemia, and dark red or mahogany colored blood mixed with the stool. Constipation is not associated with this diagnosis
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Alterations in immunoglobulin G (IgA) production have been found in individuals with this disorder.
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In Crohn disease, elevations in IgG are associated with the severity of the disease.
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Inflammation develops in crypts of Lieberkühn in the large intestine with this disease
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Ulcerative colitis Inflammation begins at the base of the crypts of Lieberkühn in the large intestine, primarily the left colon, with infiltration and release of inflammatory cytokines from neutrophils, lymphocytes, plasma cells, macrophages, eosinophils, and mast cells.
