question

The kidneys are paired organs located on the posterior abdominal wall outside the peritoneal cavity.

answer

True.

question

There is a direct relationship between renal blood flow and glomerular filtration rate (GFR).

answer

True. The filtration of the plasma per unit of time is known as the glomerular filtration rate (GFR), which is directly related to the perfusion pressure in the glomerular capillaries.

question

Angiotensin II stimulates secretion of aldosterone by the adrenal cortex

answer

True.

question

The primary function of the proximal tubule is:

answer

active reabsorption of sodium.

question

The area of the kidnets that contains the glomeruli of the nephrons is the:

answer

cortex (the cortex contains all the glomeruli and portions of the tubules)

question

The _____ is the functional unit of the kidney

answer

nephron

question

The nephron contains the:

answer

renal corpuscle, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct, all of which contribute to the formation of final urine (see Figure 35-3)

question

What is the function of Mesangial cells?

answer

They have contractile and phagocytic properties, similar to monocytes, release inflammatory cytokines, and produce vasoactive substances that influence the glomerular filtration rate (GFR) by regulating glomerular capillary blood flow.

question

Which tubule is the only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area?

answer

*Proximal tubules.* The proximal tubular lumen consists of one layer of cuboidal cells with a surface layer of microvilli that increases reabsorptive surface area. This is the only surface inside the nephron where the cells are covered with microvilli (a brush border) (see Figure 35-4).

question

What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?

answer

*Juxtaglomerular apparatus* Together the juxtaglomerular cells and macula densa cells form the juxtaglomerular apparatus (JGA) (see Figure 35-6). Control of renal blood flow, glomerular filtration, and renin secretion occurs at this site.

question

Kidney stones in the upper part of the ureter would produce pain referred to the:

answer

umbilicus

question

Innervation of the bladder and internal urethral sphincter is supplied by which nerves?

answer

Parasympathetic nervous system

question

How much urine accumulates in the bladder before the mechanoreceptors sense bladder fullness?

answer

*250-300ml* When the bladder accumulates 250 to 300 ml of urine, the bladder contracts and the internal urethral sphincter relaxes through activation of the spinal reflex arc (known as the micturition reflex).

question

The trigone is the:

answer

smooth triangular area between the openings of the two ureters and the urethra.

question

The glomerular filtration rate (GFR) is directly related to:

answer

perfusion pressure in the glomerular capillaries.

question

The kidneys are highly vascular organs and usually receive 1000 to 1200 ml of blood per minute, or about 20% to 25% of the cardiac output.

answer

True.

question

What effects do exercise and body position have on renal blood flow?

answer

They activate renal sympathetic neurons and cause mild vasoconstriction.

question

lood vessels of the kidneys are innervated by the:

answer

*Sympathetic nervous system* The blood vessels of the kidney are innervated by the sympathetic noradrenergic fibers that cause arteriolar vasoconstriction and reduce renal blood flow.

question

An action of renin is the:

answer

*activation of angiotensin I* When renin is released, it cleaves an α-globulin (angiotensinogen produced by liver hepatocytes) in the plasma to form angiotensin I, which is physiologically inactive.

question

What effect do natriuretic peptides (NAP) have when right atrial pressure rises?

answer

*Inhibits renin and aldosterone and relaxes vascular smooth muscle* When the heart dilates during volume expansion or heart failure, ANP (a type of NAP) and BNP inhibit secretion of renin, inhibit angiotensin-induced secretion of aldosterone, vasodilate the afferent and constrict the efferent glomerular arterioles, and inhibit sodium and water absorption by kidney tubules.

question

What is the direct action of atrial natriuretic hormone?

answer

*Excrete sodium* ANP and BNP inhibit secretion of renin, inhibit angiotensin-induced secretion of aldosterone, vasodilate the afferent and constrict the efferent glomerular arterioles, and inhibit sodium and water absorption by kidney tubules.

question

What is an indication that the carrier molecule for glucose is saturated?

answer

Glucosuria

question

How high does the serum glucose have to be for the threshold for glucose to be achieved?

answer

180 mg/dl

question

What force(s) creates passive transport of water in the proximal tubule?

answer

*Peritubular capillary oncotic and osmotic pressures* The osmotic force generated by active sodium transport promotes the passive diffusion of water out of the tubular lumen and into the peritubular capillaries. Passive transport of water is further enhanced by the elevated oncotic pressure of the blood in the peritubular capillaries.

question

Which hormone is required for water to be reabsorbed in the distal tubule and collecting duct?

answer

Antidiuretic hormone (ADH)

question

The end product of protein metabolism excreted in urine is:

answer

Urea

question

The action of urodilatin is that it:

answer

*inhibits salt and water reabsorption.* Urodilatin (a natriuretic peptide) inhibits sodium and water reabsorption from medullary part of collecting duct, thereby producing diuresis. (See Table 35-1.)

question

The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by the:

answer

Posterior pituitary

question

Urodilatin:

answer

*is stimulated by a rise in blood pressure and an increase in extracellular volume.* Urodilatin (a natriuretic peptide) is produced by distal tubule and collecting duct when there is increased circulating volume and increased blood pressure; inhibits sodium and water reabsorption from medullary part of collecting duct, thereby producing diuresis.

question

What stimulates the renal hydroxylation step to produce vitamin D?

answer

Parathyroid hormone

question

_____ is a hormone synthesized and secreted by the kidneys.

answer

Erythropoietin

question

The best estimate of functioning renal tissue is:

answer

glomerular filtration rate (GFR).

question

Which is found in older adults?

answer

A decrease in the number of nephrons

question

The specific gravity of urine in older adults is normally:

answer

low normal.

question

Creatinine clearance is a good estimate of:

answer

glomerular filtration rate (GFR)

question

The principle symptom of renal stones is:

answer

renal colic

question

A neurogenic bladder is a functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder.

answer

*True.* Neurogenic bladder is a general term for bladder dysfunction caused by neurologic disorders. The types of dysfunction are related to the sites in the nervous system that control sensory and motor bladder function (Figure 36-3).

question

Lower motor neuron lesions result in detrusor areflexia with underactive, hypotonic, or atonic bladder function.

answer

True

question

Two clinical manifestations of nephrotic syndrome include:

answer

increased glomerular permeability and decreased proximal tubule reabsorption.

question

Azotemia indicates:

answer

increased serum urea levels and frequently increased creatinine levels as well.

question

How does acute unilateral renal obstruction predispose people to hypertension?

answer

*The reduced perfusion of the affected kidney activates the renin-angiotensin-aldosterone system, which causes constriction of peripheral arterioles.* Angiotensin II promotes glomerular hypertension and hyperfiltration caused by efferent arteriolar vasoconstriction and also promotes systemic hypertension.

question

The most common type of renal stone is comprised of:

answer

calcium oxalate.

question

In the formation of renal calculi, pyrophosphate, potassium citrate, and magnesium all:

answer

inhibit crystal growth.

question

Hypercalciuria is usually attributable to:

answer

intestinal hyperabsorption of dietary calcium and less commonly to a defect in renal calcium reabsorption. Hyperparathyroidism and bone demineralization associated with prolonged immobilization are also known to cause hypercalciuria.

question

What part of the central nervous system coordinates the detrusor and urethral sphincter muscles during micturition?

answer

Pons

question

Considering the innervation of the circular muscles of the bladder neck, which classification of drug is used to treat bladder neck obstruction?

answer

*α-Adrenergic blocking medications* Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by α-adrenergic blocking (antimuscarinic) medications.

question

Renal cell carcinoma arises from epithelial cells in the:

answer

*proximal tubules* Renal cell carcinomas are adenocarcinomas that usually arise from tubular epithelium commonly in the renal cortex.

question

Bladder cancer is associated with gene mutation of:

answer

*TP53.* Oncogenes of the ras gene family and tumor-suppressor genes including TP53 mutations and inactivation of retinoblastoma gene (pRb) are implicated in bladder cancer.

question

The most common causes of uncomplicated urinary tract infections are:

answer

Escherichia coli.

question

Which clinical manifestation of pyelonephritis is different from those of cystitis?

answer

*Flank pain.* Clinical manifestations of cystitis usually include frequency, urgency, dysuria (painful urination), and suprapubic and low back pain. Hematuria, cloudy and foul-smelling urine, and flank pain are more serious symptoms. Pyelonephritis symptoms include fever, chills, and flank or groin pain.

question

Considering host defense mechanisms, which element in the urine is bacteriostatic?

answer

*High urea* Dilute urine washes out bacteria, and urine with higher urea concentrations (high osmolarity) is more bacteriostatic.

question

Clinical manifestations of a urinary tract infection in an 85 year old may include:

answer

confusion and poorly localized abdominal discomfort.

question

Pyelonephritis is usually caused by antibody-coated:

answer

*bacteria* The responsible microorganism is usually E. coli, Proteus, or Pseudomonas.

question

Struvite stones

answer

Are more common in women b/c they have an increased incidence of UTIs. They grow large and branch into a staghorn configuration in renal pelvis and calyces.They are closely associated with urinary tract infections caused by urease-producing bacteria, such as Pseudomonas.

question

Which abnormal lab value is found in glomerular disorders?

answer

*Elevated creatinine clearance* Reduced GFR during glomerular disease is evidenced by elevated plasma urea, creatinine concentration, or reduced renal creatinine clearance (p. 1378)

question

Which glomerular lesion is characterized by thickening of the glomerular wall with immune deposition of immunoglobulin G (IgG) and C3?

answer

*Membranous* Membranous lesions are characterized by thickening of the glomerular capillary wall.

question

Goodpasture syndrome is an example of:

answer

*antiglomerular basement membrane disease.* Antiglomerular basement membrane disease (Goodpasture syndrome) is a type of RPGN. The disease is rare and associated with IgG antibody formation against pulmonary capillary and glomerular basement membranes. (most common in children) (p. 1383)

question

In glomerulonephritis, the glomerular cell walls are damaged by:

answer

*lysis from complement.* Activated complement, inflammatory cytokines, oxidants, proteases, and growth factors attack epithelial cells, alter membrane permeability, and cause proteinuria.(p. 1383)

question

The kidney disorder characterized by hypoalbuminemia, edema, hyperlipidemia and lipiduria is:

answer

*nephrotic syndrome.* Hypoalbuminemia results from urinary loss of albumin combined with a diminished synthesis of replacement albumin by the liver. Symptoms include edema, hyperlipidemia, lipiduria, vitamin D deficiency, and hypothyroidism. (p. 1384-1385)

question

Which antibiotics are considered "major culprits" in causing nephrotoxic acute tubular necrosis (ATN)?

answer

*Neomycin, gentamicin, and tobramycin* Nephrotoxic ATN can be produced by numerous antibiotics, but the aminoglycosides (neomycin, gentamicin, tobramycin) are the major culprits. (p. 1387)

question

Which urine characteristics are indicative of acute tubular necrosis (ATN) caused by intrinsic (intrarenal) failure?

answer

Urine sodium >30 mEq/L (p. 1389-Table 36-11)

question

How are glucose and insulin used to treat hyperkalemia associated with acute renal failure?

answer

*When insulin transports glucose into the cell, it also carries potassium with it.* Glucose metabolism causes potassium to move to the intracellular fluid, and insulin infusions therefore can be effective in shifting potassium from the extracellular to intracellular space, along with the transport of glucose. (p.1389)

question

Creatinine is constantly released from _____ tissue and excreted primarily by glomerular filtration.

answer

muscle (p.1393)

question

What statements are true about the skeletal alterations caused by chronic renal failure? When the glomerular filtration rate (GFR) declines to 25% of normal

answer

*1) parathyroid hormone (PTH) is no longer effective in maintaining serum phosphate levels. 2) there is impaired synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium. 3) there is impaired synthesis of 1,25-vitamin D3, which impairs the effectiveness of calcium and phosphate resorption from bone by parathyroid hormone (PTH).* Bone and skeletal changes develop with alterations in calcium and phosphate metabolism (Table 36-16). These changes begin when GFR decreases to 25% or less. The combined effect of hyperparathyroidism and vitamin D deficiency can result in renal osteodystrophies (i.e., osteomalacia and osteitis fibrosa with increased risk for fractures. (p.1394)

question

Anemia of chronic renal failure can be successfully treated with:

answer

*erythropoietin.* Reduced erythropoietin secretion and reduced red cell production; uremic toxins shorten red blood cell survival and alter platelet function may be treated with dialysis.

question

What are prerenal causes of acute renal failure?

answer

Prerenal injury can result from renal vasoconstriction, hypotension, *hypovolemia*, hemorrhage, or inadequate cardiac output. (p. 1387)

question

What are intrarenal causes of acute renal failure?

answer

Intrarenal (intrinsic) acute kidney injury (AKI) may result from ischemic *acute tubular necrosis* (ATN), nephrotoxic ATN, acute glomerulonephritis, vascular disease, allograft rejection, or interstitial disease (drug allergy, infection, tumor growth). (p. 1387)

question

What are postrenal causes of acute renal failure?

answer

Postrenal acute kidney injury occurs with urinary tract obstruction that affects the kidneys bilaterally (e.g., bilateral ureteral obstruction, bladder outlet obstruction - *prostatic hypertrophy*, tumors or neurogenic bladder, and urethral obstruction). (p. 1388)

question

The entire epithelial population is replaced about every______

answer

4 to 7 days (p.1434)

question

When vitamin B12 is bound to intrinsic factor, it is resistant to digestion.

answer

*True* Most vitamin B12 (cobalamin) is bound to intrinsic factor (making it resistant to digestion) and absorbed in the terminal ileum. (p. 1426)

question

Potassium concentration in gastric juice is greater than in plasma.

answer

*True* Potassium remains relatively constant, but its concentration is greater in gastric juice than in plasma.(p. 1426)

question

What foods increase peristalsis/gastric emptying, and which decrease or delay peristalsis/gastric emptying?

answer

Larger volumes of food increase gastric pressure, peristalsis, and rate of emptying. Solids, fats, and nonisotonic solutions delay gastric emptying. (p. 1425)

question

What is the function of the chief cells of the gastric glands?

answer

The chief cells within the glands secrete *pepsinogen*, an enzyme precursor that is readily converted to pepsin (a proteolytic enzyme) in the gastric juice. *Pepsin* is a proteolytic enzyme that breaks down protein-forming polypeptides in the stomach. (p. 1426)

question

What is the function of phospholipase?

answer

Phospholipase cleaves fatty acids from phospholipids, and cholesterol esterase breaks cholesterol esters into fatty acids and glycerol. (p. 1433)

question

Is insulin required for active absorption of carbohydrates by the small intestine?

answer

No, insulin is not required for the intestinal absorption of carbohydrates. The sugars are absorbed primarily in the duodenum and upper jejunum. (p. 1430)

question

How does the liver play an important role in destroying intestinal bacteria?

answer

Kupffer cells (macrophages) in the sinusoids of the liver remove bacteria and foreign particles from the portal blood. Because the liver receives all of the venous blood from the gut and pancreas, the Kupffer cells play an important role in destroying intestinal bacteria and preventing infections. (p. 1441)

question

The ileogastric reflex inhibits gastric motility when the ileum becomes distended, but the gastroileal reflex stimulates ileal motility and relaxes the ileocecal sphincter.

answer

The ileogastric reflex inhibits gastric motility when the ileum becomes distended. The gastroileal reflex, which is activated by an increase in gastric motility and secretion, stimulates an increase in ileal motility and relaxation of the ileocecal sphincter. (p. 1435)

question

Salivary α-amylase initiates the digestion of _____ in the mouth and stomach.

answer

*carbohydrates* Saliva consists mostly of water that contains varying amounts of mucus, sodium, bicarbonate, chloride, potassium, and salivary α-amylase (ptyalin), an enzyme that initiates carbohydrate digestion in the mouth and stomach. (p. 1422)

question

Which elements in saliva protect against tooth decay?

answer

Exogenous fluoride and a pH of 7.4. The bicarbonate concentration of saliva sustains a pH of about 7.4, which neutralizes bacterial acids and prevents tooth decay. Exogenous fluoride (e.g., fluoride in drinking water) is absorbed and then secreted in the saliva, providing additional protection against tooth decay. (p. 1422)

question

Saliva contains which immunoglobulin?

answer

Saliva contains IgA, which helps prevent infection.

question

What is the effect of inhibiting the parasympathetic nervous system with a drug such as *atropine*?

answer

*Salivation decreases.* The sympathetic and parasympathetic divisions of the autonomic nervous system control salivation. Because cholinergic parasympathetic fibers stimulate the salivary glands, atropine (an anticholinergic agent) inhibits salivation and makes the mouth dry.

question

Which stimulus increases the tone of the esophageal sphincter?

answer

*Gastrin* Relaxation is coordinated by efferent, nonadrenergic, noncholinergic vagal fibers and is facilitated by gastrin and cholecystokinin, two polypeptide hormones secreted by the gastrointestinal mucosa. (p. 1424)

question

Food enters the stomach via the _____ orifice.

answer

*cardiac* The anatomy of the stomach is presented in Figure 38-5. Its major anatomic boundaries are the lower esophageal sphincter, where food passes through the cardiac orifice (gastroduodenal junction) into the stomach.(p. 1423)

question

Which stimulus inhibits gastric motility by raising the threshold potential of muscle fibers?

answer

*Secretin* Gastrin, motilin (an intestinal hormone), and the vagus nerve increase contraction by making the threshold potential of muscle fibers less negative. Sympathetic activity and *secretin* (another intestinal hormone) are inhibitory and make threshold potential more negative. (p.1424)

question

The _____ cells in the stomach secrete hydrochloric acid.

answer

*Parietal* The parietal cells (oxyntic cells) within the glands secrete hydrochloric acid and intrinsic factor. (p. 1426)

question

The _____ cells in the stomach secrete histamine.

answer

enterochromaffin-like (p. 1426)

question

The presence of chyme in the duodenum stimulates which hormones?

answer

*Secretin and cholecystokinin* Swallowing causes the fundus to relax (receptive relaxation) to receive a bolus of food from the esophagus. Relaxation is coordinated by efferent, nonadrenergic, noncholinergic vagal fibers and is facilitated by gastrin and cholecystokinin, two polypeptide hormones secreted by the gastrointestinal mucosa. (p. 1424, Table 38-1)

question

Which gastric hormone inhibits acid and pepsinogen secretion as well as the release of gastrin?

answer

*Somatostatin* (p. 1424, Table 38-1)

question

Which enzyme breaks down protein-forming polypeptides in the stomach?

answer

*Pepsin* (p. 1427)

question

Exposure to which substance protects the mucosal barrier of the stomach?

answer

*Prostaglandins* Prostaglandins and enterogastrones, such as gastric inhibitory peptide, somatostatin, and secretin, inhibit acid secretion. (p. 1427)

question

The ileum and jejunum are suspended by folds of the peritoneum that contain an extensive vascular and nervous network that is called the:

answer

*mesentery.* The ileum and jejunum are suspended in loose folds from the posterior abdominal wall by a peritoneal membrane called the *mesentery*. The mesentery facilitates intestinal motility and supports blood vessels, nerves, and lymphatics. (p. 1429)

question

Lymphocytes, plasma cells, and macrophages are produced in the small intestine in the:

answer

*lamina propria.* The lamina propria (a connective tissue layer of the mucous membrane) lies beneath the epithelial cells of the villi and contains lymphocytes; plasma cells, which produce immunoglobulins; and macrophages. (p. 1429)

question

The reason that water and electrolytes are transported in both directions through tight junctions and intercellular spaces rather than across cell membranes is because:

answer

*the epithelial cell membranes are formed of lipids that are hydrophobic and thus repel water.* Therefore, water and electrolytes are transported in both directions (toward the capillary blood or toward the intestinal lumen) through the tight junctions and intercellular spaces rather than across cell membranes. (p. 1430)

question

In the small intestine, sodium is transported into the intestinal cells in exchange for _____ at the brush border.

answer

*Hydrogen* (p. 1430)

question

Chloride actively enters the cell in exchange for _____ to maintain electroneutrality in the ileum.

answer

*bicarbonate* (p. 1430)

question

Which electrolyte and acid-base imbalances are caused by prolonged diarrhea?

answer

*Hypokalemic metabolic acidosis* Because of potassium secretion in the colon and the exchange of chloride for bicarbonate, prolonged diarrhea results in hypokalemic metabolic acidosis. (p. 1430)

question

The pancreatic enzyme responsible for the breakdown of carbohydrates is:

answer

*amylase* Salivary and pancreatic amylases break down starches to oligosaccharides by splitting α-1,4-glucosidic linkages of long-chain molecules. (p. 1430)

question

What accomplishes the formation of water-soluble molecules to facilitate the absorption of the byproducts of lipid hydrolysis?

answer

*Micelles* The products of lipid hydrolysis must be made water soluble if they are to be absorbed efficiently from the intestinal lumen. This is accomplished by the formation of water-soluble molecules known as *micelles*. (p. 1433, Figure 38-14)

question

The two requirements necessary in order for calcium at concentrations less than 5 mmol/L to be absorbed through the ileum are vitamin:

answer

*D3 and a carrier protein.* When its concentration in the lumen is greater than 5 mmol/L, calcium is absorbed by passive diffusion. At concentrations less than 5 mmol/L, calcium is transported actively across cell membranes, bound to a carrier protein. The carrier formation requires the presence of the active form of vitamin D3 (1,25-dihydroxyvitamin D). (p. 1433)

question

The primary source of physiologic iron is:

answer

heme from hemoglobin.

question

What are the characteristics of vitamin B12?

answer

Normally the liver can store vitamin B12 for years. Vitamin B12 attaches to the carrier protein transcobalamin and is transported into tissue. Vitamin B12 binds to intrinsic factor and is absorbed in the terminal ileum. (Note: Vitamin B12 is NOT necessary for platelet maturation!) (p. 1434)

question

Which water-soluble vitamin is absorbed by passive diffusion?

answer

*Vitamin B6* (see p. 1434, Table 38-2)

question

Which water-soluble vitamins are dependent on sodium for absorption?

answer

*Vitamin C and folic acid* (see p. 1434, Table 38-2)

question

The vitamin that facilitates the absorption of iron by the epithelial cells of the duodenum and jejunum is vitamin:

answer

*Vitamin C* The presence of vitamin C reduces ferric iron to ferrous iron, which is the form more easily absorbed. (p. 1434)

question

The role of the normal intestinal bacterial flora is to:

answer

*metabolize bile salts, estrogens, and lipids.* The intestinal bacteria do not have major digestive or absorptive functions. They do play a role in the metabolism of bile salts (contributing to the intestinal reabsorption of bile and the elimination of toxic bile metabolites); the metabolism of estrogens, androgens, and lipids and conversion of unabsorbed carbohydrates to absorbable organic acids; the synthesis of vitamin K2; and metabolism of various nitrogenous substances and drugs. (p. 1437)

question

Kupffer cells are best described as:

answer

*bactericidal and able to metabolize lipids and bilirubin.* Kupffer cells are part of the mononuclear phagocyte system (see Chapter 25) and are the largest population of tissue macrophages. They are bactericidal and are important for bilirubin production and lipid metabolism. (p. 1438-1439)

question

Bilirubin is a byproduct of the destruction of aged _____ that are destroyed by macrophages in the spleen and liver.

answer

*erythrocytes (RBCs)* (p. 1440)

question

The process of conjugation of bilirubin in the liver is best described as the transformation of:

answer

*unconjugated (fat-soluble) bilirubin into conjugated (water-soluble) bilirubin.* In the liver, unconjugated bilirubin moves from plasma in the sinusoids into the hepatocytes. Within hepatocytes it joins with glucuronic acid to form conjugated bilirubin, which is water soluble. (p. 1440)

question

What describes the function of the gallbladder?

answer

Within *30 minutes* after eating, the gallbladder begins to contract and the *sphincter of Oddi* relaxes, forcing bile into the *duodenum* through the major *duodenal papilla*. Cholinergic branches of the *vagus nerve* mediate gallbladder contraction. *Cholecystokinin and motilin* provide hormonal regulation of gallbladder contraction. The *sphincter of Oddi* controls the flow of bile from the gallbladder. (p. 1442)

question

Which structure of the digestive system synthesizes clotting factors and vitamin K necessary for hemostasis?

answer

*Liver* The liver has hemostatic functions. It synthesizes prothrombin, fibrinogen, and factors I, II, VII, IX, and X, all of which are necessary for effective clotting (see Chapter 25). Vitamin K, a fat-soluble vitamin, is essential for the synthesis of other clotting factors. Because bile salts are needed for reabsorption of fats, vitamin K absorption depends on adequate bile production in the liver. Impairment of vitamin K absorption diminishes production of clotting factors and increases risk of bleeding. (p. 1441)

question

What are the functions of the pancreas?

answer

*Release of pancreatic enzymes is stimulated by cholecystokinin and acetylcholine. Pancreatic lipases hydrolyze triglycerides, cholesterol, and phospholipids. Pancreatic proteolytic enzymes are not activated until they enter the duodenum.* Enzymatic secretion follows stimulation by cholecystokinin and acetylcholine (from the parasympathetic vagus nerve). Once in the small intestine, activated pancreatic enzymes inhibit the release of more cholecystokinin and acetylcholine. This feedback mechanism inhibits the secretion of more pancreatic enzymes. Acetylcholine is liberated from pancreatic branches of the vagus nerve during the cephalic phase of digestion. Pancreatic polypeptide is released after eating and inhibits postprandial pancreatic exocrine secretion. (Table 38-1 summarizes hormonal stimulation of pancreatic secretions...p. 1444)

question

_____ stimulates the gallbladder to eject bile and pancreas to secrete alkaline fluid.

answer

*Cholecystokinin* (p. 1425, Table 38-1)

question

_____ stimulates the pancreas to secrete alkaline pancreatic juice.

answer

*Secretin* (table 38-1)

question

_____ delays gastric and small bowel emptying.

answer

*Peptide YY* (table 38-1)

question

_____ decreases pancreatic bicarbonate and enzyme secretions.

answer

*Pancreatic polypeptide* (Table 38-1)

question

____ enhances insulin release, lipolysis, and ketogenesis.

answer

*Enteroglucagon* (Table 38-1)

question

What is parietal pain?

answer

Parietal pain arises from the parietal peritoneum. This pain 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. (p. 1455)

question

With losses of more than 1000 ml or more, the heart rate is greater than 100 beats per minute and systolic blood pressure is less than 100 mm Hg.

answer

*True* Blood losses of 1000 ml or more over a short time cause a decrease in cardiac output, a decrease in systolic and diastolic blood pressure, and an increase in pulse rate. With losses of 1000 ml or more, the heart rate is greater than 100 beats per minute and systolic blood pressure is less than 100 mm Hg. (p. 1456)

question

Chronic gastritis of antrum is more common than gastritis of the fundus.

answer

*True* Chronic antral gastritis generally involves the antrum only and is approximately four times more common than fundal gastritis. (p. 1464)

question

Chronic gastritis tends to occur in older adults and causes thinning and degeneration of the stomach wall.

answer

*True* Chronic gastritis tends to occur in older adults and causes chronic inflammation, mucosal atrophy, and epithelial metaplasia. (p. 1464)

question

Endoscopy and biopsy may show long-standing inflammatory process and gastric atrophy indicating chronic gastritis in an individual with no history of abdominal distress.

answer

True. (p. 1464)

question

After a gastrectomy, individuals develop anemia from deficiencies in iron, folate, and vitamin B12.

answer

True, anemia after gastrectomy results from iron, vitamin B12, or folate deficiency. (p. 1470)

question

Obesity is defined as a BMI greater than _____

answer

*30* (25-30= overweight)

question

Ammonia formation may increase hepatic encephalopathy.

answer

*True* Liver dysfunction and collateral vessels that shunt blood around the liver to the systemic circulation permit neurotoxins and other harmful substances (i.e., ammonia) to be absorbed from the gastrointestinal tract to circulate freely to the brain. (p. 1485)

question

Hepatitis D virus (HDV) occurs in individuals with hepatitis B.

answer

True. HDV occurs in individuals with hepatitis B. The delta virus depends on the hepatitis B virus (HBV) for its replication because the coat of the delta virus consists of HBsAg molecules that are on the surface of HBV. (Remember: The *D*og goes nowhere without his *B*oy)

question

How is Hepatitis A transmitted?

answer

The usual mode of transmission is the *fecal-oral route* (contaminated food or water), but the virus can be spread also by the transfusion of infected blood. Approximately 45% of adults in urban areas have hepatitis A virus antibodies in their blood. (p. 1488)

question

Hepatitis B is a sexually transmitted disease.

answer

True. (p. 1489)

question

Individuals with chronic hepatitis C are at increased risk for chronic liver disease.

answer

True. It is the most common cause of chronic liver disease in the Western world. (p. 1489)

question

What is primary biliary cirrhosis?

answer

Primary biliary cirrhosis is an autoimmune disease of unknown etiology leading to destruction of small intrahepatic bile ducts. (p. 1493)

question

The chemoreceptor trigger zone (CTZ) for vomiting is located in the:

answer

Medulla Oblongata

question

The action of antiemetics, such as domperidone, and haloperidol is to _____ the effects of _____.

answer

*stimulate; dopamine (D2)* D2 receptors play a role in mediating vomiting. Apomorphine, levodopa, and bromocriptine are dopamine D2 agonists that cause nausea and vomiting. Metoclopramide, domperidone, and haloperidol are dopamine D2 antagonists and are effective antiemetics. (p. 1453)

question

_____ vomiting is caused by direct stimulation of the vomiting center by neurologic lesions involving the brainstem.

answer

Projectile.

question

Normal bowel habits range from two or three evacuations per day to one per:

answer

week.

question

More than _____ stools per day is considered abnormal.

answer

three

question

The adult intestine processes approximately _____ L of luminal content per day.

answer

*9*. The adult intestine processes approximately 9 L of luminal content per day; 2 L is ingested, and the remaining 7 L consists of intestinal secretions. (p. 1454)

question

A person who has cholera would be expected to have which type of diarrhea?

answer

*Secretory*. 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). (p. 1454)

question

The type of diarrhea that is a result of unhydrolyzed lactose is referred to as:

answer

*Osmotic* Lactase deficiency is the most common cause of osmotic diarrhea and loss of pancreatic enzymes can be a contributing factor. In this condition the nonabsorbable substance is milk sugar, or lactose. Lactose remains in the intestinal lumen because it is not digested or absorbed. (p. 1454)

question

How is abdominal pain produced?

answer

Chemical mediators, such as histamine, bradykinin, and serotonin produce abdominal pain. Edema and vascular congestion produce abdominal pain by stretching. Ischemia caused by distention of bowel obstruction or mesenteric vessel thrombosis produces abdominal pain. (p. 1455)

question

Abdominal pain is best described as visceral pain that:

answer

*is diffused, vague, poorly localized, and dull.* 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. (p. 1455)

question

Gastroesophageal reflux disease (GERD) is a result of:

answer

a zone of low pressure of the lower esophageal sphincter (LES). (p. 1458)

question

Frank bleeding of the rectum is called:

answer

*hematochezia.* Hematochezia is frank bright red or burgundy blood from the rectum. (p. 1456)

question

Functional dysphagia is caused by:

answer

a neural or muscular disorder. (that interferes w/ voluntary swallowing or peristalsis)

question

Reflux esophagitis may be defined as a(n):

answer

*inflammatory response to gastroesophageal reflux.* In some individuals, however, a combination of factors causes injury and an inflammatory response to reflux called reflux esophagitis. (p. 1458)

question

Intussusception causes intestinal obstruction by:

answer

telescoping of part of the intestine into another usually causing strangulation of the blood supply. (p. 1461; Table 39-2)

question

The most commonly occurring small intestinal obstruction is:

answer

*adhesions.* (account for 50-70% of small bowel obstructions)

question

An intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing the:

answer

*excessive loss of hydrogen ions normally absorbed from gastric juice.* If the obstruction is at the pylorus or high in the small intestine, metabolic alkalosis develops initially as a result of excessive loss of hydrogen ions that normally would be reabsorbed from the gastric juice. (p. 1461)

question

The cardinal symptoms of small intestinal obstruction include:

answer

colicky pain caused by distention followed by vomiting. (p. 1461)

question

Which inflammatory cytokines are released in chronic gastritis?

answer

*TNF-α, IL-6, IL-8, IL-10, and leukotrienes* Release of inflammatory cytokines (e.g., TNF-α, IL-1, IL-6, IL-8, IL-10, and leukotrienes) damages the gastric epithelium. (p. 1464)

question

The primary cause of duodenal ulcers is:

answer

*Helicobacter pylori.*

question

A peptic ulcer may occur in all of the following areas:

answer

stomach, duodenum, esophagus (NOT the jejunum!!) (p. 1464)

question

What are the contributing factors of duodenal ulcers?

answer

1) There are a greater than usual number of parietal cells in the gastric mucosa. 2)High serum gastrin levels remain high longer than normal after eating. 3)Failure of the feedback mechanism occurs, whereas acid in the gastric antrum inhibits gastrin release.4) *Rapid gastric emptying* overwhelms the buffering capacity of the bicarbonate-rich pancreatic secretions. (p. 1465)

question

After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are a result of:

answer

*a rapid gastric emptying and creation of a high osmotic gradient in the small intestine that causes a sudden shift of fluid from the blood vessels to the intestinal lumen.* *Dumping syndrome* occurs with varying severity in 5% to 10% of individuals who have undergone partial gastrectomy or pyloroplasty. Rapid gastric emptying and creation of a high osmotic gradient within 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. (p. 1468)

question

Which of the following is consistent with dumping syndrome?

answer

Usually responds well to dietary management. (p. 1469)

question

The desire to eat is stimulated by:

answer

agouti-related protein (AgRP). (p. 1478)

question

Eating behavior, energy metabolism, and body fat mass are regulated by the:

answer

hypothalamus. (p. 1478)

question

The most common clinical manifestation of portal hypertension is _____ bleeding.

answer

*esophageal* The vomiting of blood from bleeding *esophageal varices* is the most common clinical manifestation of portal hypertension. (p.1483)

question

The most common manifestation of portal hypertension induced splenomegaly is:

answer

*thrombocytopenia.* Thrombocytopenia (decreased platelet count) is the most common manifestation of congestive splenomegaly and can contribute to an increased bleeding tendency. (p. 1483)

question

Which statements are true concerning the accumulation of fluid in the peritoneal cavity?

answer

*Impaired excretion of sodium by the kidneys promotes water retention. Decreased oncotic pressure and increased hepatic sinusoidal hydrostatic pressure cause movement of fluid into the peritoneal cavity. Decreased blood flow to the kidneys activates aldosterone, which retains sodium.* The arterial vasodilation theory proposes that circulating nitric oxide or 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 renin-angiotensin-aldosterone, increased sympathetic tone, and changes in the intrarenal blood flow. (p. 1483)

question

What are the sources of increased ammonia that contribute to hepatic encephalopathy?

answer

End products of intestinal protein digestion, digested blood leaking from ruptured varicose, and ammonia-forming bacteria in the colon. (note: nothing to do with short-chain fatty acids!!!) -p. 1485

question

Which are the early (prodromal) clinical manifestations of hepatitis?

answer

*Fatigue, fever, hyperalgia, and vomiting.* The prodromal (preicteric) phase of hepatitis begins about 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. (p. 1490)

question

Hepatic fat accumulation is seen in which form of cirrhosis?

answer

*Alcoholic* Alcoholic cirrhosis is a complex process that begins with fatty infiltration (hepatic steatosis). Fatty infiltration can occur without subsequent hepatitis or cirrhosis. Fat deposition (deposition of triglycerides) within the liver hepatocytes is caused primarily by increased lipogenesis and decreased fatty acid oxidation by hepatocytes. (p. 1492)

question

What statements are true regarding the pathophysiology of alcoholic cirrhosis?

answer

*1) Alcohol is transformed to acetaldehyde, which promotes liver fibrosis. 2) Mitochondrial function is impaired, decreasing oxidation of fatty acids. 3) Acetaldehyde inhibits export of proteins from the liver.* Note: 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. (p. 1493)

question

What statements are true regarding the pathophysiology of acute pancreatitis?

answer

1) Pancreatic acinar cells metabolize ethanol, which generates toxic metabolites. 2) Injury to the pancreatic acinar cells permits leakage of pancreatic enzymes that digest pancreatic tissue. 3) Acute pancreatitis is an autoimmune disease in which IgG coats the pancreatic acinar cells so they are destroyed by the pancreatic enzymes.

question

Acute pancreatitis (contd.)

answer

Acute pancreatitis (acute hemorrhagic pancreatitis) is initiated by intrapancreatic activation of proteases. The pancreatic acinar cell metabolizes ethanol with the generation of toxic metabolites. The most common theory is that pancreatitis develops because of an injury or disruption of pancreatic acinar cells, which permits leakage of pancreatic enzymes (trypsin, chymotrypsin, and elastase) into pancreatic tissue. Activated proteolases (trypsin and elastase) and lipases break down tissue and cell membranes, causing inflammation, edema, vascular damage, hemorrhage, necrosis, and fibrosis.

question

The mutation of which gene occurs in cancers of the stomach, colon, liver, gallbladder, and pancreas?

answer

*TP53 tumor-suppressor gene* Alterations in TP53 and p21 gene expression and DNA ploidy occur in gastric carcinomas. Most primary carcinomas of the gallbladder are adenocarcinomas. A few are squamous cell carcinomas; p53 gene mutation, altered expression of P-glycoprotein, COX-2, epidermal growth factor receptor, and K-ras gene mutation occur. Although a K-ras mutation is the most common genetic alteration seen in cancer of the pancreas, tumor-suppressor gene alterations are also found, including TP53, p16, and DCC. (p. 1499, 1504-1505)

question

Which clinical manifestation is not consistent with cancer of the cecum and ascending colon?

answer

*constipation* Clinical manifestations include pain, a palpable mass in the lower right quadrant, anemia, and dark red or mahogany-colored blood mixed with the stool. (p. 1501)

question

Alterations in immunoglobulin G production have been found in individuals with this disorder.

answer

*Chron's disease* In Crohn disease, elevations in IgG are associated with severity of disease. (p. 1473)

question

Inflammation develops in crypts of Lieberkühn in the large intestine in which dz?

answer

*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. (p.1471)

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